Comparative analisis of closed sinus-lifting: anatomical, surgical and clinical aspects
REVIEWS
Abstract
The article presents a structured analysis of modern techniques of closed (transalveolar) sinus lift, based on 15 clinical and experimental studies published between 2018 and 2025. Both technical aspects and long-term outcomes are considered, providing a comprehensive view of current trends in implantology and bone surgery.
Key anatomical factors influencing surgical decision-making are discussed, including sinus pneumatization, bone wall thickness, septa, mucosal thickening, and anatomical variations. These parameters determine the complexity of the procedure, the risk of complications, and the feasibility of minimally invasive approaches.
A comparative review of major techniques is provided: osteotome, hydraulic, balloon-assisted, piezosurgical, osseodensification, combined, and graft-less protocols. Each is evaluated in terms of invasiveness, risk of Schneiderian membrane perforation, surgical time, long-term implant survival, and complication rates.
The review highlights that the osteotome technique remains the most widely used but carries a higher risk of perforations; hydraulic and balloon methods are more tissue-preserving but require specialized equipment and experience; piezosurgery reduces trauma yet prolongs surgery; osseodensification improves peri-implant bone density but is limited in highly pneumatized sinuses.
The importance of individualized surgical planning is emphasized, taking into account residual bone volume, ridge width, patient’s systemic condition, and surgeon’s expertise. The use of CBCT and careful preoperative assessment are identified as key factors for achieving reliable and safe outcomes in closed sinus lift procedures.
References
Farina R., Franceschetti G., Travaglini D., Consolo U., Minenna L., Schincaglia G.P., Riccardi O., Bandieri A., Maietti E., Trombelli L. Morbidity following transcrestal and lateral sinus floor elevation: a randomized trial. J Clin Periodontol. 2018;45(9):1128–1139. https://doi.org/10.1111/jcpe.12985.
Rammelsberg P., Kilian S., Büsch C., Kappel S. Transcrestal sinus-floor elevation without graft on long-term prognosis of implants. J Clin Periodontol. 2020;47(5):640–648. https://doi.org/10.1111/jcpe.13278.
Tsai C.-F., Pan W.-L., Pan Y.-P., Chan C.-P., Ju Y.-R., Wang Y.- M., Lin C.-Y., Chang C.-C. Comparison of 4 sinus augmentation techniques. Medicine (Baltimore). 13;99(46):e23180. https://doi.org/10.1097/MD.0000000000023180.
Summers R.B. A new concept in maxillary implant surgery: the osteotome technique. Compend Contin Educ Dent. 1994;5(2):152, 154–156, 158 passim; quiz 162.
López-Quiles J., Melero-Alarcón C., Cano-Duran J.A., Sánchez-Martínez-Sauceda E.I., Ortega R. Balloon lifting and deferred implantation: prospective study. Int J Oral Maxillofac Surg. 2018;47(10):1343–1349. https://doi.org/10.1016/j.ijom.2018.04.014.
Mazor Z., Gaspar J., Silva R., Pohl S., Gandhi Y., Huwais S., Bergamo E.T.P., Bonfante E.A., Neiva R. Osseodensification-mediated transcrestal sinus elevation. Clin Implant Dent Relat Res. 2024;26(6):1172–1180. https://doi.org/10.1111/cid.13368.
Kuo P.-Y., Lin C.-Y. Grafted bone remodeling following transcrestal sinus floor elevation: A cone-beam computed tomography study. Biomed J. 2020;44(5):627–635. https://doi.org/10.1016/j.bj.2020.05.011.
Lin Z.-Z. et al. Factors impacting new bone formation in transcrestal sinus floor elevation followed by implant placement: a cross-sectional study. BMC Oral Health. 2022;22:319. https://doi.org/10.1186/s12903-022-02352-6.
Cho Y.-S. et al. Radiologic comparative analysis between saline and platelet-rich fibrin filling after hydraulic transcrestal sinus lifting without adjunctive bone graft: A randomized controlled trial. Clin Oral Implants Res. 2020;31(11):1087–1093. https://doi.org/10.1111/clr.13655.
Praveen A.A. et al. Efficacy of Two Different Hydrodynamic Sinus Lift Systems for Atraumatic Elevation in Immediate Implant Placement. Patient Prefer Adherence. 2023;17:1197–1207. https://doi.org/10.2147/PPA.S403036.
Alajami M.M. Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial. BMC Oral Health. 2024;24:916. https://doi.org/10.1186/s12903-024-04609-8.
Samir M. et al. Osseodensification versus piezoelectric internal sinus elevation (PISE) technique in delayed implant placement (a randomized controlled clinical trial). BMC Oral Health. 2024;24:1306. https://doi.org/10.1186/s12903-024-04964-6.
Fugazzoto P.A. Immediate implant placement following a modified trephine/osteotome approach: success rates of 116 implants to 4 years in function. Int J Oral Maxillofac Implants. 2002;17(4):537–545.
Veluri S., Gottumukkala S.N.V.S., Mantena S.R., Penmetsa G.S., Ramesh K., Pasupuleti M.K., Gera D. Clinical and radiological outcomes of osseodensification and crestal approach sinus kit for transcrestal sinus elevation — A randomized clinical trial. Dent Res J (Isfahan). 2025;22:17. https://doi.org/10.4103/drj.drj_711_23.
Zhou Y. The comparative evaluation of transcrestal and lateral sinus floor elevation in sites with residual bone height ≤6 mm: A two-year prospective randomized study. Clin Oral Implants Res. 2021:32(2):180–191. https://doi.org/10.1111/clr.13688.
Albadani M.M., Elayah S.A., Al-Wesabi M.A., Al-Aroomi O.A., Al Qadasy N.E., Saleh H. Graftless maxillary sinus lifting: prospective study. BMC Oral Health. 2024; 24(1):227. https://doi.org/10.1186/s12903-024-03949-9.
