Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study

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Minimally invasive sinus augmentation techniques, such as CAS KIT–assisted indirect sinus elevation, aim to reduce surgical morbidity; however, evidence regarding patient-reported outcomes and quality of life following such interventions remains limited. Objective To evaluate oral health–related quality of life and patient-reported outcomes following implant rehabilitation using CAS KIT–assisted indirect maxillary sinus augmentation. Materials and Methods This observational cross-sectional study included 34 patients who underwent CAS KIT–assisted transcrestal sinus augmentation with implant placement in the posterior maxilla. Postoperative recovery and satisfaction were assessed using the HRQOLquestionnaire over seven postoperative days. OHRQoL was evaluated using the OHIP-14 questionnaire at baseline and one month after prosthetic rehabilitation. Data were analyzed using repeated measures ANOVA with a significance level set at p < 0.05. Results HRQOLscores showed a statistically significant improvement over the seven-day postoperative period (p < 0.001), with stabilization observed from Day 5 onward. OHIP-14 scores demonstrated a highly significant reduction from baseline to post-intervention assessment (p < 0.001), indicating marked improvement in OHRQoL across all participants. Conclusion CAS KIT–assisted indirect sinus augmentation followed by implant rehabilitation results in rapid postoperative recovery and significant improvement in patient-reported outcomes, supporting its role as a predictable and patient-centered treatment modality for posterior maxillary rehabilitation. 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F1000Research 2026, 15 :579 ( https://doi.org/10.12688/f1000research.179345.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] Sanath Kumar Shetty 1 , Mallikarjuna Ragher https://orcid.org/0009-0001-3233-975X 2 , Rajesh Shetty https://orcid.org/0000-0002-2538-2012 3 , Savitha Dandekeri 4 , Sunaina M 5 , Nafiya Abdul Aziz 6 Sanath Kumar Shetty 1 , Mallikarjuna Ragher https://orcid.org/0009-0001-3233-975X 2 , [...] Rajesh Shetty https://orcid.org/0000-0002-2538-2012 3 , Savitha Dandekeri 4 , Sunaina M 5 , Nafiya Abdul Aziz 6 PUBLISHED 19 Apr 2026 Author details Author details 1 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangaluru, Karnataka, India 2 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 3 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 4 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 5 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 6 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India Sanath Kumar Shetty Roles: Methodology, Supervision, Validation, Visualization Mallikarjuna Ragher Roles: Conceptualization, Investigation, Methodology, Project Administration Rajesh Shetty Roles: Data Curation, Investigation, Resources, Validation Savitha Dandekeri Roles: Visualization, Writing – Original Draft Preparation Sunaina M Roles: Writing – Original Draft Preparation, Writing – Review & Editing Nafiya Abdul Aziz Roles: Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Background Partial edentulism in the posterior maxilla is frequently complicated by alveolar bone resorption and maxillary sinus pneumatization, limiting implant placement and negatively affecting oral health–related quality of life (OHRQoL). Minimally invasive sinus augmentation techniques, such as CAS KIT–assisted indirect sinus elevation, aim to reduce surgical morbidity; however, evidence regarding patient-reported outcomes and quality of life following such interventions remains limited. Objective To evaluate oral health–related quality of life and patient-reported outcomes following implant rehabilitation using CAS KIT–assisted indirect maxillary sinus augmentation. Materials and Methods This observational cross-sectional study included 34 patients who underwent CAS KIT–assisted transcrestal sinus augmentation with implant placement in the posterior maxilla. Postoperative recovery and satisfaction were assessed using the HRQOLquestionnaire over seven postoperative days. OHRQoL was evaluated using the OHIP-14 questionnaire at baseline and one month after prosthetic rehabilitation. Data were analyzed using repeated measures ANOVA with a significance level set at p < 0.05. Results HRQOLscores showed a statistically significant improvement over the seven-day postoperative period (p < 0.001), with stabilization observed from Day 5 onward. OHIP-14 scores demonstrated a highly significant reduction from baseline to post-intervention assessment (p < 0.001), indicating marked improvement in OHRQoL across all participants. Conclusion CAS KIT–assisted indirect sinus augmentation followed by implant rehabilitation results in rapid postoperative recovery and significant improvement in patient-reported outcomes, supporting its role as a predictable and patient-centered treatment modality for posterior maxillary rehabilitation. READ ALL READ LESS Keywords Maxillary Sinus Augmentation; Dental Implants; Quality of Life; Patient-Reported Outcome Measures; Posterior Maxilla; Minimally Invasive Surgical Procedures Corresponding Author(s) Mallikarjuna Ragher ( [email protected] ) Close Corresponding author: Mallikarjuna Ragher Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Kumar Shetty S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Kumar Shetty S, Ragher M, Shetty R et al. Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.12688/f1000research.179345.1 ) First published: 19 Apr 2026, 15 :579 ( https://doi.org/10.12688/f1000research.179345.1 ) Latest published: 19 Apr 2026, 15 :579 ( https://doi.org/10.12688/f1000research.179345.1 ) Introduction Partial edentulism in the posterior maxilla remains a prevalent clinical condition with significant implications for oral health–related quality of life (OHRQoL). 1 Individuals with fewer than 20 natural teeth consistently report poorer OHRQoL compared with those retaining functional dentitions, as tooth loss compromises masticatory efficiency, speech, facial esthetics, and self-esteem, thereby influencing nutritional intake, social interaction, and overall wellbeing. 2 Following tooth extraction, the posterior maxilla undergoes progressive alveolar bone resorption accompanied by maxillary sinus pneumatization, frequently resulting in reduced vertical bone height that limits conventional implant placement. Epidemiological studies indicate that posterior maxillary bone deficiency is among the most common anatomical constraints encountered in implant dentistry, necessitating adjunctive bone augmentation procedures that may prolong functional disability and restrict treatment options. 3 – 5 The evolution of maxillary sinus augmentation techniques reflects a progressive shift from invasive surgical procedures toward more conservative and predictable approaches. Traditionally, sinus floor elevation has been performed using either the lateral (direct) window technique or the crestal (indirect) approach. The lateral window technique permits substantial vertical bone augmentation and is indicated in cases of severe alveolar bone deficiency; however, it is associated with increased surgical trauma, longer operative time, higher postoperative morbidity, and delayed recovery. Conversely, the transcrestal approach was introduced as a less invasive alternative, offering reduced patient discomfort and faster healing, though earlier techniques were limited by restricted control over sinus membrane elevation. Advances in surgical philosophy have driven a paradigm shift toward minimally invasive sinus augmentation, emphasizing reduced tissue trauma, shorter procedure duration, lower complication rates, and enhanced patient comfort. This shift has been facilitated by innovations such as hydraulic pressure systems, balloon-assisted membrane elevation, and piezoelectric instruments, which improve the safety and predictability of Schneiderian membrane elevation. Among these developments, the Crestal Approach Sinus (CAS) Kit represents a significant advancement by enabling controlled, atraumatic, and minimally invasive transcrestal sinus elevation. Its calibrated instrumentation allows precise membrane elevation while minimizing the risk of perforation, aligning with contemporary trends in patient-centered implant therapy. While clinical and radiographic outcomes of sinus augmentation—including implant survival rates, bone gain, and complication rates—are well documented, these parameters fail to capture patients’ subjective experiences. 6 – 8 Contemporary dental research increasingly emphasizes patient-reported outcome measures (PROs) as essential indicators of treatment success, with OHRQoL representing a multidimensional construct encompassing functional limitation, physical pain, psychological discomfort, and social disability. Previous systematic reviews demonstrate that implant-supported prostheses improve oral health–related quality of life (OHRQoL) in edentulous and partially edentulous patients; however, evidence comparing different surgical modalities—particularly CAS-KIT assisted technique remains limited. It is unclear whether the improved surgical control and predictability associated with CAS-guided indirect sinus augmentation translate into superior patient-centered outcomes, including chewing efficiency, dietary habits, psychosocial wellbeing, and overall satisfaction. Therefore, a significant knowledge gap exists regarding the impact of CAS KIT–assisted indirect maxillary sinus augmentation followed by implant rehabilitation on OHRQoL and PROs. The objective of this cross-sectional study was to evaluate oral health–related quality of life and patient-reported outcomes in individuals who underwent implant rehabilitation following CAS KIT–assisted indirect maxillary sinus augmentation. The null hypothesis was that CAS KIT–assisted indirect sinus augmentation followed by implant rehabilitation would not result in significant improvements in OHRQoL, while the alternative hypothesis proposed that this minimally invasive approach would significantly enhance OHRQoL, yield high patient satisfaction, and exert minimal negative impact on daily functioning. Materials and methods Study design and ethical considerations This observational cross-sectional study was conducted to evaluate oral health–related quality of life (OHRQoL) and patient-reported outcomes following implant rehabilitation using CAS KIT–assisted indirect maxillary sinus augmentation. The cross-sectional design was chosen to assess patient-centered outcomes after completion of surgical and prosthetic treatment without modifying standard clinical care. Ethical approval was obtained from the Yenepoya Ethics Committee-2(Ref. YEC2/2024/342), Yenepoya (Deemed To Be University) prior to study initiation, and the study was conducted in accordance with the Declaration of Helsinki (2013 revision). Written informed consent was obtained from all participants after providing detailed information in their native language. The study adhered to the STROBE guidelines for reporting cross-sectional studies. Study population and setting The study was carried out at the Centre for Oral Implantology a university-based tertiary care center, between June 2024 and September 2025. Thirty-four patients aged 18–60 years ( Table 1 ) requiring implant-supported rehabilitation in the deficient posterior maxilla with CAS KIT–assisted indirect sinus augmentation were recruited using simple random sampling. All participants completed implant placement followed by prosthetic rehabilitation and consented to participate in questionnaire-based evaluation. Table 1. Demographic characteristics of participants. Characteristic N (%) or Mean ± SD Number of patients 34 Age (years) 42.3 ± 11.5 Sex – Male 18 (52.9%) – Female 16 (47.1%) Implant site – Right posterior maxilla 20 (58.8%) – Left posterior maxilla 14 (41.2%) Sample size calculation Sample size estimation was performed using G*Power software based on data from a previous study by Hadar et al. Power analysis for an independent t-test was conducted with a conventional effect size of 0.5, a type I error rate (α) of 5%, and a type II error rate (β) of 20%, corresponding to a power of 80%. The calculated minimum sample size required for the study was 34 participants. Surgical protocol All participants underwent preoperative clinical evaluation and cone-beam computed tomography (CBCT) imaging to assess residual alveolar bone height and maxillary sinus anatomy. Digital planning was performed to guide implant positioning and depth control using the CAS KIT system. Indirect maxillary sinus augmentation was carried out via a transcrestal approach following the CAS KIT drilling protocol, with controlled elevation of the Schneiderian membrane and implant placement performed as per standard clinical indications. Postoperative care included routine medications, oral hygiene instructions, and scheduled follow-up visits. Prosthetic rehabilitation Prosthetic rehabilitation was completed following an adequate healing period and confirmation of implant stability. Implant-supported restorations were fabricated and delivered based on clinical requirements, with the type of prosthesis and loading protocol determined according to patient-specific factors and standard implant prosthetic principles. Patient-reported outcome measures Patient-reported outcomes were assessed using two validated questionnaires. Postoperative recovery and satisfaction were evaluated using the HRQOL questionnaire consisting of 19 items assessing oral function, general activity, other symptoms, and pain, recorded daily for seven postoperative days using a five-point Likert scale through structured telephonic interviews. Oral health–related quality of life was assessed using the OHIP-14 questionnaire at baseline and one month following prosthetic rehabilitation, with responses recorded on a five-point frequency scale and analyzed both as overall scores and across seven standardized subdomains. Data collection and quality assurance All questionnaires were administered in the participants’ native language using validated translations. Measures were taken to ensure completeness and consistency of responses, and participants with incomplete or inconsistent data were excluded according to predefined withdrawal criteria. Collected data were anonymized, securely stored, and prepared for statistical analysis. Statistical analysis Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including mean, standard deviation (SD), standard error (SE), and coefficient of variation, were calculated for HRQOL and OHIP scores at different time points. Changes in HRQOL scores over the seven-day observation period were analyzed using repeated measures analysis of variance (ANOVA) to assess the effect of time. Following a significant ANOVA result, post hoc pairwise comparisons were performed to identify specific differences between individual days. Changes in OHIP scores between pre- and post-intervention assessments were also evaluated using repeated measures ANOVA. A p value <0.05 was considered statistically significant for all analyses. Results The HRQOL scores demonstrated a significant improvement over the seven-day observation period. Repeated measures ANOVA revealed a statistically highly significant effect of time on HRQOL scores (F = 261.1, p < 0.001). The mean HRQOL score decreased progressively from Day 1 (1.429 ± 0.109) to Day 4 (1.053 ± 0.090), indicating an improvement in health-related quality of life over time. Post hoc pairwise comparisons showed significant differences between Day 1 and all subsequent days, as well as between Day 2 and Days 3–7 (p < 0.001). No significant difference was observed between Day 3 and Day 4 (p = 0.325). From Day 5 onwards, HRQOL scores stabilized at 1.000 with no inter-individual variability, and no significant differences were observed among Days 5, 6, and 7, indicating sustained improvement [ Tables 2 - 4 ; Graph 1 ]. Table 2. Descriptive statistics of HRQOL scores across the 7-day follow-up period. Descriptive statistics Day Mean SD SE Coefficient of variation 1 1.429 0.109 0.019 0.076 2 1.247 0.071 0.012 0.057 3 1.059 0.092 0.016 0.087 4 1.053 0.090 0.015 0.085 5 1.000 0.000 0.000 0.000 6 1.000 0.000 0.000 0.000 7 1.000 0.000 0.000 0.000 Table 3. Repeated measures ANOVA showing changes in HRQOL scores over time. Repeated measure ANOVA Cases Sum of squares df Mean square F p HRQOL 5.540 6 0.923 261.1 < .001 Table 4. Post hoc pairwise comparisons of HRQOL scores between different time points. Post hoc comparisons – HRQOL Day vs day Mean difference SE df t p value 1 2 0.182 0.017 33 10.642 < .001 1 3 0.371 0.020 33 18.095 < .001 1 4 0.376 0.022 33 16.834 < .001 1 5 0.429 0.019 33 23.015 < .001 1 6 0.429 0.019 33 23.015 < .001 1 7 0.429 0.019 33 23.015 < .001 2 3 0.188 0.008 33 22.978 < .001 2 4 0.194 0.010 33 18.863 < .001 2 5 0.247 0.012 33 20.391 < .001 2 6 0.247 0.012 33 20.391 < .001 2 7 0.247 0.012 33 20.391 < .001 3 4 0.006 0.006 33 1.000 0.325 3 5 0.059 0.016 33 3.708 0.005 3 6 0.059 0.016 33 3.708 0.005 3 7 0.059 0.016 33 3.708 0.005 4 5 0.053 0.015 33 3.447 0.006 4 6 0.053 0.015 33 3.447 0.006 4 7 0.053 0.015 33 3.447 0.006 5 6 0.000 0.000 33 NaN NaN 5 7 0.000 0.000 33 NaN NaN 6 7 0.000 0.000 33 NaN NaN Graph 1. Graph depicting trend of Mean HRQOL Scores Over the 7-Day Observation Period. A statistically highly significant reduction in OHIP scores was observed from pre- to post-intervention assessment. Repeated measures ANOVA demonstrated a significant effect of time on OHIP scores (F = 1706, p < 0.001). The mean OHIP score decreased from 2.050 ± 0.148 at baseline to 1.000 ± 0.000 following the intervention, indicating a marked improvement in oral health–related quality of life. The absence of variability in post-intervention scores reflects uniform improvement across all participants [ Tables 5 , 6 ; Graph 2 ]. Table 5. Descriptive statistics of OHIP scores at pre- and post-intervention assessments. Descriptive statistics OHIP Mean SD SE Coefficient of variation Pre 2.050 0.148 0.025 0.072 Post 1.000 0.000 0.000 0.000 Table 6. Repeated measures ANOVA comparing pre- and post-intervention OHIP scores. Repeated measures ANOVA Cases Sum of squares df Mean square F p OHIP 18.743 1 18.743 1,706 < .001 Graph 2. Graph depicting comparison of Mean OHIP Scores Before and After Intervention. Discussion This study demonstrated a statistically significant improvement in oral health–related quality of life following the intervention, thereby rejecting the null hypothesis and fulfilling the primary research objectives. Both HRQOL and OHIP-14 scores showed substantial reductions over the observation period, reflecting marked improvement in patient-reported outcomes. This study evaluates patient-centered outcomes following CAS KIT–assisted indirect sinus augmentation, offering novel evidence that this minimally invasive approach translates directly into measurable patient-reported benefits. The most pronounced improvement occurred during the early follow-up phase, with HRQOL scores demonstrating rapid and sustained normalization from Day 5 onwards, indicating high levels of patient satisfaction and consistent clinical success across the study population. The uniform post-intervention OHIP-14 scores further underscore the effectiveness of the intervention in minimizing the perceived impact of oral health on daily functioning. Collectively, these findings highlight favorable clinical outcomes, the presence of strong time-dependent effects as key predictors of improvement, and the significant value of incorporating patient-reported outcome measures into evaluations of minimally invasive sinus augmentation techniques. The postoperative recovery pattern observed in the present study demonstrates a rapid improvement during the early healing phase (Days 1–4), followed by stabilization between Days 5 and 7, which is consistent with patient-reported outcome data from sinus augmentation literature. Rengo et al. reported moderate pain limited to the first two postoperative days with a progressive decline thereafter, alongside low discomfort scores and high willingness to repeat the procedure, indicating favorable short-term morbidity. 9 Similarly, Schiegnitz et al. showed that procedure-related complaints peak immediately postoperatively and significantly diminish over time. Compared with lateral window approaches, which are commonly associated with prolonged swelling, discomfort, and delayed recovery, transcrestal techniques have been shown to result in reduced morbidity and faster functional recovery. 10 These findings may be attributed to reduced surgical trauma, preservation of Schneiderian membrane integrity, and minimal bone manipulation inherent to indirect sinus elevation techniques. The accelerated recovery timeline observed in the present study appears comparable or superior to conventional crestal approaches reported in the literature, supporting the clinical advantage of minimally invasive sinus augmentation strategies. Beyond early recovery, the complete restoration of oral health–related quality of life observed post-intervention, reflected by a uniform OHRQoL score of 1.000, aligns with previous studies demonstrating significant improvements following implant rehabilitation in the posterior maxilla. Schiegnitz et al. reported marked enhancement across functional, physical, and psychological OHIP domains following sinus augmentation, particularly in edentulous patients. 10 The multidimensional improvement observed—including functional limitation, psychosocial disability, and patient satisfaction—can be attributed to restored masticatory efficiency, improved esthetics, and enhanced psychosocial wellbeing, reinforcing the patient-centered benefits of successful sinus augmentation and implant-supported rehabilitation as outlined in the introduction. At present, there is a clear absence of literature specifically evaluating CAS Kit–guided sinus augmentation; however, meaningful inferences can be drawn by comparing its principles with established transcrestal techniques described in the literature. Comprehensive reviews, including that by Lafzi et al., consistently demonstrate that transcrestal approaches—particularly those employing drill-based, hydraulic, balloon-assisted, and piezoelectric modalities—are associated with lower postoperative morbidity, reduced membrane perforation rates, and faster patient recovery when compared with the lateral window technique. These advantages underpin the broader paradigm shift toward minimally invasive sinus augmentation. The CAS approach conceptually aligns with this evolution by emphasizing controlled sinus membrane elevation, elimination of malleting forces, and gradual, predictable manipulation of the sinus floor. Such controlled elevation mechanisms parallel those reported in hydraulic and balloon-assisted techniques, which distribute pressure evenly across the Schneiderian membrane and reduce focal stress concentrations, thereby minimizing perforation risk. 11 Furthermore, the ability to achieve predictable bone graft placement and simultaneous implant insertion with minimal bone manipulation supports improved surgical precision and patient tolerance. Collectively, these characteristics suggest that CAS-KIT assisted sinus elevation represents a logical refinement of existing transcrestal methodologies and may account for the superior clinical and patient-reported outcomes observed, even in the absence of technique-specific comparative trials. The uniform post-intervention scores with zero variability observed in this study indicate a high level of procedural reliability and reproducibility of the crestal approach technique. This consistency suggests predictable membrane elevation and graft stabilization with minimal technique-related variability. Although the use of specialized crestal systems involves an initial equipment cost and learning curve, these factors are balanced by improved patient comfort, reduced morbidity, shorter operative time, and fewer postoperative complications. Careful patient selection remains essential, with favorable outcomes primarily seen in cases with adequate residual bone height, favorable sinus anatomy, and absence of sinus pathology. When appropriately indicated, the crestal approach can be effectively integrated into treatment planning for posterior maxillary rehabilitation, facilitating minimally invasive sinus augmentation with simultaneous implant placement and enhanced patient-centered outcomes. The present study has several limitations that warrant consideration. Its cross-sectional design, with a single post-treatment assessment and absence of a control or comparison group, restricts causal inference and direct comparison with alternative sinus augmentation techniques. Although the sample size provided adequate statistical power, the single-center setting limits the generalizability of the findings. Additionally, the lack of long-term follow-up beyond the immediate post-prosthetic period precludes evaluation of the durability of patient-reported benefits. The reliance on subjective outcome measures without objective functional assessments, such as masticatory performance or nutritional evaluation, further limits comprehensive outcome interpretation, while retrospective baseline OHIP-14 assessment may be subject to recall bias. Future research should focus on well-designed comparative studies evaluating CAS KIT against conventional transcrestal and lateral window techniques, with extended follow-up. Incorporation of radiographic parameters, implant stability measures, economic evaluations, multicenter validation, and objective functional outcomes would strengthen the evidence base and better define the clinical value of minimally invasive sinus augmentation techniques. Conclusion Within the limitations of this cross-sectional study, CAS KIT–assisted indirect maxillary sinus augmentation followed by implant-supported rehabilitation resulted in significant improvement in oral health–related quality of life and patient-reported outcomes. The rapid postoperative recovery, minimal functional impairment, and uniform improvement in OHIP-14 scores reflect high patient satisfaction and favorable psychosocial impact associated with this minimally invasive approach. These findings suggest that the enhanced surgical control and reduced morbidity of CAS-KIT assisted sinus augmentation translate into meaningful patient-centered benefits. Incorporation of patient-reported outcome measures alongside clinical and radiographic parameters is essential for comprehensive evaluation of treatment success in posterior maxillary implant rehabilitation. Further longitudinal and comparative studies are warranted to validate these findings and assess long-term outcomes. Data availability and extended data Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [Data set]. Zenodo. https://doi.org/10.5281/zenodo.19274689 . 12 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Morinaga D, Nagai S, Kaku T, et al. : Effects of various prosthetic methods for patients with Kennedy Class I partial edentulism on oral hypofunction, subjective symptoms, and oral health-related quality of life. Int. J. Implant. Dent. 2024 Jun 27; 10 (1): 33. PubMed Abstract | Publisher Full Text | Free Full Text 2. Berniyanti T, Palupi R, Alkadasi BA, et al. : Oral health-related quality of life (OHRQoL) analysis in partially edentulous patients with and without denture therapy. Clin. Cosmet. Investig. Dent. 2023 May 16; 15 : 89–98. 3. Oh WS, Saglik B, Bak SY: Bone loss in the posterior edentulous mandible with implant-supported overdentures vs complete dentures: A systematic review and meta-analysis. Int. J. Prosthodont. 2020; 33 (2): 184–191. Publisher Full Text 4. Alrabiah M, Al Deeb M, Alsahhaf A, et al. : Clinical and radiographic assessment of narrow-diameter and regular-diameter implants in the anterior and posterior jaw: 2 to 6 years of follow-up. J. Periodontal Implant Sci. 2020; 50 (2): 97–105. Publisher Full Text 5. Lombardi T, Rapani A, Ezeddine F, et al. : Clinical Outcomes of Bone-Level and Tissue-Level Short Implants Placed in Posterior Maxilla: A Case-Control Study. Clin. Implant. Dent. Relat. Res. 2025 Feb; 27 . Publisher Full Text 6. Comuzzi L, Tumedei M, Petrini M, et al. : Clinical and radiological evaluation of a self-condensing bone implant in one-stage sinus augmentation: A 3-year follow-up retrospective study. Int. J. Environ. Res. Public Health. 2023 Jan 31; 20 (3): 2583. 7. Mamidi AR, Gottumukkala SNVS, Mantena SR, et al. : Comparison of clinical and radiological outcomes using crestal approach sinus kit and piezoelectric surgery for sinus membrane elevation: A prospective clinical trial. Dent. Res. J (Isfahan). 2022 Oct 20; 19 : 88. 8. Toledano-Serrabona J, Romeu-I-Fontanet A, Gay-Escoda C, et al. : Clinical and histological outcomes of maxillary sinus floor augmentation with synthetic bone substitutes for dental implant treatment: A meta-analysis. J. Oral Implantol. 2022 Apr 1; 48 (2): 158–167. Publisher Full Text 9. Rengo C, Fiorino A, Cucchi A, et al. : Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study. Clin. Oral Investig. 2021 Jul; 25 (7): 4431–4444. Publisher Full Text 10. Schiegnitz E, Kämmerer PW, Sagheb K, et al. : Impact of maxillary sinus augmentation on oral health-related quality of life. Int. J. Implant. Dent. 2017 Dec; 3 (1): 10. 11. Lafzi A, Atarbashi-Moghadam F, Amid R, et al. : Different techniques in transalveolar maxillary sinus elevation: A literature review. J. Adv. Periodontol. Implant. Dent. 2021 Apr 6; 13 (1): 35–42. PubMed Abstract | Publisher Full Text | Free Full Text 12. Shetty SK, Ragher M, Shetty R, et al. : Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study. [Data set]. Zenodo. 2026. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangaluru, Karnataka, India 2 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 3 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 4 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 5 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India 6 PROSTHODONTICS, Yenepoya (Deemed to be University) Dental College, Mangalore, Karnataka, 575018, India Sanath Kumar Shetty Roles: Methodology, Supervision, Validation, Visualization Mallikarjuna Ragher Roles: Conceptualization, Investigation, Methodology, Project Administration Rajesh Shetty Roles: Data Curation, Investigation, Resources, Validation Savitha Dandekeri Roles: Visualization, Writing – Original Draft Preparation Sunaina M Roles: Writing – Original Draft Preparation, Writing – Review & Editing Nafiya Abdul Aziz Roles: Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 19 Apr 2026, 15:579 https://doi.org/10.12688/f1000research.179345.1 Copyright © 2026 Kumar Shetty S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Kumar Shetty S, Ragher M, Shetty R et al. Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.12688/f1000research.179345.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 19 Apr 2026 Views 0 Cite How to cite this report: Aradya A. Reviewer Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477155 ) The direct URL for this report is: https://f1000research.com/articles/15-579/v1#referee-response-477155 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 May 2026 Anupama Aradya , JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.197850.r477155 The manuscript addresses a clinically relevant topic by evaluating patient-reported outcomes following CAS KIT–assisted indirect sinus augmentation and implant rehabilitation. The emphasis on oral health–related quality of life adds value to the existing literature The ... Continue reading READ ALL The manuscript addresses a clinically relevant topic by evaluating patient-reported outcomes following CAS KIT–assisted indirect sinus augmentation and implant rehabilitation. The emphasis on oral health–related quality of life adds value to the existing literature The introduction is comprehensive; however, the rationale for selecting a cross-sectional design should be explained more clearly, particularly considering that baseline and postoperative assessments were performed over time. The methodology section requires clarification regarding the timing of OHIP-14 administration. Please specify whether the baseline questionnaire was administered before surgery or retrospectively after treatment completion. The discussion section is well supported with relevant literature, but additional comparison with recent studies evaluating minimally invasive sinus augmentation techniques would strengthen the manuscript further. Minor grammatical and formatting inconsistencies are present throughout the manuscript (e.g., spacing, punctuation, and author affiliation superscripts) and should be carefully revised during proofreading. Overall, the manuscript is informative and clinically relevant. After addressing the above comments and improving methodological clarity, the article may be considered suitable for indexing. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: implant dentistry, gerodontology, prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Aradya A. Reviewer Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477155 ) The direct URL for this report is: https://f1000research.com/articles/15-579/v1#referee-response-477155 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Dhawan P. Reviewer Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477157 ) The direct URL for this report is: https://f1000research.com/articles/15-579/v1#referee-response-477157 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 May 2026 Pankaj Dhawan , Manav Rachna International Institute Of Research And Studies, Faridabad, Haryana, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.197850.r477157 1. The study evaluates the CAS KIT, an established system for minimally invasive transcrestal sinus elevation. Because the study does not introduce a new protocol and completely lacks a comparison group (e.g., conventional crestal approaches vs. lateral window techniques), it adds ... Continue reading READ ALL 1. The study evaluates the CAS KIT, an established system for minimally invasive transcrestal sinus elevation. Because the study does not introduce a new protocol and completely lacks a comparison group (e.g., conventional crestal approaches vs. lateral window techniques), it adds very little novel data to the existing literature. 2. The authors explicitly describe their research as an "observational cross-sectional study". However, they track patient outcomes over a 7-day postoperative period and compare baseline OHIP-14 data with 1-month follow-up. Tracking the same subjects across multiple time points defines a longitudinal or cohort study, which means the paper's core methodological classification is incorrect. 3. There is a massive statistical anomaly in the reported results. From Day 5 onward, the HRQOL scores stabilized at exactly 1.000 with a standard deviation of 0.000. Furthermore, the post-intervention OHIP scores were also reported as 1.000 with a standard deviation of 0.000. In subjective, questionnaire-based human research involving 34 distinct individuals, achieving absolute zero variability is biologically and psychologically implausible. This suggests a severe data entry error, a misunderstanding of the questionnaire, or data manipulation. 4. The study was conducted at a single university-based tertiary care center (Center for Oral Implantology). This single-center approach severely restricts the external validity and generalizability of the findings to broader clinical populations. 5. In the discussion, the authors claim that their findings suggest "superior clinical and patient-reported outcomes observed". Because the study lacks a control group or an active comparator, any claims of "superiority" over other surgical methods are unscientific and unjustified, and must be scaled back to reflect the actual data. 6. While the bibliography does include recent papers up to 2025 regarding the general quality of life and sinus augmentation, it lacks depth regarding the specific intervention. Out of 12 references, only one (Mamidi et al., 2022) directly evaluates the CAS kit. By ignoring the established body of foundational literature on this exact transcrestal system, the authors fail to properly contextualize their findings or justify the necessity of their research. 7. The authors used repeated measures ANOVA to show a "statistically highly significant effect of time" (p < 0.001). However, performing an ANOVA on data with zero variance at later time points is mathematically questionable, as it violates the assumptions of normality and homogeneity of variance required for parametric testing. 8. The post hoc pairwise comparisons in Table 4 report "NaN" (Not a Number) for comparisons between Days 5, 6, and 7. This occurs because the software cannot calculate a t-value when there is zero difference and zero variance between groups, further highlighting that the data distribution is unsuitable for this type of statistical analysis. 9. Claims of superiority and predictability require comparative and longitudinal data, which this study lacks. Major Revision. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: IMPLANTOLOGY I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Dhawan P. Reviewer Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477157 ) The direct URL for this report is: https://f1000research.com/articles/15-579/v1#referee-response-477157 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Apr 2026 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 19 Apr 26 read read Pankaj Dhawan , Manav Rachna International Institute Of Research And Studies, Faridabad, India Anupama Aradya , JSS Academy of Higher Education and Research, Mysuru, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Aradya A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 May 2026 | for Version 1 Anupama Aradya , JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India 0 Views copyright © 2026 Aradya A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript addresses a clinically relevant topic by evaluating patient-reported outcomes following CAS KIT–assisted indirect sinus augmentation and implant rehabilitation. The emphasis on oral health–related quality of life adds value to the existing literature The introduction is comprehensive; however, the rationale for selecting a cross-sectional design should be explained more clearly, particularly considering that baseline and postoperative assessments were performed over time. The methodology section requires clarification regarding the timing of OHIP-14 administration. Please specify whether the baseline questionnaire was administered before surgery or retrospectively after treatment completion. The discussion section is well supported with relevant literature, but additional comparison with recent studies evaluating minimally invasive sinus augmentation techniques would strengthen the manuscript further. Minor grammatical and formatting inconsistencies are present throughout the manuscript (e.g., spacing, punctuation, and author affiliation superscripts) and should be carefully revised during proofreading. Overall, the manuscript is informative and clinically relevant. After addressing the above comments and improving methodological clarity, the article may be considered suitable for indexing. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise implant dentistry, gerodontology, prosthodontics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Aradya A. Peer Review Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477155) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/15-579/v1#referee-response-477155 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 May 2026 | for Version 1 Pankaj Dhawan , Manav Rachna International Institute Of Research And Studies, Faridabad, Haryana, India 0 Views copyright © 2026 Dhawan P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. The study evaluates the CAS KIT, an established system for minimally invasive transcrestal sinus elevation. Because the study does not introduce a new protocol and completely lacks a comparison group (e.g., conventional crestal approaches vs. lateral window techniques), it adds very little novel data to the existing literature. 2. The authors explicitly describe their research as an "observational cross-sectional study". However, they track patient outcomes over a 7-day postoperative period and compare baseline OHIP-14 data with 1-month follow-up. Tracking the same subjects across multiple time points defines a longitudinal or cohort study, which means the paper's core methodological classification is incorrect. 3. There is a massive statistical anomaly in the reported results. From Day 5 onward, the HRQOL scores stabilized at exactly 1.000 with a standard deviation of 0.000. Furthermore, the post-intervention OHIP scores were also reported as 1.000 with a standard deviation of 0.000. In subjective, questionnaire-based human research involving 34 distinct individuals, achieving absolute zero variability is biologically and psychologically implausible. This suggests a severe data entry error, a misunderstanding of the questionnaire, or data manipulation. 4. The study was conducted at a single university-based tertiary care center (Center for Oral Implantology). This single-center approach severely restricts the external validity and generalizability of the findings to broader clinical populations. 5. In the discussion, the authors claim that their findings suggest "superior clinical and patient-reported outcomes observed". Because the study lacks a control group or an active comparator, any claims of "superiority" over other surgical methods are unscientific and unjustified, and must be scaled back to reflect the actual data. 6. While the bibliography does include recent papers up to 2025 regarding the general quality of life and sinus augmentation, it lacks depth regarding the specific intervention. Out of 12 references, only one (Mamidi et al., 2022) directly evaluates the CAS kit. By ignoring the established body of foundational literature on this exact transcrestal system, the authors fail to properly contextualize their findings or justify the necessity of their research. 7. The authors used repeated measures ANOVA to show a "statistically highly significant effect of time" (p < 0.001). However, performing an ANOVA on data with zero variance at later time points is mathematically questionable, as it violates the assumptions of normality and homogeneity of variance required for parametric testing. 8. The post hoc pairwise comparisons in Table 4 report "NaN" (Not a Number) for comparisons between Days 5, 6, and 7. This occurs because the software cannot calculate a t-value when there is zero difference and zero variance between groups, further highlighting that the data distribution is unsuitable for this type of statistical analysis. 9. Claims of superiority and predictability require comparative and longitudinal data, which this study lacks. Major Revision. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise IMPLANTOLOGY I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Dhawan P. Peer Review Report For: Oral Health–Related Quality of Life and Patient-Reported Outcomes After Implant Rehabilitation Using CAS Kit–Assisted Indirect Maxillary Sinus Augmentation: A Cross-Sectional Study [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 15 :579 ( https://doi.org/10.5256/f1000research.197850.r477157) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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