Determinants of Early and Late Complications After Lateral Window Sinus Elevation: A Two-Year Retrospective Cohort Study
Abstract
Objectives: To evaluate early postoperative complications and 1- and 2-year implant-related outcomes following lateral window maxillary sinus floor augmentation by correlating CBCT-based anatomical parameters with surgical and prosthetic variables.
Materials and Methods: This retrospective single-center cohort study included 134 patients who underwent lateral window sinus augmentation between 2020 and 2023. Preoperative CBCT imaging was used to assess residual bone height, lateral wall thickness, palatal–nasal recess angle, ostium diameter, Schneiderian membrane thickness (<3 mm or ≥3 mm), presence of septa, sinus pathology, and alveolar antral artery (AAA) diameter (≤2 mm or >2 mm). Early postoperative complications were recorded within the first month. Implant-related outcomes at 1 and 2 years were classified as implant failure or peri-implant crestal bone resorption (CBR). Statistical analyses included univariate tests and multivariate logistic regression (p<0.05).
Results: Early postoperative complications were rare and mainly consisted of graft exposure/infection and bleeding/hematoma. A significantly higher incidence of early complications was observed in cases with AAA diameter >2 mm, with bleeding/hematoma occurring exclusively in this group (p=0.006). Other anatomical parameters, including ostium diameter, showed no significant association with early complications. At 1 year, implant outcomes were significantly associated with prosthetic superstructure type, residual crestal bone height, intraoperative complications—particularly Schneiderian membrane perforation—and postoperative complication management strategy. These associations were primarily driven by increased CBR rather than implant failure. At 2 years, prosthetic superstructure type remained significantly associated with outcomes, while Schneiderian membrane thickness ≥3 mm was linked to higher CBR rates. Implant failure remained infrequent throughout the follow-up period.
Conclusions: Lateral window sinus augmentation yielded predictable short- and mid-term outcomes when guided by CBCT-based presurgical assessment and structured postoperative management. Vascular anatomy, particularly AAA diameter, was the main determinant of early bleeding-related complications, whereas prosthetic design was the most consistent factor influencing long-term crestal bone changes.
Keywords
maxillary sinus augmentation lateral window cone-beam computed tomography crestal bone resorption prosthetic design
Ethical Statement
The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Istinye University Human Research Ethics Committee (Meeting Date: 07 March 2025; Meeting No: 2025/01; Protocol No: 25-07).
Supporting Institution
There was no support for this study.
References
- 1. Alshamrani AM, Mubarki M, Alsager AS, Alsharif HK, AlHumaidan SA, Al-Omar A. Maxillary sinus lift procedures: an overview of current techniques, presurgical evaluation, and complications. Cureus 2023;15(11):e49553.
- 2. Alsharekh MS, Almutairi AA, Jahlan AS, Alhazani AS, Almohaimeed SM, Aljnoubi LA et al. Evolving techniques and trends in maxillary sinus lift procedures in implant dentistry: a review of contemporary advances. Cureus 2024;16(10):e71424.
- 3. Goyushov S, Dursun E, Orhan K, Tözüm TF. Three-Dimensional Calculation of Sinus Augmentation Volume after Maxillary Sinus Floor Elevation. Cumhuriyet Dent J 2021;24:2:163-169.
- 4. Stern A., Green J. Maxillary sinus lift procedures: an overview of current techniques. Dent Clin North Am 2012;56(1):219-233.
- 5. Ozec İ, Kilic E, Muderris S. Maksiller sinüs septa: bilgisayarlı tomografi ve panoramik radyografi ile değerlendirme. Cumhuriyet Dent J 2008;11(2):82-86.
- 6. Lee JW, Yoo JY, Paek SJ, Park WJ, Choi EJ, Choi MG, et al. Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting. J Korean Assoc Oral Maxillofac Surg 2016;42(5):278-283.
- 7. 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;15:41.
- 8. Dewidar O, Shamseer L, Melendez-Torres GJ, Akl EA, Ramke J, Wang X, et al. Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration. JAMA Netw Open 2025;8(9):e2532512.
- 9. Tavelli L, Borgonovo AE, Re D, Maiorana C. Sinus presurgical evaluation: a literature review and a new classification proposal. Minerva Stomatol 2017;66(3):115-131.
- 10. Schiavo-Di Flaviano V, Egido-Moreno S, González-Navarro B, Velasco-Ortega E, López-López J, Monsalve-Guil L. Influence of Schneiderian membrane perforation on implant survival rate: a systematic review and meta-analysis. J Clin Med 2024;13(13):3751.
- 11. Monje A, Diaz KT, Aranda L, Insua A, Garcia-Nogales A, Wang HL. Schneiderian membrane thickness and clinical implications for sinus augmentation: a systematic review and meta-regression analyses. J Periodontol 2016;87(8):888-899.
- 12. Amid R, Kadkhodazadeh M, Moscowchi A, Nami M. Effect of Schneiderian membrane thickening on the maxillary sinus augmentation and implantation outcomes: a systematic review. J Maxillofacial Oral Surg 2021;20(4):534-544.
- 13. Cruz RS, Araújo Lemos CA, Batista VES, Oliveira HFFE, Gomes JML, Pellizzer EP et al. Short implants versus longer implants with maxillary sinus lift: a systematic review and meta-analysis. Braz Oral Res 2018;32:e86.
- 14. Anitua E, Piñas L, Alkhraisat MH. Long-term comparative outcomes of short implants versus maxillary sinus elevation in posterior maxilla rehabilitation. Dent J (Basel) 2024;13(1):12.
- 15. Durrani F, Karthickraj SM, Imran F, Ahlawat S, Kumari E, Vani SUG. Comparative evaluation of hard and soft tissue parameters using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla. J Indian Soc Periodontol 2024;28(1):106-112.
- 16. Alemán BO, Rivera-Velazquez I, Jana-Hernández Z, Rivas-Tumanyan S, Guerrero-Rodríguez LM, Elias-Boneta AR. Long-term outcomes of short versus long dental implants with sinus lift in atrophied posterior maxillae: a systematic review and meta-analysis. P R Health Sci J 2025;44(1):54-62.
- 17. Ke Y, Xuan G. Does sinus membrane thickness influence the risk of perforation during lateral sinus lift surgery for dental implants? A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2024;29(4):e568-e574.
- 18. Beck-Broichsitter BE, Westhoff D, Behrens E, Wiltfang J, Becker ST. Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: a follow-up on bone graft stability and implant success. Int J Implant Dent 2018;4(1):6.
- 19. Liu S, Chen S, Chen Z, He X, Huang X. Effects of bone grafting and non-bone grafting on implant stability and new bone formation in patients undergoing maxillary sinus floor elevation combined with Bicon short implants. Altern Ther Health Med 2023;29(8):240-245.
- 20. Iușan SAL, Costache C, Lucaciu OP, Petrescu BN, Mirică IC, Toc DA, et al. Correlations between dental implant infectious pathologies and maxillary sinusitis: a review article. J Clin Med 2023;12(15):5059.
Lateral Pencere Tekniği ile Sinüs Elevasyonu Sonrası Erken ve Geç Komplikasyonların Belirleyicileri: İki Yıllık Retrospektif Kohort Çalışması
Abstract
Amaç: Lateral pencere tekniği ile maksiller sinüs tabanı yükseltimi sonrası erken postoperatif komplikasyonlar ile 1 ve 2 yıllık implant ilişkili sonuçları, CBCT temelli anatomik parametrelerin cerrahi ve protetik değişkenlerle birlikte değerlendirilmesi yoluyla incelemektir.
Gereç ve Yöntemler: Bu retrospektif, tek merkezli kohort çalışmaya 2020–2023 yılları arasında lateral pencere sinüs augmentasyonu uygulanan 134 hasta dahil edilmiştir. Preoperatif CBCT görüntüleri kullanılarak rezidüel kemik yüksekliği, lateral duvar kalınlığı, palatal–nazal reses açısı, ostium çapı, Schneiderian membran kalınlığı (<3 mm veya ≥3 mm), septa varlığı, sinüs patolojisi ve alveolar antral arter (AAA) çapı (≤2 mm veya >2 mm) değerlendirilmiştir. Erken postoperatif komplikasyonlar ilk ay içinde kaydedilmiştir. İmplant ilişkili sonuçlar 1. ve 2. yıllarda implant kaybı veya peri-implant krestal kemik rezorpsiyonu (CBR) olarak sınıflandırılmıştır. İstatistiksel analizlerde tek değişkenli testler ve çok değişkenli lojistik regresyon kullanılmıştır (p<0,05).
Bulgular: Erken postoperatif komplikasyonlar nadir görülmüş ve çoğunlukla greft açığa çıkması/enfeksiyon ile kanama/hematom şeklinde ortaya çıkmıştır. AAA çapının >2 mm olduğu olgularda erken komplikasyon sıklığı anlamlı derecede daha yüksek bulunmuş, kanama/hematom yalnızca bu grupta gözlenmiştir (p=0,006). Ostium çapı dahil diğer anatomik parametreler ile erken komplikasyonlar arasında anlamlı ilişki saptanmamıştır. Birinci yılda implant sonuçları; protetik üst yapı tipi, rezidüel krestal kemik yüksekliği, özellikle Schneiderian membran perforasyonu olmak üzere intraoperatif komplikasyonlar ve postoperatif komplikasyon yönetimi ile anlamlı ilişki göstermiştir. Bu ilişkiler ağırlıklı olarak artmış CBR ile ilişkili olup implant kaybı nadir izlenmiştir. İkinci yılda protetik üst yapı tipi anlamlılığını korurken, Schneiderian membran kalınlığının ≥3 mm olması daha yüksek CBR oranları ile ilişkili bulunmuştur.
Sonuçlar: CBCT temelli cerrahi planlama ve düzenli postoperatif takip ile lateral pencere sinüs elevasyonu kısa ve orta dönemde öngörülebilir sonuçlar sağlamaktadır. Erken kanama ilişkili komplikasyonlarda vasküler anatomi belirleyici olurken, uzun dönem krestal kemik değişikliklerinde protetik tasarımın daha etkili olduğu görülmüştür.
Keywords
maksiller sinüs augmentasyonu lateral pencere konik ışınlı bilgisayarlı tomografi krestal kemik rezorpsiyonu protetik tasarım
Ethical Statement
Bu çalışma, Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüş ve İstinye Üniversitesi İnsan Araştırmaları Etik Kurulu tarafından onaylanmıştır (Toplantı Tarihi: 07 Mart 2025; Toplantı No: 2025/01; Protokol No: 25-07).
Supporting Institution
Bu çalışma için her hangi bir destek alınmamıştır.
References
- 1. Alshamrani AM, Mubarki M, Alsager AS, Alsharif HK, AlHumaidan SA, Al-Omar A. Maxillary sinus lift procedures: an overview of current techniques, presurgical evaluation, and complications. Cureus 2023;15(11):e49553.
- 2. Alsharekh MS, Almutairi AA, Jahlan AS, Alhazani AS, Almohaimeed SM, Aljnoubi LA et al. Evolving techniques and trends in maxillary sinus lift procedures in implant dentistry: a review of contemporary advances. Cureus 2024;16(10):e71424.
- 3. Goyushov S, Dursun E, Orhan K, Tözüm TF. Three-Dimensional Calculation of Sinus Augmentation Volume after Maxillary Sinus Floor Elevation. Cumhuriyet Dent J 2021;24:2:163-169.
- 4. Stern A., Green J. Maxillary sinus lift procedures: an overview of current techniques. Dent Clin North Am 2012;56(1):219-233.
- 5. Ozec İ, Kilic E, Muderris S. Maksiller sinüs septa: bilgisayarlı tomografi ve panoramik radyografi ile değerlendirme. Cumhuriyet Dent J 2008;11(2):82-86.
- 6. Lee JW, Yoo JY, Paek SJ, Park WJ, Choi EJ, Choi MG, et al. Correlations between anatomic variations of maxillary sinus ostium and postoperative complication after sinus lifting. J Korean Assoc Oral Maxillofac Surg 2016;42(5):278-283.
- 7. 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;15:41.
- 8. Dewidar O, Shamseer L, Melendez-Torres GJ, Akl EA, Ramke J, Wang X, et al. Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration. JAMA Netw Open 2025;8(9):e2532512.
- 9. Tavelli L, Borgonovo AE, Re D, Maiorana C. Sinus presurgical evaluation: a literature review and a new classification proposal. Minerva Stomatol 2017;66(3):115-131.
- 10. Schiavo-Di Flaviano V, Egido-Moreno S, González-Navarro B, Velasco-Ortega E, López-López J, Monsalve-Guil L. Influence of Schneiderian membrane perforation on implant survival rate: a systematic review and meta-analysis. J Clin Med 2024;13(13):3751.
- 11. Monje A, Diaz KT, Aranda L, Insua A, Garcia-Nogales A, Wang HL. Schneiderian membrane thickness and clinical implications for sinus augmentation: a systematic review and meta-regression analyses. J Periodontol 2016;87(8):888-899.
- 12. Amid R, Kadkhodazadeh M, Moscowchi A, Nami M. Effect of Schneiderian membrane thickening on the maxillary sinus augmentation and implantation outcomes: a systematic review. J Maxillofacial Oral Surg 2021;20(4):534-544.
- 13. Cruz RS, Araújo Lemos CA, Batista VES, Oliveira HFFE, Gomes JML, Pellizzer EP et al. Short implants versus longer implants with maxillary sinus lift: a systematic review and meta-analysis. Braz Oral Res 2018;32:e86.
- 14. Anitua E, Piñas L, Alkhraisat MH. Long-term comparative outcomes of short implants versus maxillary sinus elevation in posterior maxilla rehabilitation. Dent J (Basel) 2024;13(1):12.
- 15. Durrani F, Karthickraj SM, Imran F, Ahlawat S, Kumari E, Vani SUG. Comparative evaluation of hard and soft tissue parameters using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla. J Indian Soc Periodontol 2024;28(1):106-112.
- 16. Alemán BO, Rivera-Velazquez I, Jana-Hernández Z, Rivas-Tumanyan S, Guerrero-Rodríguez LM, Elias-Boneta AR. Long-term outcomes of short versus long dental implants with sinus lift in atrophied posterior maxillae: a systematic review and meta-analysis. P R Health Sci J 2025;44(1):54-62.
- 17. Ke Y, Xuan G. Does sinus membrane thickness influence the risk of perforation during lateral sinus lift surgery for dental implants? A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2024;29(4):e568-e574.
- 18. Beck-Broichsitter BE, Westhoff D, Behrens E, Wiltfang J, Becker ST. Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: a follow-up on bone graft stability and implant success. Int J Implant Dent 2018;4(1):6.
- 19. Liu S, Chen S, Chen Z, He X, Huang X. Effects of bone grafting and non-bone grafting on implant stability and new bone formation in patients undergoing maxillary sinus floor elevation combined with Bicon short implants. Altern Ther Health Med 2023;29(8):240-245.
- 20. Iușan SAL, Costache C, Lucaciu OP, Petrescu BN, Mirică IC, Toc DA, et al. Correlations between dental implant infectious pathologies and maxillary sinusitis: a review article. J Clin Med 2023;12(15):5059.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery, Oral and Maxillofacial Radiology |
| Journal Section | Research Article |
| Authors | |
| Submission Date | January 27, 2026 |
| Acceptance Date | March 12, 2026 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1873010 |
| IZ | https://izlik.org/JA25JP57YX |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.
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