Patient-Reported Outcome Measures (PROMs) in Sinus Lift Procedures: A Systematic Review and Meta-Analysis.

Abstract

Background: Implant rehabilitation has become one of the primary treatment options for both partial and total edentulism in contemporary dentistry. In the posterior maxilla, a challeng frequently arises from insufficient available bone volume; to overcome this limitation, sinus floor elevation (SFE) procedures are often necessary. Two main techniques are employed for this purpose: the lateral window approach and the transcrestal one.

Purpose: to evaluate patient-reported outcome measures related to maxillary sinus augmentation and alternative options for the rehabilitation of atrophic posterior maxilla.

Study selection: An electronic search was conducted on PubMed, Scopus and Cochrane CENTRAL up to January 31st, 2025 to identify randomized and non-randomized comparative clinical studies involving at least one group treated with maxillary SFE, with a minimum of 5 patients per group, in which PROMs were assessed. The focused question was: In patients requiring rehabilitation of atrophic posterior maxilla, is there a protocol superior to others among SFE using lateral or transcrestal approach with or without grafting, and implant placement without augmentation, in terms of patient-reported outcome measures? Pairwise meta-analysis was undertaken to estimate the overall effect when at least two studies with similar treatment comparisons, reporting the same outcome, were found. The primary outcome was postoperative pain, measured using the VAS scale in the first seven days after surgery. Secondary outcomes were any other PROMs like postoperative symptoms or standard satisfaction questionnaires.

Results: The electronic search initially identified 104 articles. After deduplication, 56 articles were screened, and 12 studies (12 RCTs and 1 non-RCT) were finally included. Ten studies were judged at moderate risk of bias and one RCT at high risk. The non-RCT study was judged at moderate risk of bias. Meta-analysis could be performed only for the proportion of patients reporting pain at 1, 3 and 7 days postoperatively. The graftless approach resulted in less pain at 3- and 7-days post-op compared to SFE with graft. Transcrestal SFE also showed less post-op discomfort than lateral SFE.

Conclusions: The results indicated that patients may experience reduced discomfort and inflammation when graftless procedures and transcrestal approaches are used. Overall, there is a paucity of evidence regarding the assessment of PROMs in the rehabilitation of atrophic posterior maxilla.