A Descriptive Decision-Tree Model for Predicting Complications in Osseodensification-Assisted Transosseous Maxillary Sinus Lift

Objective: To develop a descriptive, clinically interpretable decision-tree model for predicting complications following osseodensification-assisted transosseous maxillary sinus lift using preoperative CBCT-derived anatomic variables. Methods: A prospective cohort study was conducted on 171 consecutive cases undergoing transosseous sinus floor elevation using osseodensification burs. Preoperative CBCT measurements included residual bone height (RBH), Schneiderian membrane thickness, maxillary sinus ostium (MSO) status, site of surgery, and intended vertical bone gain. The primary outcome was the presence or absence of intraoperative or postoperative complications. A descriptive decision-tree model (Al-Jamal Decision Tree; AJDT) was constructed to stratify complication risk based on anatomic predictors. Results: Complications occurred in 18 cases (10.5%). The mean RBH was 3.45±0.94 mm, the mean Schneiderian membrane thickness was 1.85±0.58 mm, and the mean vertical bone gain was 5.59±1.30 mm. RBH emerged as the primary decision node, followed by membrane thickness and MSO status, allowing clear stratification of patients into distinct risk categories. Conclusion: The AJDT provides a practical, anatomy-based framework for preoperative risk assessment in osseodensification-assisted transosseous sinus lifts and supports individualized surgical decision-making.