{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:44:32Z","timestamp":1785926672456,"version":"3.56.0"},"reference-count":39,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Transcrestal sinus floor elevation (TSFE) includes several surgical approaches that differ in access, instruments, and force delivery. Existing meta-analyses often combine these approaches. This umbrella review examined methodological quality, primary-study overlap, and the limits of clinical interpretation across three decisions: short implants versus sinus floor elevation, transcrestal versus lateral access, and technique choice within transcrestal elevation. Methods: Following the Cochrane Handbook and PRISMA 2020 reporting standards, eligible meta-analyses on TSFE published between 2015 and April 2026 were identified through a three-phase systematic search across PubMed, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus. Methodological quality was assessed using AMSTAR 2 with verbatim per-item evidence; primary-study overlap was quantified using the Corrected Covered Area. Results: Thirty meta-analyses met the inclusion criteria. AMSTAR 2 confidence was MODERATE in nine reviews, LOW in 11, and CRITICALLY LOW in 10; none was rated HIGH. Pool-level Corrected Covered Area was 0.92%, while cluster-level overlap reached 10.90% in the graftless osteotome cluster. Implant survival was generally high across the reviewed comparisons. Data on membrane perforation, benign paroxysmal positional vertigo (BPPV), and patient-reported outcomes were less complete and were reported inconsistently. Within the limited technique-specific evidence, BPPV was reported mainly with osteotome-based procedures, including one case among 24 patients (4.17%) in the osteotome group reported by Cobo-V\u00e1zquez et al. Conclusions: The available meta-analytic evidence supports high implant survival across the main treatment options, but it does not support a simple ranking of techniques. Clinical interpretation should follow the decision being made: whether sinus elevation is needed, whether transcrestal or lateral access is appropriate, and which transcrestal technique fits the case. Signals for BPPV and other complications with osteotome-based procedures are suggestive, but event reporting is sparse and certainty is limited. Biomechanical explanations should therefore be treated as clinical context rather than as causal findings of this umbrella review.<\/jats:p>","DOI":"10.3390\/dj14080483","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:16:22Z","timestamp":1785921382000},"page":"483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Umbrella Review of Meta-Analyses on Transcrestal Sinus Floor Elevation: Methodological Quality, Primary-Study Overlap, and Interpretive Boundaries"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7493-5026","authenticated-orcid":false,"given":"Hadar","family":"Better","sequence":"first","affiliation":[{"name":"Maccabi-Dent Medical & Quality Assurance Department, Tel Aviv 6801298, Israel"},{"name":"Maccabi-Dent Research and Innovation Department, Tel Aviv 6801298, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Better","sequence":"additional","affiliation":[{"name":"Department of Information and Computing Sciences, Utrecht University, 3584 CC Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1875-7402","authenticated-orcid":false,"given":"Thabet","family":"Asbi","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaul","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Endodontics and Dental Trauma, Rambam Health Care Campus, Haifa 3109601, Israel"},{"name":"The Ruth and Bruce Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 3525422, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-4978","authenticated-orcid":false,"given":"Gavriel","family":"Chaushu","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9238-7940","authenticated-orcid":false,"given":"Doron","family":"Haim","sequence":"additional","affiliation":[{"name":"Maccabi-Dent Research and Innovation Department, Tel Aviv 6801298, Israel"},{"name":"Department of Health Systems Management, Faculty of Health Sciences, Ariel University, Ariel 40700, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2026, April 22). Cochrane Handbook for Systematic Reviews of Interventions, Available online: https:\/\/training.cochrane.org\/handbook."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Aromataris, E., Lockwood, C., Porritt, K., Pilla, B., and Jordan, Z. (2024). JBI Manual for Evidence Synthesis, JBI.","DOI":"10.46658\/JBIMES-24-01"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.prosdent.2020.08.002","article-title":"Short versus standard implants associated with sinus floor elevation: An umbrella review of meta-analyses of multiple outcomes","volume":"126","author":"Vetromilla","year":"2021","journal-title":"J. Prosthet. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6681","DOI":"10.1007\/s00784-022-04628-1","article-title":"Short versus standard implants at sinus augmented sites: A systematic review and meta-analysis","volume":"26","author":"Toledano","year":"2022","journal-title":"Clin. Oral Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"j4008","DOI":"10.1136\/bmj.j4008","article-title":"AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both","volume":"358","author":"Shea","year":"2017","journal-title":"BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jclinepi.2013.11.007","article-title":"Systematic review finds overlapping reviews were not mentioned in every other overview","volume":"67","author":"Pieper","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"ref_8","first-page":"261","article-title":"Implant prosthetic rehabilitation in partially edentulous patients with bone atrophy. An umbrella review based on systematic reviews of randomised controlled trials","volume":"11","author":"Merli","year":"2018","journal-title":"Eur. J. Oral Implantol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1902\/jop.2017.160665","article-title":"Graft-free maxillary sinus floor elevation: A systematic review and meta-analysis","volume":"88","author":"Duan","year":"2017","journal-title":"J. Periodontol."},{"key":"ref_10","first-page":"231","article-title":"A meta-analysis of complications during sinus augmentation procedure","volume":"48","author":"Geminiani","year":"2017","journal-title":"Quintessence Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/jopr.12576","article-title":"Clinical and radiological outcomes of implants in osteotome sinus floor elevation with and without grafting: A systematic review and a meta-analysis","volume":"27","author":"Chen","year":"2018","journal-title":"J. Prosthodont."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/cid.12660","article-title":"Does intraoperative perforation of Schneiderian membrane during sinus lift surgery cause an increased the risk of implants failure?: A systematic review and meta-regression analysis","volume":"20","author":"Alkhutari","year":"2018","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_13","first-page":"487","article-title":"Lateral sinus floor augmentation with a synthetic bone substitute material containing only \u03b2-tricalcium phosphate: A systematic review with meta-analysis","volume":"27","author":"Aludden","year":"2018","journal-title":"Implant Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.11607\/jomi.6417","article-title":"Clinical performance of dental implants following sinus floor augmentation: A systematic review and meta-analysis of clinical trials with at least 3 years of follow-up","volume":"33","author":"Antonoglou","year":"2018","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Al-Moraissi, E.A., Altairi, N.H., Abotaleb, B., Al-Iryani, G., Halboub, E., and Alakhali, M.S. (2019). What is the most effective rehabilitation method for posterior maxillas with 4 to 8 mm of residual alveolar bone height below the maxillary sinus with implant-supported prostheses? A frequentist network meta-analysis. J. Oral Maxillofac. Surg., 77.","DOI":"10.1016\/j.joms.2018.08.009"},{"key":"ref_16","first-page":"590","article-title":"Prosthetic rehabilitation of the posterior atrophic maxilla, short (\u22646 mm) or long (\u226510 mm) dental implants? A systematic review, meta-analysis, and trial sequential analysis: Naples Consensus Report Working Group A","volume":"28","author":"Wang","year":"2019","journal-title":"Implant Dent."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5935","DOI":"10.1038\/s41598-020-62407-y","article-title":"Therapeutic outcomes of non-grafted and platelet concentrations-grafted transcrestal maxillary sinus elevation (TSFE): A systematic review and meta-analysis","volume":"10","author":"Guo","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40729-021-00325-y","article-title":"The survival rate of transcrestal sinus floor elevation combined with short implants: A systematic review and meta-analysis of observational studies","volume":"7","author":"Lin","year":"2021","journal-title":"Int. J. Implant Dent."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s40729-021-00358-3","article-title":"Outcomes of implants placed after osteotome sinus floor elevation without bone grafts: A systematic review and meta-analysis of single-arm studies","volume":"7","author":"Ye","year":"2021","journal-title":"Int. J. Implant Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s40729-022-00443-1","article-title":"Simultaneous placement of short implants (\u22648 mm) versus standard length implants (\u226510 mm) after sinus floor elevation in atrophic posterior maxillae: A systematic review and meta-analysis","volume":"8","author":"Tang","year":"2022","journal-title":"Int. J. Implant Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"869","DOI":"10.11607\/jomi.9758","article-title":"The prognostic outcome of transalveolar sinus floor elevation with or without grafting materials: A meta-analysis","volume":"37","author":"Shi","year":"2022","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"681","DOI":"10.11607\/jomi.10048","article-title":"The impact of sinus floor elevation techniques on sinus membrane perforation: A systematic review and network meta-analysis","volume":"38","author":"Lee","year":"2023","journal-title":"Int. J. Oral Maxillofac. Implants"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.prosdent.2023.04.021","article-title":"Evaluation of implant stability and increase in bone height in indirect sinus lift done with the osseodensification and osteotome technique: A systematic review and meta-analysis","volume":"133","author":"Potdukhe","year":"2025","journal-title":"J. Prosthet. Dent."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1111\/clr.14155","article-title":"Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height \u22646 mm: A systematic review and meta-analysis","volume":"34","author":"Shi","year":"2023","journal-title":"Clin. Oral Implants Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.bjoms.2024.05.006","article-title":"Clinical outcomes of implants placed with transcrestal maxillary sinus elevation: A systematic review and meta-analysis","volume":"62","author":"Kadkhodazadeh","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40729-025-00615-9","article-title":"Clinical and radiographic evaluation for two crestal sinus lift techniques: Osteotome versus osseodensification. A systematic review and meta-analysis","volume":"11","year":"2025","journal-title":"Int. J. Implant Dent."},{"key":"ref_27","first-page":"e1","article-title":"Transcrestal maxillary sinus membrane elevation using osseodensification compared with alveolar ridge augmentation using the lateral window or osteotome technique: A systematic review and meta-analysis","volume":"16","author":"Bruun","year":"2025","journal-title":"J. Oral Maxillofac. Res."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Menini, M., Canullo, L., Pesce, P., Bixio, F., Bagnasco, F., and Del Fabbro, M. (2025). Patient-reported outcome measures (PROMs) in sinus lift procedures: A systematic review and meta-analysis. Int. J. Oral Maxillofac. Implants, Online ahead of print.","DOI":"10.11607\/jomi.11434"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Schiavo-Di Flaviano, V., Egido-Moreno, S., Gonz\u00e1lez-Navarro, B., Velasco-Ortega, E., L\u00f3pez-L\u00f3pez, J., and Monsalve-Guil, L. (2024). Influence of Schneiderian membrane perforation on implant survival rate: Systematic review and meta-analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133751"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4103\/jisp.jisp_196_21","article-title":"Efficacy of simultaneous placement of dental implants in osteotome-mediated sinus floor elevation with and without bone augmentation: A systematic review and meta-analysis","volume":"27","author":"Rahate","year":"2023","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.ijom.2017.01.021","article-title":"Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: A systematic review and meta-analysis","volume":"46","author":"Moraschini","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/jips.jips_283_22","article-title":"Survival rate of dental implant placed using various maxillary sinus floor elevation techniques: A systematic review and meta-analysis","volume":"22","author":"Shah","year":"2022","journal-title":"J. Indian Prosthodont. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Mester, A., Onisor, F., Di Stasio, D., Piciu, A., Cosma, A.-M., and Bran, S. (2023). Short implants versus standard implants and sinus floor elevation in atrophic posterior maxilla: A systematic review and meta-analysis of randomized clinical trials with \u22655 years\u2019 follow-up. J. Pers. Med., 13.","DOI":"10.3390\/jpm13020169"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e029826","DOI":"10.1136\/bmjopen-2019-029826","article-title":"Short implants (\u22646 mm) versus longer implants with sinus floor elevation in atrophic posterior maxilla: A systematic review and meta-analysis","volume":"9","author":"Yan","year":"2019","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Wang, M., Liu, F., Ulm, C., Shen, H., and Rausch-Fan, X. (2022). Short implants versus longer implants with sinus floor elevation: A systematic review and meta-analysis of randomized controlled trials with a post-loading follow-up duration of 5 years. Materials, 15.","DOI":"10.3390\/ma15134722"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/jcpe.13055","article-title":"Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis","volume":"46","author":"Raghoebar","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wolff, J. (1892). Das Gesetz der Transformation der Knochen, Hirschwald.","DOI":"10.1055\/s-0028-1144106"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/ar.1092260402","article-title":"Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff\u2019s Law: The bone modeling problem","volume":"226","author":"Frost","year":"1990","journal-title":"Anat. Rec."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/01.id.0000204762.39826.0f","article-title":"\u201cPASS\u201d principles for predictable bone regeneration","volume":"15","author":"Wang","year":"2006","journal-title":"Implant Dent."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:55:16Z","timestamp":1785923716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/8\/483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["dj14080483"],"URL":"https:\/\/doi.org\/10.3390\/dj14080483","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}