RISK FACTORS AND PREVENTION STRATEGIES FOR SCHNEIDERIAN MEMBRANE PERFORATION DURING MAXILLARY SINUS AUGMENTATION VIA THE LATERAL WINDOW TECHNIQUE: AN INTEGRATIVE LITERATURE REVIEW

Abstract

Perforation of the sinus membrane (Schneiderian membrane) is the most frequently reported intraoperative complication during maxillary sinus elevation via the lateral window technique, with average rates in the literature ranging from 19% to 24% of procedures. This literature review aimed to synthesize current scientific evidence regarding the incidence, risk factors, classification, prevention, and management of this complication. Observational studies, systematic reviews, and meta-analyses published in major scientific databases were analyzed. Key risk factors identified include reduced residual ridge height, the presence of sinus septa, inadequate membrane thickness, smoking, and the use of conventional rotary instruments rather than piezosurgery. Preoperative planning using cone-beam computed tomography, combined with the use of piezoelectric instrumentation and surgical guides, proved effective in reducing the incidence of perforations. When properly recognized and repaired, perforation does not significantly compromise the survival of implants placed in grafted sinuses. It is concluded that prevention—based on detailed planning and careful selection of the surgical technique—combined with proficiency in repair management, constitutes the most effective strategy for reducing complications and ensuring the success of the sinus grafting procedure.