SIGNIFICANT FACTORS IN THE PROGNOSTIC MODEL FOR SCHNEIDERIAN MEMBRANE PERFORATION DURING OPEN SINUS LIFT SURGERY IN PATIENTS WITH VARYING INDIVIDUAL ANATOMICAL CHARACTERISTICS
DOI:
https://doi.org/10.11603/2311-9624.2026.3.16711Keywords:
open sinus-lift, SM perforation, factors of SM perforation, local anatomical predictors of intraoperative complications, mathematical prognostic model of SM perforationAbstract
The occurrence of Schneiderian membrane (SM) perforations during open sinus-lift surgery is quite often influenced by local anatomical factors. Smoking contributes to the development of chronic sinusitis and leads to thickening of the SM, which reduces elasticity and increases the risk of its perforation. Aim of the study. Based on the results of the analysis of literature data and proceeding from our own clinical observations, we set as our aim to develop a prognostic mathematical model for an individualized comprehensive assessment of the risk factors for the occurrence of SM perforation during open sinus-lift surgery in dental patients with different individual anatomical features. Materials and methods of the study. A total of 92 patients participated in this study, who underwent a comprehensive clinical and radiological examination before open sinus-lift surgery. The clinical and morphological characteristics that were included in the analysis of the identified risk factors for the occurrence of SM perforation included: thin SM (≤ 2 mm), certain contours of the maxillary sinus recesses, thin gingival phenotype, classes I–VI of maxillary sinus septa (according to the classification of Sigaroudi et al., 2017), and thickness of the lateral wall of the maxillary sinus (types 1–3). Fisher’s exact test and Pearson’s X² (chi-square) test were used to assess the statistical significance of differences between groups according to frequency indicators. A difference at p < 0.05 was considered statistically significant. Results of the study. Using the logistic regression method, 10 of the most statistically significant factors were identified, which, when acting in combination, have a significant influence on the occurrence of SM perforation, namely: age (years), mesoprosopic and chamaeprosopic skull shape, SM thickness (types II, III, and IV), presence of harmful habits (smoking), presence of SM thickening, narrow contour of the maxillary sinus recess, and presence of a thin gingival phenotype. Among the specified 10 factors, six have a preventive effect (when they are present in a patient, the risk of developing SM perforation decreases); these included: age, mesoprosopic and chamaeprosopic skull shape, as well as types II, III, and IV of SM thickness. The factors with a provoking effect (when they are present in a patient, the risk of developing SM perforation increases) included: presence of harmful habits (smoking), presence of SM hyperplasia (polyposis), narrow contours of the maxillary sinus recesses, and a thin gingival phenotype. The above-mentioned indicators, except for age, were represented in the risk assessment model as binary variables, where the presence of a feature was coded with the value “1” and its absence with the value “0”. For each factor, a regression coefficient for the occurrence of SM perforation was determined. The obtained model is statistically significant (p < 0.01). The value of the Nagelkerke coefficient is 61.79%. Conclusions. The model constructed by us explains well the relationship between the risk of SM perforation and the independent variables (risk factors included in this model). The accuracy of the obtained prediction of the risk of SM perforation was 93.48%. The positive predictive value – the probability of SM perforation occurring when a high-risk value is obtained (M equals 50% or more) – is 93.75%; accordingly, the negative predictive value (the probability of the absence of SM perforation when an M value of less than 50% is obtained) is 93.42%. Based on the obtained regression indicators, we modeled a formula for calculating the probability of the occurrence of SM perforation.
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