Association between smoking and Schneiderian membrane perforation during maxillary sinus floor augmentation: A systematic review and meta-analysis.

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OBJECTIVE: To estimate the association between smoking and Schneiderian membrane perforation in sinus floor augmentation.

MATERIALS AND METHODS: Searches were conducted in PubMed, Web of Science, Embase, and Cochrane Library. Data were extracted by two authors independently. The inclusion criteria were the (1) age of patients >18, (2) the number of participants >10, and (3) smoking and the patients of Schneiderian membrane perforation were accurately recorded. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Statistics analyses were conducted using Reman5.4.1 and Stata (15.0). The association of Schneiderian membrane perforation with smoking habits during maxillary sinus floor elevation was expressed as odds ratios (ORs) with a 95% confidence interval (95% CIs). And the I statistic was used to estimate statistical heterogeneity. The funnel plot and Egger's tests were used to evaluate the reliability and stability of the results.

RESULTS: Of 1463 articles screened, nine studies were included in our systematic review, and eight were synthesized for meta-analysis. Eight were retrospective observational studies and one was a clinical trial, with a total of 1424 patients included. The nine studies were proved as high quality according to the NOS. There was no significant publication bias in the studies (p = 0.827). A random-effects model was used because of differences in the adopted methodologies (p = 0.39, I  = 5%). During maxillary sinus augmentation, smoking and Schneiderian membrane perforation were associated (odds ratios, 1.58 [95% CI, 1.10-2.25]).

CONCLUSION: Smoking increased the risk of membrane perforation in maxillary sinus floor augmentation. Our evaluation was limited by the poor reporting of the number of cigarettes smoked per day (PROSPERO number was CRD42022306570).