Incidence of sinus membrane perforation in transcrestal graftless maxillary sinus augmentation: a meta-analysis

OBJECTIVES: This meta-analysis aimed to evaluate Schneiderian membrane perforation incidence and complications in graftless transcrestal sinus floor elevation. MATERIALS AND METHODS: Several databases (PubMed, Embase, Cochrane Library, Web of Science and Scopus) were searched for studies reporting perforation rates, early implant failure (≤12 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. RESULTS: 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 (≤12 months) was also 1% (95% CI: 0-6%) based on 711 evaluated implants, showing no heterogeneity (I² = 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: Clinicians can confidently utilise graftless sinus floor elevation approaches with appropriate patient selection and careful surgical techniques to minimise complications.