The Hammock Proposal: A Modification of Loma Linda Pouch Technique

Abstract

Introduction: A technique, the "Loma Linda pouch," is introduced for repairing the perforated maxillary sinus membrane during sinus grafting procedures. The collagen membrane is then folded along the lateral access window to form a pouch that surrounds and isolates the graft material. In this review, we planned to devise a modification to the “Loma Linda pouch technique”. This ‘‘hammock’’ approach immobilizes the collagen membrane as far as possible, promotes greater blood supply, thereby increasing vital bone formation. Case presentation: When perforation occurs during elevation of the Schneiderian membrane, elevation of the membrane from the internal sinus walls must be completed. In this approach, plasma rich in growth factors is used as a graft carrier to achieve a more compact and homogeneous bone graft and to avoid particle dispersion. The rest of the procedure follows the classic sinus augmentation approach. Discussion: Ranges of techniques involve repairing perforations that range in size from 2 mm to 1.5 cm. For larger perforations (≥1.5mm), the only reported possibility is the use of a resorbable collagen membrane. Displacement of the collagen membrane is one of the most frequent complications. For this reason, perfect immobilization of the membrane is the key to success. Compared with other methods, this modified approach enhances the fixation of the collagen membrane not only on the buccal side but also on the palatal side of the sinus cavity. Conclusion: This technique achieves stable immobilization of the collagen membrane and, with it, better treatment predictability in future.