Non-Cochrane · intervention · PMC13706686
Crestal Versus Lateral Window Approaches for Maxillary Sinus Floor Augmentation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
2026 · PubMed
Findings
Population Adults undergoing maxillary sinus floor augmentation with dental implant placement
15 findings
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Schneiderian membrane perforation intraoperative · Surgical sinus floor augmentation with implant placement · Sensitivity: post hoc reintroduction of Bensaha 2011 | RR 0.54 [0.25, 1.19] GRADE not reported 10 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Implant failure 12 months or longest follow-up · Surgical sinus floor augmentation with implant placement · Primary analysis (patient-level data; Mantel-Haenszel fixed effect) | RR 0.5 [0.1, 2.61] -18 per 1000 [-33, 57] per 1000 Very low Downgraded: risk of bias, imprecision 3 studies · 223 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Vertical bone gain 6 months · Surgical sinus floor augmentation with implant placement · Primary analysis (random effects, Hartung-Knapp) | MD -1.07 [-2.5, 0.36] -1.07 [-2.50, 0.36] mm Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 147 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Vertical bone gain 12 months · Surgical sinus floor augmentation with implant placement · Primary analysis (random effects, Hartung-Knapp) | MD -0.81 [-1.94, 0.33] -0.81 [-1.94, 0.33] mm Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 147 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Vertical bone gain 6 months · Surgical sinus floor augmentation with implant placement · Sensitivity: patient- or sinus-level data only (Cheng, Zhou) | MD -0.55 [-8.41, 7.32] GRADE not reported 2 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Peri-implant marginal bone loss 12 months · Surgical sinus floor augmentation with implant placement · Sensitivity: adding Farina (floor-censored data) | MD -0.05 [-0.19, 0.1] GRADE not reported 5 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Implant failure 12 months or longest follow-up · Surgical sinus floor augmentation with implant placement · Sensitivity: adding implant-level data (Bacevic, Cheng, Fettouh, Mattar, Yu) | RR 0.84 [0.31, 2.29] GRADE not reported 7 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Peri-implant marginal bone loss 12 months · Surgical sinus floor augmentation with implant placement · Primary analysis | MD -0.08 [-0.31, 0.15] -0.08 [-0.31, 0.15] mm Low Downgraded: risk of bias, imprecision 4 studies · 119 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Schneiderian membrane perforation intraoperative · Surgical sinus floor augmentation with implant placement · Sensitivity: adding implant-level data from Mattar 2026 | RR 0.62 [0.29, 1.3] GRADE not reported 10 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Schneiderian membrane perforation intraoperative · Surgical sinus floor augmentation with implant placement · Primary analysis (patient-, sinus-, or site-level data) | RR 0.63 [0.29, 1.38] -43 per 1000 [-84, 45] per 1000 Very low Downgraded: risk of bias, imprecision 9 studies · 388 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Postoperative pain day of surgery to day 1 · Surgical sinus floor augmentation with implant placement · Sensitivity: leave-one-out excluding Lv 2022 | SMD -1.07 [-1.61, -0.53] GRADE not reported 3 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Postoperative pain day of surgery to day 1 · Surgical sinus floor augmentation with implant placement · Primary analysis (random effects, Hartung-Knapp) | SMD -1.56 [-3.31, 0.2] Very low Downgraded: risk of bias, imprecision, inconsistency 4 studies · 136 participants |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Implant failure 12 months or longest follow-up · Surgical sinus floor augmentation with implant placement · Sensitivity: excluding Xhanari 2019 (within-patient trial) | RR 0.67 [0.12, 3.77] GRADE not reported 2 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Vertical bone gain 12 months · Surgical sinus floor augmentation with implant placement · Sensitivity: patient- or sinus-level data only (Cheng, Zhou) | MD -0.52 [-8.3, 7.27] GRADE not reported 2 studies |
| Crestal (transalveolar) sinus floor augmentation | Lateral window sinus floor augmentation | Peri-implant marginal bone loss 12 months · Surgical sinus floor augmentation with implant placement · Sensitivity: excluding Xhanari 2019 (within-patient trial) | MD -0.1 [-0.46, 0.27] GRADE not reported 3 studies |
Included primary studies 32
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Lv 2022 Flapless osteotome-mediated sinus floor elevation using platelet-rich fibrin versus lateral approach using deproteinised bovine bone… PMID:35488479 | 2022 | 1 other review | not stated | not extracted yet |
| Zhou 2021 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Bacevic 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bacevic 2021 Intraoperative and postoperative outcomes of sinus floor elevation using the lateral window technique versus the hydrodynamic… PMID:33694027 | 2021 | this review only | not stated | not extracted yet |
| Cannizzaro 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Cannizzaro 2013 Early implant loading in the atrophic posterior maxilla: 1-stage lateral versus crestal sinus lift and 8 mm hydroxyapatite-coated… PMID:23513199 | 2013 | this review only | not stated | not extracted yet |
| Cannizzaro 2020 EARLY IMPLANT LOADING IN THE ATROPHIC POSTERIOR MAXILLA: AN 11-YEAR RANDOMISED CONTROLLED TRIAL OF 1-STAGE LATERAL VERSUS CRESTAL SINUS… DOI:10.36130/ctd.04.2020.04 | 2020 | this review only | not stated | not extracted yet |
| Cannizzaro 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Cheng 2026 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Cheng 2026 The Clinical Effectiveness Comparison Between Modified Crestal Approach and Lateral Window Sinus Floor Elevation: A Prospective Study. PMID:41623265 | 2026 | this review only | not stated | not extracted yet |
| Farina 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farina 2018 Morbidity following transcrestal and lateral sinus floor elevation: A randomized trial. PMID:29992594 | 2018 | this review only | not stated | not extracted yet |
| Farina 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farina 2019 Radiographic outcomes of transcrestal and lateral sinus floor elevation: One-year results of a bi-center, parallel-arm randomized trial. PMID:31240743 | 2019 | this review only | not stated | not extracted yet |
| Farina 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farina 2022 Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial. PMID:35013782 | 2022 | this review only | not stated | not extracted yet |
| Farina 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farina 2023 Six-year extension results of a randomized trial comparing transcrestal and lateral sinus floor elevation at sites with 3-6 mm of residual… PMID:37303113 | 2023 | this review only | not stated | not extracted yet |
| Fettouh 2026 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Fettouh 2026 Graftless Sinus Floor Elevation Using the Lateral or Transcrestal Approach. A Randomized Clinical Trial With One Year Follow-Up. PMID:41074385 | 2026 | this review only | not stated | not extracted yet |
| Gaspar 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gaspar 2024 Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical… PMID:38018261 | 2024 | this review only | not stated | not extracted yet |
| Mattar 2026 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mattar 2026 Implant Outcomes in Crestal Versus Open Sinus Elevation: A Randomized Clinical Trial. PMID:40553623 | 2026 | this review only | not stated | not extracted yet |
| Temmerman 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Temmerman 2017 Volumetric changes of grafted volumes and the Schneiderian membrane after transcrestal and lateral sinus floor elevation procedures: A… PMID:28382627 | 2017 | this review only | not stated | not extracted yet |
| Wittmers 2026 [Systematic detection of the polarization of the sky]. PMID:20261786 | 1947 | this review only | not stated | not extracted yet |
| Wittmers 2026 Comparing Two Surgical Approaches Using Cross-Linked Hyaluronic Acid-Biofunctionalized Alloplast Particulate in Sinus Floor Elevation: A… PMID:41745548 | 2026 | this review only | not stated | not extracted yet |
| Xhanari 2019 CRESTAL VERSUS LATERAL SINUS LIFT: ONE-YEAR RESULTS FROM A WITHIN PATIENT RANDOMISED CONTROLLED TRIAL DOI:10.36130/ctd.01.2019.06 | 2020 | this review only | not stated | not extracted yet |
| Xhanari 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Yu 2017 Outcomes of 6.5-mm Hydrophilic Implants and Long Implants Placed with Lateral Sinus Floor Elevation in the Atrophic Posterior Maxilla: A… PMID:27436543 | 2017 | this review only | not stated | not extracted yet |
| Zhou 2021 The comparative evaluation of transcrestal and lateral sinus floor elevation in sites with residual bone height ≤6 mm: A two-year… PMID:33220090 | 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 question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults undergoing maxillary sinus floor augmentation with dental implant placement | Adults undergoing maxillary sinus floor augmentation with implants (13 trials) |
| Intervention | Crestal (transalveolar) sinus floor augmentation | Crestal approach (osteotome, hydraulic, osseodensification, short implant variants) |
| Comparison | Lateral window sinus floor augmentation | Lateral window approach |
| Outcomes | Implant failure; Schneiderian membrane perforation; marginal bone loss at 12 months; vertical bone gain at 6 and 12 months; postoperative pain | Implant failure (k=3 pooled); membrane perforation (k=9); marginal bone loss 12 mo (k=4); vertical bone gain 12 mo (k=4) and 6 mo (k=4); postoperative pain day 0-1 (k=4) |
| Study designs | Randomized and quasi-randomized controlled trials | Randomized controlled trials (n=13; 17 reports) |
| Timing | Marginal bone loss 12 months; vertical bone gain 6 and 12 months; pain earliest timepoint within 24 hours | 6 to 12 months; follow-up up to 11 years in some trials |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Yes | no |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Moderate | yes |