Conventional versus endoscopic-assisted crestal sinus lifting with simultaneous implant placement: a comparative clinical study

Abstract

PATIENTS Twenty patients with residual bone heights of 4-7 mm in the posterior maxilla were randomly divided into two groups: Group 1 (conventional crestal approach) and Group 2 (endoscopic-assisted crestal approach). A 2.7 mm rigid endoscope was used to monitor membrane integrity after each surgical step. Bone grafting with a xenograft-platelet-rich fibrin mix was performed, followed by implant placement. Membrane perforation rates, surgical time, and bone density changes were evaluated. RESULTS Twenty-two implants were placed (11 in each group). Membrane perforation occurred in 33% of cases in Group 1 and 10% in Group 2 (p = 0.582). Group 2 had significantly longer surgical times (27.3 ± 2.00 min) compared to Group 1 (15.4 ± 2.22 min, p < 0.0001). Bone density increased significantly from 609.55 ± 108.71 HU postoperatively to 878.38 ± 114.60 HU at six months (p < 0.001). Endoscopic-assisted techniques significantly reduced perforation rates and improved surgical precision. CONCLUSIONS The endoscopic-assisted crestal sinus lifting is a unique technique allowing visualization and assessment of membrane integrity and may enhance the safety and the predictability during membrane elevation, reducing complications such as membrane perforation. However, its benefits must be weighed against increased surgical time and cost.