A new study published in the Journal of Oral Implantology reports that sinus membrane perforations most frequently occur during implant placement in crestal sinus elevation procedures. Researchers from Loma Linda University and the University of Corsica conducted a human cadaver study comparing two techniques—bone-added osteotome sinus floor elevation (BAOSFE) and osseodensification drills—and found no statistically significant difference in perforation rates between the methods (40% and 50%, respectively). Notably, most perforations occurred during implant placement rather than during elevation or bone grafting. The findings highlight the high risk of membrane perforation when performing crestal sinus lifts in cases with limited residual bone height and underscore the need for further research to better understand contributing factors.
GLEN ALLEN, Va., March 2, 2026 /PRNewswire-PRWeb/ -- Journal of Oral Implantology – In implant dentistry, crestal sinus elevation is commonly used to increase vertical bone height in the posterior maxilla, enabling implant placement in areas with limited residual bone after tooth loss. Although this minimally invasive approach offers advantages over other techniques, the sinus membrane cannot be fully visualized during the procedure, increasing the risk of membrane perforation. This is among the most frequent and clinically significant complications associated with sinus augmentation procedures.
Researchers from Loma Linda University in Loma Linda, California, and the University of Corsica in Corte, France, recently published a human cadaver study in the Journal of Oral Implantology comparing the rate of maxillary sinus membrane perforation during crestal sinus elevation using two techniques: bone-added osteotome sinus floor elevation (BAOSFE) and osseodensification drills. Lead author Thaer Alqadoumi, DDS, MS, and colleagues state, "The primary aim of this study is to evaluate the incidence of sinus membrane perforation during a crestal sinus lift of 5 mm in height when there is a 5-8 mm of residual bone present; comparing the BAOSFE procedure to the osseodensification technique". The secondary aim is to evaluate the timing of perforation: during elevation, bone graft placement, or implant placement."
Researchers in this split-mouth study analyzed 10 fresh human cadaver heads, evaluating a total of 20 maxillary sinuses. One side of each cadaver underwent crestal sinus elevation using the BAOSFE technique (osteotome group), while the other side used osseodensification drills (osseodensification group). High-definition video recording was used to provide a clear view of the sinus membrane throughout drilling, bone grafting, and implant placement. This allowed researchers to precisely identify membrane perforations and their timing.
Results showed that the osteotome group had a sinus membrane perforation rate of 40%, whereas the osseodensification group had a rate of 50%. There was no statistically significant difference between the BAOSFE and osseodensification techniques. Most perforations occurred during implant placement, accounting for 20% of cases in the osteotome group and 40% in the osseodensification group. No perforations were observed during bone graft placement in either group. These findings suggest that, regardless of technique, crestal sinus elevation performed with 5 mm of residual bone is associated with a high risk of membrane perforation, many of which may go clinically undetected.
Overall, the study highlights the risk of sinus membrane perforation during crestal sinus lift procedures at sites with minimal residual bone height. Alqadoumi and colleagues conclude that "There were no statistically significant differences in the maxillary sinus membrane. Perforation rates were similar between the 2 techniques, with most perforations occurring during implant placement. Further research is needed to validate these findings, with particular emphasis on the angle of the sinus floor and its potential impact on sinus membrane perforation."
Full text of the article, "Incidence of Maxillary Sinus Membrane Perforation During Crestal Sinus Elevation: A Comparison of Osteotomes and Osseodensification Drills in Human Cadavers," Journal of Oral Implantology, Vol. 52, No. 1, 2026, is available at http://www.joionline.org.
About Journal of Oral Implantology:
The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry and the American Academy of Implant Prosthodontics. It provides valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, please visit: http://www.joionline.org
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SOURCE Journal of Oral Implantology
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