Incidence and Associated Factors of Schneiderian Membrane Perforation in Maxillary Sinus Floor Elevation: A Meta-Analysis.

INTRODUCTION AND AIMS: Schneiderian membrane perforation (SMP) is a common intraoperative event during maxillary sinus floor elevation (MSFE), yet contemporary estimates of its incidence and determinants remain inconsistent, leaving preoperative assessment, surgical planning, and perioperative counselling insufficiently informed. This systematic review and meta-analysis synthesized evidence on SMP incidence and prespecified anatomical, patient-related, and procedural factors associated with intraoperative perforation.

METHODS

Six databases were searched from inception to October 2025 for observational studies reporting intraoperative SMP incidence and/or associated factors during MSFE. Two reviewers independently performed study selection, data extraction, and quality appraisal (AHRQ for cross-sectional studies; Newcastle-Ottawa Scale for cohort studies). Random-effects meta-analyses pooled incidence (patient- and surgery-level) and odds ratios (ORs).

RESULTS

Twenty-six studies (4519 patients) were included. The pooled SMP incidence was 0.19 (95% confidence interval [CI] 0.14-0.24; I² = 91.4%) per patient and 0.19 (95% CI 0.15-0.23; I² = 91.9%) per surgery. Sinus septa (OR = 3.56, 95% CI = 1.82-6.96) and smoking (OR = 2.57, 95% CI = 1.47-4.47) were associated with higher odds of perforation, whereas other prespecified factors showed no significant pooled effects. Findings were robust across sensitivity analyses, and no marked small-study effects were detected for the main pooled outcomes.

CONCLUSIONS

SMP occurs in approximately one in five MSFE procedures. Preoperative identification of septa and targeted counselling for smokers may improve preoperative assessment and contingency planning. Future studies should adopt standardized CBCT measurement landmarks and report perforation phenotype and management.

CLINICAL RELEVANCE: Findings support structured preoperative assessment and informed consent focused on septa and smoking.