{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:04:11Z","timestamp":1780574651091,"version":"3.54.1"},"reference-count":32,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["AOS"],"abstract":"<jats:p>Objectives: This meta-analysis aimed to evaluate Schneiderian membrane perforation incidence and complications in graftless transcrestal sinus floor elevation.\nMaterials and methods: Several databases (PubMed, Embase, Cochrane Library, Web of Science and Scopus) were searched for studies reporting perforation rates, early implant failure (\u226412 months) and postoperative complications. Two reviewers independently selected studies, extracted data and assessed bias. Random-effects meta-analysis was performed. Evidence certainty was graded using the GRADE system.\nResults: Among 14 studies comprising 2119 sinus-lift sites, the pooled incidence of Schneiderian membrane perforation was 1% (95% CI: 0% (95% CI: 0% the pooled incidence of Schneiderian membrane perforation was 1% (95% CI: 0% months) and postoperative failure (\u226412 months) was also 1% (95% CI: 0\u20136%) based on 711 evaluated implants, showing no heterogeneity (I\u00b2 = 0%). No postoperative complications (acute sinusitis or epistaxis) were reported in the included literature. Subgroup analysis revealed that motor-driven techniques were associated with a significantly higher perforation rate (34%) compared to conventional osteotome methods (0%). The certainty of evidence was rated as very low for all outcomes, including membrane perforation and secondary indicators.\nConclusions: Graftless transcrestal sinus elevation is associated with low Schneiderian membrane perforation rates, favourable implant survival and minimal postoperative complications. Despite methodological heterogeneity, current evidence supports the clinical safety of graftless techniques.\nClinical relevance: Clinicians can confidently utilise graftless sinus floor elevation approaches with appropriate patient selection and careful surgical techniques to minimise complications.<\/jats:p>","DOI":"10.2340\/aos.v85.46021","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:32:05Z","timestamp":1780572725000},"page":"311-320","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of sinus membrane perforation in transcrestal graftless maxillary sinus augmentation: a meta-analysis"],"prefix":"10.2340","volume":"85","author":[{"given":"Zhi-Cheng","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Ling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi-Qi","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Li","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Qin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"157877","doi-asserted-by":"crossref","unstructured":"Lyu M, Xu D, Zhang X, Yuan Q. Maxillary sinus floor augmentation: a review of current evidence on anatomical factors and a decision tree. Int J Oral Sci. 2023;15(1):41.","DOI":"10.1038\/s41368-023-00248-x"},{"key":"157878","doi-asserted-by":"crossref","unstructured":"Bacevic M, Compeyron Y, Lecloux G, Rompen E, Lambert F. Intraoperative and postoperative outcomes of sinus floor elevation using the lateral window technique versus the hydrodynamic transalveolar approach: a preliminary randomized controlled trial. Clin Oral Investig. 2021;25(9):5391\u2013401.","DOI":"10.1007\/s00784-021-03847-2"},{"key":"157879","doi-asserted-by":"crossref","unstructured":"Alalshaikh M, Tabasum A, Alotaibi N, Alotaibi A, Alesawy A, Ahmad S. Risk factors contributing to membrane perforation in lateral window maxillary sinus elevation: systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2025;139(6):642\u201359.","DOI":"10.1016\/j.oooo.2024.12.008"},{"key":"157880","doi-asserted-by":"crossref","unstructured":"Shalash M, Mounir M, Elbanna T. Evaluation of crestal sinus floor elevation in cases exhibiting an oblique sinus floor with a residual bone height of 4.0\u20137.0 mm using Densah burs with simultaneous implant placement: a prospective clinical study. Int J Implant Dent. 2023;9(1):41.","DOI":"10.1186\/s40729-023-00510-1"},{"key":"157881","doi-asserted-by":"crossref","unstructured":"Duan DH, Fu JH, Qi W, Du Y, Pan J, Wang HL. Graft-free maxillary sinus floor elevation: a systematic review and meta-analysis. J Periodontol. 2017;88(6):550\u201364.","DOI":"10.1902\/jop.2017.160665"},{"key":"157882","doi-asserted-by":"crossref","unstructured":"Soares LFF, Malzoni CMA, da Silveira ML, Junior EM, Pigossi SC. Evaluation of different approaches for sinus membrane perforation repair during sinus elevation: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2024;39(1):107\u201318.","DOI":"10.11607\/jomi.10180"},{"key":"157883","doi-asserted-by":"crossref","unstructured":"Albadani MM, Elayah SA, Al-Wesabi MA, Al-Aroomi OA, Al Qadasy NE, Saleh H. A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study. BMC Oral Health. 2024;24(1):227.","DOI":"10.1186\/s12903-024-03949-9"},{"key":"157884","doi-asserted-by":"crossref","unstructured":"Elghobashy MTM, Shaaban AM, Melek LNF. Radiographic comparison between Densah burs and osteotome for graftless internal sinus lifting with simultaneous implant placement: a randomized clinical trial. Int J Oral Maxillofac Surg. 2023;52(3):388\u201395.","DOI":"10.1016\/j.ijom.2022.06.020"},{"key":"157885","doi-asserted-by":"crossref","unstructured":"Markovi\u0107 A, Mi\u0161i\u0107 T, Calvo-Guirado JL, Delgado-Ru\u00edz RA, Janji\u0107 B, Abboud M. Two-center prospective, randomized, clinical, and radiographic study comparing osteotome sinus floor elevation with or without bone graft and simultaneous implant placement. Clin Implant Dent Relat Res. 2016;18(5):873\u201382.","DOI":"10.1111\/cid.12373"},{"key":"157886","doi-asserted-by":"crossref","unstructured":"Yang T, Yi W, Xu W, Xing X, Wu B. Evaluation of accuracy and membrane perforation in robotic-assisted implant surgery for transalveolar sinus floor elevation: a retrospective case series. BMC Oral Health. 2025;25(1):474.","DOI":"10.1186\/s12903-025-05848-z"},{"key":"157887","doi-asserted-by":"crossref","unstructured":"Walsh KL, Winegarner A, Hayward GL. Echocardiographic imaging of a bifurcated double barrel coronary sinus. J Cardiothorac Surg. 2023;18(1):41.","DOI":"10.1186\/s13019-023-02105-8"},{"key":"157888","doi-asserted-by":"crossref","unstructured":"Lv H, Sun X, Wang J, Wang H, Wang L, Zhou Y. Flapless osteotome-mediated sinus floor elevation using platelet-rich fibrin versus lateral approach using deproteinised bovine bone mineral for residual bone height of 2-6 mm: a randomised trial. Clin Oral Implants Res. 2022;33(7):700\u201312.","DOI":"10.1111\/clr.13934"},{"key":"157889","doi-asserted-by":"crossref","unstructured":"Karande P, Thakuria J, Sinha AP, Karande V, Asthana S, Gupta S. Comparative assessment of Schneiderian membrane thickness in smokers and non-smokers using cone-beam computed tomography: an observational study. Cureus. 2025;17(3):e81481.","DOI":"10.7759\/cureus.81481"},{"key":"157890","doi-asserted-by":"crossref","unstructured":"Cruz RS, Lemos CAA, Batista VES, Hiskell Francine Fernandes E Oliveira, J\u00e9ssica Marcela de Luna Gomes, Eduardo Piza Pellizzer. Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis. Braz Oral Res. 2018;32:e86.","DOI":"10.1590\/1807-3107bor-2018.vol32.0086"},{"key":"157891","doi-asserted-by":"crossref","unstructured":"Nedir R, Nurdin N, Khoury P, Perneger T, Hage ME, Bernard JP. Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla. A 1-year prospective randomized controlled study. Clin Oral Implants Res. 2013;24(11):1257\u201364.","DOI":"10.1111\/j.1600-0501.2012.02569.x"},{"key":"157892","doi-asserted-by":"crossref","unstructured":"Brizuela A, Mart\u00edn N, Fern\u00e1ndez-Gonzalez FJ, Larraz\u00e1bal C, Anta A. Osteotome sinus floor elevation without grafting material: results of a 2-year prospective study. J Clin Exp Dent. 2014;6(5):e479\u201384.","DOI":"10.4317\/jced.51576"},{"key":"157893","unstructured":"Zill A, Precht C, Beck-Broichsitter B, Sehner S, Smeets R, Heiland M. Implants inserted with graftless osteotome sinus floor elevation \u2013 a 5-year post-loading retrospective study. Eur J Oral Implantol. 2016;9(3):277\u201389."},{"key":"157894","doi-asserted-by":"crossref","unstructured":"French D, Nadji N, Shariati B, Hatzimanolakis P, Larjava H. Survival and success rates of dental implants placed using osteotome sinus floor elevation without added bone grafting: a retrospective study with a follow-up of up to 10 years. Int J Periodontics Restorative Dent. 2016;36(Suppl):s89\u201397.","DOI":"10.11607\/prd.2191"},{"key":"157895","doi-asserted-by":"crossref","unstructured":"Nedir R, Nurdin N, Abi Najm S, El Hage M, Bischof M. Short implants placed with or without grafting into atrophic sinuses: the 5-year results of a prospective randomized controlled study. Clin Oral Implants Res. 2017;28(7):877\u201386.","DOI":"10.1111\/clr.12893"},{"key":"157896","doi-asserted-by":"crossref","unstructured":"Si MS, Shou YW, Shi YT, Yang GL, Wang HM, He FM. Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of 4\u20139 years. Clin Oral Implants Res. 2016;27(11):1392\u2013400.","DOI":"10.1111\/clr.12752"},{"key":"157897","doi-asserted-by":"crossref","unstructured":"Rawat A, Thukral H, Jose A. Indirect sinus floor elevation technique with simultaneous implant placement without using bone grafts. Ann Maxillofac Surg. 2019;9(1):96\u2013102.","DOI":"10.4103\/ams.ams_11_19"},{"key":"157898","doi-asserted-by":"crossref","unstructured":"Qian SJ, Mo JJ, Si MS, Qiao SC, Shi JY, Lai HC. Long-term outcomes of osteotome sinus floor elevation with or without bone grafting: the 10-year results of a randomized controlled trial. J Clin Periodontol. 2020;47(8):1016\u201325.","DOI":"10.1111\/jcpe.13260"},{"key":"157899","doi-asserted-by":"crossref","unstructured":"Rammelsberg P, Pahle J, B\u00fcsch C, Zenth\u00f6fer A. Long-term apical bone gain after implant placement combined with internal sinus-floor elevation without graft. BMC Oral Health. 2020;20(1):197.","DOI":"10.1186\/s12903-020-01178-4"},{"key":"157900","doi-asserted-by":"crossref","unstructured":"Karaca \u00c7, Ko\u00e7 O, Er N, U\u00e7ar-Boyac\u0131gil D. Evaluation of sinus membrane perforation in osteotome sinus floor elevation with and without grafting. J Oral Implantol. 2022;48(6):550\u20136.","DOI":"10.1563\/aaid-joi-D-20-00358"},{"key":"157901","doi-asserted-by":"crossref","unstructured":"Alzoubi FM, AlRumaih HS, Alhumaidan AA, Al-Sulimmani W. Implant stability after graftless motor-driven crestal sinus elevation: a cohort study. J Oral Implantol. 2024;50(5):461\u20137.","DOI":"10.1563\/aaid-joi-D-24-00015"},{"key":"157902","doi-asserted-by":"crossref","unstructured":"Mazor Z, Gaspar J, Silva R, Pohl S, Gandhi Y, Huwais S. Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: a multicenter clinical study. Clin Implant Dent Relat Res. 2024;26(6):1172\u201380.","DOI":"10.1111\/cid.13368"},{"key":"157903","doi-asserted-by":"crossref","unstructured":"Stacchi C, Bernardello F, Spinato S, Mura R, Perelli M, Lombardi T. Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height \u2264 5 mm: a retrospective multicenter study. Clin Oral Implants Res. 2022;33(8):783\u201391.","DOI":"10.1111\/clr.13959"},{"key":"157904","doi-asserted-by":"crossref","unstructured":"Li N, Jiang Z, Pu R, Zhu D, Yang G. Implant failure and associated risk factors of transcrestal sinus floor elevation: a retrospective study. Clin Oral Implants Res. 2023;34(1):66\u201377.","DOI":"10.1111\/clr.14020"},{"key":"157905","doi-asserted-by":"crossref","unstructured":"Nemati M, Khodaverdi N, Hosn Centenero SA, Tabrizi R. Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study. J Craniomaxillofac Surg. 2023;51(7\u20138):427\u201332.","DOI":"10.1016\/j.jcms.2023.06.010"},{"key":"157906","doi-asserted-by":"crossref","unstructured":"Ghosh A, Sekar A, Sriram CS, Sivakumar K, Upadhyay GA, Pandurangi UM. Septal venous channel perforation during left bundle branch area pacing: a prospective study. Europace. 2024;26(6):euae124.","DOI":"10.1093\/europace\/euae124"},{"key":"157907","doi-asserted-by":"crossref","unstructured":"Gao J, Yin W, Liu Y, Zhao X, Qu Y, Man Y. Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind-out technique: a retrospective cohort study with up to 7 years of follow-up. J Clin Periodontol. 2023;50(9):1202\u201316.","DOI":"10.1111\/jcpe.13832"},{"key":"157908","doi-asserted-by":"crossref","unstructured":"Liu F., Yuan F., Ying WG, Shan JL, Sun XD. Clinical evaluation of modified maxillary sinus floor elevation with simultaneous implant placement: a retrospective randomized controlled study. Research Square [preprint]. 2025 Nov 11; posted version v1.","DOI":"10.21203\/rs.3.rs-7527675\/v1"}],"container-title":["Acta Odontologica Scandinavica"],"original-title":[],"link":[{"URL":"https:\/\/medicaljournalssweden.se\/actaodontologica\/article\/download\/46021\/54237","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/medicaljournalssweden.se\/actaodontologica\/article\/download\/46021\/54237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:32:32Z","timestamp":1780572752000},"score":1,"resource":{"primary":{"URL":"https:\/\/medicaljournalssweden.se\/actaodontologica\/article\/view\/46021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":32,"URL":"https:\/\/doi.org\/10.2340\/aos.v85.46021","relation":{},"ISSN":["1502-3850","0001-6357"],"issn-type":[{"value":"1502-3850","type":"electronic"},{"value":"0001-6357","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}