Complications During Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa

Tassos Irinakis1, Valentin Dabuleanu2, Salwa Aldahlawi1, 3, *
1 Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
2 Private practice, Dabuleanu Dental 2 Finch Avenue, West Toronto, ON, Canada
3 Faculty of Dentistry, Umm alqura University, Mecca, Saudi Arabia

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© 2017 Irinakis et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Dentistry, Umm alqura University, Mecca, Saudi Arabia / Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Tel: +1 604- 880-4427; Fax: +1 604-608-5647; E-mails: sdahlawi@,



A new classification of maxillary sinus interfering septa based on its orientation is presented along with its relationship to the prevalence and severity of sinus membrane perforations. Additionally, the impact of membrane perforation on post-operative complications and marginal bone loss during the first year of loading is evaluated.

Materials & Methods:

Retrospective chart review of 79 consecutive sinus lift procedures with lateral window technique and 107 implants. Preoperative Cone Beam Computed Tomography (CBCT) images were evaluated for the incidence and the direction of maxillary septa. Chart notes were examined for the incidence of membrane perforation and postoperative complications. Measurements of mesial and distal marginal bone levels and average bone resorption adjacent to each implant were calculated in intraoral radiographs taken at implant placement and during follow up appointments.


Interfering septa were identified in 48.1 percent of sinuses. 71.1 percent of them had the septum oriented in a buccal-lingual direction (Class I). The overall incidence of membrane perforation was 22.8 percent, and the presence of an interfering septum on CBCT scan was found to be significantly associated with the occurrence of a sinus membrane perforation (P<0.001). The mean implant marginal bone loss for sinuses, which did not experience a membrane perforation, was 0.6±0.8mm, compared with 0.9 ± 0.9 mm for the sinuses that did experience a perforation (P = 0.325).


Septa should be identified, classified and managed with a meticulous attention to technical details. A classification based on the septal orientation is proposed since the orientation of the septa can complicate the surgical procedure and requires modification of the surgical technique.

Keywords: Direct sinus lift, Maxillary septum classification, Schneiderian membrane perforation, Dental implant, Marginal bone loss, Post operative complication, Bone graft.