Non-Cochrane · aetiology · PM42492462
Incidence and Associated Factors of Schneiderian Membrane Perforation in Maxillary Sinus Floor Elevation: A Meta-Analysis.
Liu Yanmei, Zhou Qiuyu, Li Enhong, et al. · International dental journal · 2026 · PubMed · doi:10.1016/j.identj.2026.109756
Findings
Population Patients undergoing maxillary sinus floor elevation (MSFE)
24 findings
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, surgery level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Surgical approach: Lateral window | Incidence (proportion) 0.20 [0.15, 0.25] GRADE not reported 19 studies |
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, surgery level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Timing of implant placement: Staged only | Incidence (proportion) 0.18 [0.10, 0.30] GRADE not reported Studies not reported |
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, patient level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Overall (all studies) | Incidence (proportion) 0.19 [0.14, 0.24] Very low Downgraded: risk of bias, inconsistency 19 studies |
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, surgery level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Timing of implant placement: Fully simultaneous | Incidence (proportion) 0.20 [0.09, 0.33] GRADE not reported Studies not reported |
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, surgery level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Timing of implant placement: Partial simultaneous | Incidence (proportion) 0.18 [0.14, 0.23] GRADE not reported Studies not reported |
| MSFE (single-arm pooled incidence) | None (pooled proportion) | Intraoperative Schneiderian membrane perforation (SMP) incidence, surgery level Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) · Overall (all studies) | Incidence (proportion) 0.19 [0.15, 0.23] Very low Downgraded: risk of bias, inconsistency 22 studies · 5101 participants |
| MSFE by transcrestal approach | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, surgery-level incidence Intraoperative · Surgical approach: transcrestal | Incidence (proportion) 0.13 [0.06, 0.22] GRADE not reported 3 studies |
| Sinus septa present | Sinus septa absent | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | OR 3.56 [1.82, 6.96] Low Downgraded: risk of bias, inconsistency 12 studies |
| MSFE by transcrestal approach | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, patient-level incidence Intraoperative · Surgical approach: transcrestal | Incidence (proportion) 0.14 [0.07, 0.22] GRADE not reported 5 studies |
| MSFE by lateral window approach | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, patient-level incidence Intraoperative · Surgical approach: lateral window | Incidence (proportion) 0.20 [0.16, 0.26] GRADE not reported 14 studies |
| Smoking | Non-smoking | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | OR 2.57 [1.47, 4.47] Low Downgraded: risk of bias, inconsistency 13 studies |
| Thick membrane (prespecified threshold) | Membrane below threshold | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; high heterogeneity; numeric estimate not in the text (Supplementary Figure S1B not readable); GRADE table lists 7 studies for membrane thickness Very low Downgraded: risk of bias, imprecision, inconsistency Studies not reported |
| Greater Schneiderian membrane thickness (continuous) | Lower membrane thickness | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; high heterogeneity; numeric estimate not in the text (Supplementary Figure S1A not readable); GRADE table lists 7 studies for membrane thickness Very low Downgraded: risk of bias, imprecision, inconsistency Studies not reported |
| MSFE with fully simultaneous implant placement | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, patient-level incidence Intraoperative · Timing of implant placement: fully simultaneous | Incidence (proportion) 0.16 [0.07, 0.28] GRADE not reported 4 studies |
| MSFE with partial simultaneous implant placement | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, patient-level incidence Intraoperative · Timing of implant placement: partial simultaneous | Incidence (proportion) 0.19 [0.13, 0.26] GRADE not reported 11 studies |
| Greater lateral wall thickness | Lower lateral wall thickness | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; high heterogeneity; numeric estimate not in the text (Supplementary Figure S1C not readable) Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies |
| MSFE with staged only implant placement | None (single-arm incidence) | Intraoperative Schneiderian membrane perforation, patient-level incidence Intraoperative · Timing of implant placement: staged only | Incidence (proportion) 0.22 [0.12, 0.34] GRADE not reported 4 studies |
| Residual ridge height (continuous), perforated vs non-perforated cases | Non-perforated cases | Intraoperative SMP (residual ridge height difference) Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | SMD -0.46 [-0.80, -0.12] Low Downgraded: risk of bias, inconsistency 12 studies |
| Male sex | Female sex | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; moderate to high heterogeneity; numeric estimate not in the text (Supplementary Figure S1E not readable) Low Downgraded: risk of bias, imprecision 9 studies |
| Older age | Younger age | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; moderate to high heterogeneity; numeric estimate not in the text (Supplementary Figure S1F not readable) Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies |
| Diabetes mellitus | No diabetes mellitus | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; moderate to high heterogeneity; numeric estimate not in the text (Supplementary Figure S1G not readable) Low Downgraded: risk of bias, imprecision 4 studies |
| Simultaneous implant placement | Staged implant placement | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | OR 1.87 [0.99, 3.52] Low Downgraded: risk of bias, imprecision 4 studies |
| Surgical side (one side) | Other side | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; no numeric estimate reported Low Downgraded: risk of bias, imprecision 4 studies |
| Edentulous region/type (exposure category) | Reference region/type | Intraoperative SMP Intraoperative · Maxillary sinus floor elevation surgery (lateral window or transcrestal approach) | Not statistically significant; no numeric estimate reported Very low Downgraded: risk of bias, imprecision, inconsistency 5 studies |
Included primary studies 26
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Mazor 2024 Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: A multicenter clinical… PMID:39187444 | 2024 | 1 other review | not stated | not extracted yet |
| Basma 2021 Association between lateral wall thickness and sinus membrane perforation during lateral sinus elevation: A retrospective study. PMID:34006073 | 2021 | this review only | not stated | not extracted yet |
| Boyacigil 2021 The effect of residual bone height and membrane thickness on sinus membrane perforation in crestal sinus grafting: A prospective clinical… PMID:32600745 | 2021 | this review only | not stated | not extracted yet |
| Gao 2023 Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind-out technique: A retrospective cohort… PMID:37271935 | 2023 | this review only | not stated | not extracted yet |
| Hernandez 2008 Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures. PMID:17961185 | 2008 | this review only | not stated | not extracted yet |
| Irinakis 2017 Complications During Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa. PMID:28458730 | 2017 | this review only | not stated | not extracted yet |
| Kasabah 2003 Can we predict maxillary sinus mucosa perforation? PMID:12747535 | 2003 | this review only | not stated | not extracted yet |
| Krennmair 2020 Risk Factor Analysis Affecting Sinus Membrane Perforation During Lateral Window Maxillary Sinus Elevation Surgery. PMID:32724933 | 2020 | this review only | not stated | not extracted yet |
| Li 2024 Effect of Sinus Membrane Thickness on Membrane Perforation and Bone Augmentation in Transcrestal Sinus Floor Elevation: A Retrospective… PMID:37819853 | 2024 | this review only | not stated | not extracted yet |
| Lin 2016 The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation. PMID:26076580 | 2016 | this review only | not stated | not extracted yet |
| Lum 2017 Association Between Sinus Membrane Thickness and Membrane Perforation in Lateral Window Sinus Augmentation: A Retrospective Study. PMID:28398119 | 2017 | this review only | not stated | not extracted yet |
| Marin 2019 Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis. PMID:30475442 | 2019 | this review only | not stated | not extracted yet |
| Merli 2016 A minimally invasive technique for lateral maxillary sinus floor elevation: a Bayesian network study. PMID:25382821 | 2016 | this review only | not stated | not extracted yet |
| Monje 2016 Incidence of and Factors Associated with Sinus Membrane Perforation During Maxillary Sinus Augmentation Using the Reamer Drilling… PMID:27333013 | 2016 | this review only | not stated | not extracted yet |
| Nemati 2023 Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study. PMID:37423790 | 2023 | this review only | not stated | not extracted yet |
| Park 2019 The clinical and radiographic outcomes of Schneiderian membrane perforation without repair in sinus elevation surgery. PMID:30950206 | 2019 | this review only | not stated | not extracted yet |
| Pizzini 2021 The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation. PMID:33314302 | 2021 | this review only | not stated | not extracted yet |
| Prajapati 2023 Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A… PMID:36748281 | 2023 | this review only | not stated | not extracted yet |
| Rapani 2016 Schneider membrane thickness classification evaluated by cone-beam computed tomography and its importance in the predictability of… PMID:27577868 | 2016 | this review only | not stated | not extracted yet |
| Schwarz 2015 Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation… PMID:25921824 | 2015 | this review only | not stated | not extracted yet |
| Shao 2021 Risk factors for sinus membrane perforation during lateral window maxillary sinus floor elevation surgery: A retrospective study. PMID:34750940 | 2021 | this review only | not stated | not extracted yet |
| Thomas 2014 Perforation of the sinus membrane during sinus floor elevation: a retrospective study of frequency and possible risk factors. PMID:24818213 | 2014 | this review only | not stated | not extracted yet |
| Tukel 2018 Risk factors and clinical outcomes of sinus membrane perforation during lateral window sinus lifting: analysis of 120 patients. PMID:29655818 | 2018 | this review only | not stated | not extracted yet |
| Wen 2015 The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. PMID:24891094 | 2015 | this review only | not stated | not extracted yet |
| Yilmaz 2012 Are gingival phenotype, residual ridge height, and membrane thickness critical for the perforation of maxillary sinus? PMID:21627460 | 2012 | this review only | not stated | not extracted yet |
| Zhou 2021 Responses of Sinus Membrane and Antral Pseudocyst Following Lateral Window Sinus Augmentation with Bone Grafting: A Retrospective Study. PMID:34698713 | 2021 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Incidence of sinus membrane perforation in transcrestal graftless maxillary sinus augmentation: a meta-analysis. (2026) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing maxillary sinus floor elevation | Patients undergoing MSFE (n=4519 patients; 5101 surgeries) |
| Intervention | Anatomic, patient-related or procedure-related exposures | Sinus septa, smoking, membrane thickness, lateral wall thickness, residual ridge height, sex, age, diabetes, simultaneous vs staged placement, surgical side, edentulous region |
| Comparison | Absence of the exposure or reference categories | Absence of exposure or reference category |
| Outcomes | Intraoperative Schneiderian membrane perforation (incidence and associated factors) | Membrane perforation incidence (19 studies patient-level; 22 studies surgery-level); 11 associated factors (4 to 13 studies each) |
| Study designs | Observational studies (cohort, case-control, cross-sectional) | 26 observational studies (15 cross-sectional, 11 cohort) |
| Timing | Not specified | Not specified |