Comparison of Three Surgical Approaches for Lateral Sinus Floor Elevation

This prospective comparative clinical study evaluates three surgical approaches used for lateral sinus floor elevation: the standard rotary technique, an epinephrine-soaked cotton roll-assisted technique, and a piezoelectric technique. The study compares intraoperative bleeding, surgical field visibility, procedural simplicity, operation time, and the occurrence of Schneiderian membrane perforation. It also examines whether patient- and anatomy-related factors, including smoking, residual bone height, sinus membrane thickness, and sinus septa, are associated with membrane perforation. The aim is to determine which factors contribute most strongly to surgical conditions and perforation risk during lateral sinus floor elevation.

Inclusion Criteria: * Age ≥18 years; absence of one or more maxillary posterior molars with a healing period of at least 6 months after extraction; indication for Lateral Sinus Floor Elevation with either simultaneous or delayed implant placement; residual bone height ≤5 mm at the planned implant site, as confirmed by cone-beam computed tomography (CBCT); and availability of complete medical, clinical, and radiographic records. Exclusion Criteria: * Pathological sinus mucosal thickening or other radiographic or clinical evidence of sinus disease; untreated periapical or periodontal infection adjacent to the maxillary sinus; bisphosphonate therapy; a history of head and neck radiotherapy; requirement for additional vertical or horizontal bone augmentation procedures other than LSFE; and previous LSFE involving the same maxillary sinus.