Sinus floor elevation surgery with balloon is said to be a minimally invasive technique , but to date, no systematic review was made to clearly present the study results, authors experience, and surgical outcomes. Results of studies that utilized MIAMBE technique could be discussed under these highlighted points.
Maxillary sinus entry and elevation of sinus membrane
There are two critical points in sinus floor elevation surgery which include entry to the sinus and elevation of schneiderian membrane. Several atraumatic techniques had been developed to make transalveolar approach more predictable among which minimally invasive methods introduced like MIMBE technique , novel drills, and reamers to aid in atraumatic entry to the sinus . Also, the Jeder-System which utilize hydraulic pressure had been introduced with predictable results . Anyhow, the outcomes of these techniques need to be compared to reach to a reliable clue about the most effective method in sinus lift surgery.
Sinus augmentation and bone gain
The success of sinus augmentation procedure with MIAMBE technique was ranged from 100 to 71.4% with an average of 91.6% in these studies. Bone gain with MIAMBE technique could reach for more than 10 mm, it ranged from 3 to 10.8 mm with an average of 6.96 mm. It should be mentioned that some articles failed to report the gained bone in details.
The traditional procedure (Summers’ technique) had a limitation of allowing for only a minimal amount of bone gain which is 3–4 mm. While sinus floor elevation surgery via lateral approach produced a huge elevation ≥ 10 mm , it is considered as an invasive technique.
Implants survival rates
Implant survival rate associated with MIAMBE technique was ranged from 90 to 100% with an average of 96.62% as shown in Table 2. On the other hand, systematic reviews have evaluated the implant survival rate after osteotome-mediated sinus floor elevation surgery which shows an implant survival rate higher than 90% [24,25,26]. In most of MIAMBE studies, dental implant failure occurred early during the first 6 months after operation, some authors mentioned the cause for implant failure which was associated with infection, and others did not addressed the cause.
The most common intra-operative complication associated with sinus lift procedure was sinus membrane tear . The rate of schneiderian membrane perforation with MIAMBE technique was ranged from 0 to 21.32% with an average of 6.76%. This rate was similar to the schneiderian membrane perforation rate (0–21.4%) which was reported in the systematic review of sinus floor elevation success via transalveolar approach by Tan .
In some of these studies, membrane perforation was treated successfully with collagen membrane and the procedure continued with successful MIAMBE technique; other studies aborted the procedure. Furthermore, some authors demonstrated the causes of sinus membrane perforation which could be due to the too rapidly inflated balloon, balloon rapture, and fracture of the sinus floor during the osteotome procedures. Anyhow, with minimally invasive methods, the accuracy in the diagnosis of sinus membrane perforation is difficult without the availability of endoscope. Therefore, the perforation rates in these studies should be interpreted carefully, and the tests utilized to detect the perforation should be addressed accurately Table 1. An important point to the surgeons who executed this procedure is to check for membrane integrity after each surgical step by endoscope, Valsalva maneuver, direct vision, and/or by aspiration with normal saline to accurately report the cause of perforation.
Complications registered with MIAMBE technique in these studies involved sinus membrane perforation, implant failure, infection, oroantral fistula, balloon rapture, mild self-limiting nose bleeding, and infra-orbital ecchymosis. All studies reported less post-operative pain, bleeding, and discomfort on the patient side. On the surgeon side, it offered short learning curve and less surgical time.
This systematic review detected several shortcomings in the studies utilized (MIAMBE technique), these include:
One study was not critical in the presentation of its results and did not include the failed aborted cases in the total sinus augmentation success rate.
Some studies failed to report the number of sinus augmentation procedures as it differed from the number of the patients enrolled in these studies.
Some did not mention the cause of membrane perforation or implant failure.
Some studies did not mentioned well-defined implant survival or success criteria according to which they depend in reporting the survival rate of implants.
Lack of long follow-up period in most of these studies.
Lack of randomized clinical trial (RCT) studies as shown in (Table 1).