Minimizing the Volume of Surgical Trauma in Sinus Lift: PathophysiologicalJustification of Modifiable Factors and the Conceptual Model Surgical Trauma Load

Abstract

Background. Sinus lift (maxillary sinus floor elevation) remains one of the key operations for creating bone volume in the lateral maxilla prior to implantation. A greater volume of surgical trauma in sinus augmentation is accompanied by a more intense local aseptic (sterile) inflammation and, consequently, affects the risk of Schneiderian membrane perforation and the features of bone remodeling in the augmentation zone, which together may influence the frequency of complications and the quality of osteogenesis. Thus, the trauma volume acts as a controllable input factor, whereas inflammation intensity and regenerative outcomes are its consequences.
Objective. To summarize data on the pathophysiological mechanisms of surgical trauma in sinus lift, identify modifiable intraoperative factors that potentially reduce the inflammatory load, and propose a conceptual model for integral assessment of surgical trauma burden — Surgical Trauma Load (STL), applicable to different sinus augmentation techniques.
Materials and Methods. A literature review with elements of systematic search in PubMed, Scopus, and eLibrary for 2018–2026 was performed using key terms related to sinus augmentation, Schneiderian membrane perforations, visualization, instrumental methods, and platelet concentrates. After duplicate removal, title/abstract screening and full-text selection were carried out according to predefined criteria. Quantitative synthesis (meta-analysis) was not performed due to heterogeneity of interventions and outcomes.
Results. The volume of intervention (incision/flap elevation area, bone trauma volume, duration and intensity of instrumental impact, thermal damage) increases the release of DAMP signals, activation of pro-inflammatory cascades, and may maintain an unfavorable balance of mediators that enhance osteoclastogenesis via the RANKL/OPG axis. These processes potentially increase the risk of complications and slow the transition to the reparative phase (angiogenesis/osteogenesis). An additive model STL was proposed, integrating five parameters aggregated into four clinically modifiable directions: access volume, visualization quality, type of instrument for osteotomy/antrostomy, and biological profile of materials (including platelet-rich fibrin, PRF).
Conclusions. STL is considered a non-validated conceptual scale for standardized description of sinus lift protocols, comparison of techniques, and planning of prospective clinical validation.