Abstract
The study comprised 20 lateral sinus floor elevation cases performed in 18 patients. During surgery, in four cases, a perforation of the Schneiderian membrane was detected. An attempt to suture the perforated membrane may increase the risk of enlarging the perforation. Therefore, we suggest a more conservative protocol be applied in all four cases where perforation occurred. The procedure consists of the 3-layer technique: an absorbable oxidized cellulose gauze moisturized with Dicynone was placed in this area. Under it, as a second layer, a PRF membrane is applied and then covered with a slow-resorbable collagen membrane. At that point, the surgery continues with the placement of the bone substitute material, and the sinus-lifting is finalized according to the selected protocol.
 The clinical studies demonstrate that the bone graft has a slower healing rate in areas with perforation, which is a proof of the osteogenic properties of the Schneiderian membrane. The cases described reveal that using this surgical protocol is risk-free and has a high success rate.
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