Search Strategy
The data for this systematic review and meta-analysis were obtained and processed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles (Moher et al., 2010).
Relevant articles published up to December 30th, 2020 were searched using the relevant keywords and respective Boolean logic operators (AND, OR, NOT) in the above-mentioned databases: PubMed, EMBASE, Ovid MEDLINE, Web of Science. The relevant keywords were combined as follow for the search: ((jaw, edentulous, partially) OR (partially edentulous) OR (partial edentulism) OR (full edentulism) OR (fully edentulous) OR (atrophic maxilla) OR (posterior maxilla)) OR (Lateral AND (“maxillary sinus lift” OR “sinus lift” OR “maxillary sinus floor elevation” OR “sinus floor elevation” OR “maxillary sinus floor augmentation” OR “sinus floor augmentation” OR steroids OR steroid OR corticosteroids OR corticosteroid)) OR (lateral AND (“maxillary sinus lift” OR “sinus lift” OR “maxillary sinus floor elevation” OR “sinus floor elevation” OR “maxillary sinus floor augmentation” OR “sinus floor augmentation”)) AND (pain OR pain reduction OR trismus OR swelling OR complications OR inflammation OR outcome).
Four independent reviewers (NAV, GLD, GP and LM) first screened all study titles, then read abstracts, and lastly assessed the full texts of included articles. Disagreements were resolved by discussion among reviewers. The final selections according to the inclusion and exclusion criteria were made by the same authors, as some articles were excluded only after the full text analysis.
Inclusion Criteria
Studies were included if the following criteria were met:
• Studies specifically referring to lateral sinus lift
• RCTs
• Prospective cohort studies
• Case series
• Studies published in the English language
• Explicit reference to the peri-operative (pre and/or post) pharmacological prescriptions (antibiotics, anti-inflammatories, analgesics)
• Details of at least one of the post-operative inflammatory parameters reported (swelling, suppuration, symptoms of acute sinusitis, trismus, pain, wound dehiscence)
Exclusion Criteria
• Crestal/vertical sinus lift
• Less than 20 patients or 20 sinus lift surgeries
• Case reports
• Retrospective studies
In vitro studies
• Animal studies
• Articles with same cohort of patients
• Post-operative inflammatory parameters not considered in the analysis (not mentioned in the materials and methods, or the analysis of the parameters were not clearly identifiable in the results)
• Inflammatory parameters not discernable as values for a meta-analysis
Quality Assessment
Two authors (NAV, LM) independently assessed the studies in terms of the inclusion, relevance, eligibility, and risk of bias following the Cochrane Collaboration tool for RCTs and the Newcastle-Ottawa tool for prospective cohort studies; any disagreement was resolved by consensus of reviewers and statistics researcher (ZN).
Data Extraction and Collection Process
Following the screening process, four reviewers (NAV, GLD, GP and LM) independently extracted the data of the selected articles using data tables. All extracted data were reviewed, and any conflict was resolved among the authors and confirmed by the statistician. The following information was extracted from each included trial: year of publication, study design, number of patients, number of patients at the end of the study, number of implants, dropouts, mean age of patients, age range, mean initial bone height, type of biomaterial used, type of membrane used, single or bilateral sinus augmentation, dosage and timing of antibiotics prescribed, type of antibiotic, timing and dosage of corticosteroids prescribed, other anti-inflammatory medications prescribed, type and number of intra-operative complications, and type and number of post-operative symptoms at one and two weeks.
The primary (swelling, pain, infection) and secondary outcomes (active suppuration, bleeding, wound dehiscence, trismus, hematoma, early implant failure) were classified as present or absent, as clearly reported and numbered by the authors of the selected articles. If an article did not directly provided the number of outcome occurrences, they were extrapolated from the specific scales or tables, by counting the number of patients that still reported that outcome during the first two weeks post-op; as an example, we counted the number of patients that still reported pain in a VAS pain scale after 7 days. In this case, the pain was considered to be medium-high or high.
Statistical Analysis
A meta-analysis was performed using the CMA software (Comprehensive Meta Analysis Version 2.0) for each group separate. A random effects model was performed to estimate the event rate. Heterogeneity was checked based on methods, design, and type of complications.