Endoscopic Assessment of Membrane Perforation During Osseodensification-Mediated Sinus Elevation in Sites With a Residual Bone Height (RBH) of 4-5 mm: A Pilot Study

BackgroundThe rate of sinus membrane perforation (SMP) during osseodensification-mediated transcrestal sinus floor elevation (OD-TSFE) has been assessed in a small number of clinical studies lacking diagnostic validity.Limited information is available regarding the rate of perforations under endoscopic monitoring.The objectives of this study are to assess: (i) the incidence, characteristics, and timing of occurrence of perforation during endoscopically monitored graftless OD-TSFE with simultaneous implant placement performed by a trainee periodontist; and (ii) inter-method reliability among three clinical perforation detection approaches. MethodsA prospective cohort pilot study was conducted on patients requiring single implant-supported crowns in sites with residual bone height (RBH) of 4-5 mm.Sinuses with a flat sinus floor profile, narrow bucco-palatal width, and membrane thickness <2 mm were included.All OD-TSFE procedures with simultaneous implant placement were performed by a trainee periodontist according to the manufacturer's protocol II.The incidence, timing, and characteristics of perforations were monitored intraoperatively using endoscopy, tactile evaluation, and direct visualization through the osteotomy using magnifying loupes.Six OD-TSFE procedures in five patients were included. ResultsAll implants were 8 mm in length and had a mean of 3.4 ± 0.4 mm protruding into the sinus.No perforations were detected using endoscopy and direct visualization, while tactile evaluation suggested one perforation. ConclusionThe small sample size and the actual absence of perforations precluded a meaningful comparative analysis between the three SMP detection approaches.Within the limitations of this pilot study, graftless OD-TSFE performed by a trainee periodontist under non-challenging anatomical conditions was not associated with any endoscopically detectable perforation.