Morbidity of Transcrestal and Lateral Sinus Lift: A Multicenter RCT

Objectives: To comparatively evaluate the intra- and post-operative morbidity of implant placement concomitantly with maxillary sinus floor elevation according to a transcrestal (tSFE) versus lateral (lSFE) approach.
Methods: The study was designed as a bi-center, parallel-arm, single-blind, randomized clinical trial. Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3÷6 mm were included. tSFE was performed according to the Smart Lift technique in association with deproteinized bovine bone mineral (DBBM) and a collagen matrix. For lSFE, the sinus was grafted with DBBM, and the lateral window was covered with a resorbable membrane. In both tSFE and lSFE groups, implants at least 5 mm longer than RBH were inserted concomitantly with sinus floor elevation. The postoperative course was assessed through self-administered questionnaires. The level of pain perceived by the patient (VAS_pain) was recorded on a 100-mm visual analogue scale.
Results: The per protocol study population consisted of 27 patients in the tSFE group and 28 patients in the lSFE group. tSFE and lSFE groups did not differ significantly for patient characteristics, RBH and implant dimensions. No significant inter-group differences in the incidence of membrane perforation, VAS_pain and dose of rescue analgesics were observed between groups. In tSFE group, a significantly lower limitation in continuing daily activities at day +7 and in opening the mouth at day 0, +3 and +4 was observed when compared to lSFE. Also, a significantly lower incidence of swelling between day +1 and +10, bruising between day 0 and +11, and nasal discharge/bleeding at day +5, +7 and +8, was self-reported by patients in tSFE group compared to patients in lSFE group.
Conclusions: The postoperative course of tSFE (Smart Lift technique) is characterized by less limitations in daily functions and lower incidence of swelling, bruising, and nasal discharge/bleeding compared to the postoperative course of lSFE.