Clinical Outcomes of Endoscopic Assistance in Transcrestal Sinus Floor Elevation: A Retrospective Cohort Study

OBJECTIVE: This retrospective controlled study compared endoscope-assisted versus traditional unaided-eye transcrestal sinus floor elevation (TSFE), to evaluate whether this visualisation tool influences clinical outcomes. MATERIALS AND METHODS: Patients undergoing TSFE were divided into endoscopic (EG) and unaided-eye (UEG) groups. Cone beam computed tomography was used to measure residual bone height, sinus width (SW), membrane lift height (MLH), and graft resorption (GR). Multivariable generalised estimating equation (GEE) models, adjusted for within-patient clustering, assessed the influence of anatomical factors and their interactions with surgical technique on complications and GR. RESULTS: Of the 173 patients (211 implants) analysed, 43 patients (49 implants) were in the EG and 130 patients (162 implants) were in the UEG. Multivariable GEE analysis identified SW as an important risk factor for predicting GR (P < .05). Overall, GR was not significantly different between the groups (P = .118). As the endoscope serves primarily as an observation tool, its use was not associated with a difference in membrane perforation rates (P = .975). The interactions of surgical technique with anatomical factors did not reach statistical significance (P > .05); however, exploratory subgroup analyses revealed a close relationship between MLH and perforation with elevated GR on UEG, and such relationships were not statistically significant in the EG. A 100% implant survival rate was achieved. CONCLUSION: Serving primarily as an observation aid, endoscopic assistance was not associated with a reduced incidence of membrane perforation, nor did it remarkably decrease overall graft resorption rates during TSFE within the confines of this comparative study. Nonetheless, endoscopy provides possible protection in cases that require substantial membrane elevation or perforation management. CLINICAL SIGNIFICANCE: The clinical success of TSFE is dependent mainly on a thorough evaluation of anatomical risk factors alongside a scrupulous surgical technique, rather than mere reliance on endoscopic assistance.