Dental implant clinicians often face the concern of maxillary sinus perforation during sinus floor elevation (SFE) procedures. The most common complication of SFE is the perforation of the Schneiderian membrane, with a reported prevalence of 8% to 32%. This can increase the risk of developing sinusitis and may affect the success of the graft or implant. Various methods have been developed to repair perforated membranes, but most studies focus on repair procedures via a lateral approach. However, the lateral approach requires a second surgical site and can cause discomfort for the patient.
Sinusitis after SFE has been reported to have a prevalence of 8.4% to 9.8%, with a lower incidence rate for crestal approaches compared to lateral approaches. Membrane perforation is a risk factor for postoperative sinusitis, which can decrease implant survival rates. Therefore, it is important for clinicians to be aware of the various methods for closing perforations and to diagnose and treat infections promptly to prevent severe complications.
To minimize complications during SFE procedures, clinicians should identify and diagnose any anatomical structures or pathological findings before surgery. Cooperation with an otorhinolaryngologist may be necessary in certain cases. Evaluating alveolar bone resorption and the position of arteries can help prevent arterial bleeding. The thickness of the sinus lateral wall should also be considered, as thin or thick walls increase the risk of membrane perforation. Additionally, factors such as maxillary ostium patency, sinus septums, and nasal abnormalities can affect the risk of complications.
Two case reports highlight successful crestal sinus lift procedures. In the first case, a patient with a missing upper molar underwent a crestal sinus lift using a specialized kit. The procedure was minimally invasive, and the implant was successfully placed without trauma to the sinus membrane. In the second case, a patient with a congenitally missing molar underwent a sinus lift and implant placement to improve chewing efficiency and prevent supra-eruption of the opposing molar. The procedure involved extraction of a wisdom tooth, sinus lift, and grafting with subsequent implant placement. The final restoration showed natural aesthetics and harmony with the adjacent tissue.
Overall, clinicians should aim to prevent complications during SFE procedures, but in cases where complications occur, it is crucial to diagnose and treat them promptly. Close collaboration with specialists and adherence to proper surgical techniques can help minimize the risk of complications and improve patient outcomes.