Sinus Membrane Perforation Research Articles

Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation

The aim of this study was to follow 41 intraoperative perforations of the Schneiderian membrane during sinus floor elevation and to identify potential differences from patients without perforations. Two hundred and one sinus floor elevations were performed at the department of oral and maxillofacial surgery of the University Hospital of Schleswig-Holstein in the years 2005 and 2006. Forty-one intraoperative perforations (20.4%) were documented and treated according to the following scheme: defects smaller than 5 mm were covered with a collagen membrane. Larger defects were additionally sutured. Particulated jawbone mixed 50 : 50 with bone substitute (25 cases) and a 50 : 50 mix of particulated iliac crest bone and BioOss (six cases) mainly served as graft material in the perforation group. In 12 cases, implants were installed at the time of sinus grafting, and in 27 cases, a second operation was performed. Four sinus lift procedures had to be discontinued intraoperatively. Over a mean control interval of 162 days, one implant of the 93 inserted had to be replaced in the perforation group. After 1 year, the implant survival rate was 14 out of 14 in the perforation group vs. 81/92 in the control group. With appropriate treatment, intraoperative sinus membrane perforations did not represent an elevated risk for implant loss, infectious complications or displacement of graft material in the investigated population.

Simultaneous dental implant placement and endoscope‐guided internal sinus floor elevation: 2‐year post‐loading outcomes

To determine whether endoscope-guided sinus elevation procedures can be consistently used to create sufficient bone support for stable implant placement and long-term implant success. Sixty-two implants were surgically placed into 30 patients (14 men and 16 women) following internal sinus elevation without the use of graft material. Panoramic radiographs were made pre-, post-operative and after 24 months in order to evaluate the peri-implant bone and maxillary sinuses. Resonance frequency analysis (RFA) was used to evaluate implant stability immediately upon placement and just before prosthesis delivery. The average pre-operative height of the maxillary alveolar bone was 8.4+/-2.2 mm at the premolar and 7.3+/-3.1 mm at the molar regions. The average bone gain was 3.5+/-1.8 and 4.5+/-1.9 mm in the premolar and molar sites, respectively. Clinical parameters and the RFA (4 and 12 weeks post-operative) outcomes show sufficient stability (ISQ=60) of the inserted implants. Three implants failed during the healing period of 12 weeks. The overall implant success rate was 94%. After loading, no further implant failure was observed. The overall success rate after beginning of implant loading was 100%. Sinus floor elevation is a well-established procedure for augmentation of the atrophic maxillary posterior region. The minimally invasive internal sinus floor elevation procedure visually guided by an endoscope helped to prevent, diagnose and manage complications such as sinus membrane perforation. The clinical outcomes of this study show that endoscope-controlled internal sinus floor elevation combined with implant placement results in low intra operative trauma, good implant stability upon placement, low incidence of post-operative symptoms and high success rates after 24 months of loading.

Management of Perforated Sinus Membrane Using Absorbable Haemostat and Fibrin Adhesive for Sinus Lift Procedure

Objective: Common problems of the sinus lift procedure are perforation of sinus membrane and mobilisation of grafted materials. The purpose of this study was to evaluate the effect of absorbable haemostat and fibrin adhesive in sinus lift procedures.Patients and Methods: Eight patients who had sinus membrane perforation during sinus lift procedures from May to December 2003 were enrolled. Absorbable haemostat containing oxidised regenerative cellulose was used to cover the perforated membrane. Fibrin adhesive was applied for the immobilisation of grafted materials and its synergistic effect on the management of sinus membrane perforation was analysed.Results: No patients experienced specific complications. Successful bone healing was shown by histopathological examination.Conclusion: The clinical outcomes suggest that absorbable haemostat with fibrin adhesive may be a suitable regimen for managing perforated sinus membrane in sinus lift procedures.

P.206 New technique for large sinus membrane perforation repair

P.206 New technique for large sinus membrane perforation repair

Maxillary Sinus Membrane Repair: Update on Technique for Large and Complete Perforations

Maxillary sinus membrane perforation is the most common complication that occurs with sinus elevation augmentation surgery. A technique using a slow resorbing type I collagen membrane for repair of large and complete sinus membrane perforations is described. The biocompatibility and semirigid structural integrity of this membrane, along with external tack fixation, allows for optimal membrane stabilization and maintenance.

Survival rate of implant placement in the maxilla treated with sinus elevation by the lateral approach: A retrospective study

Purpose: Osseointegration of implants in patients with pneumatized maxillary sinuses is difficult to achieve due to the deficiency of available bone in the posterior maxilla after loss of teeth. Maxillary sinus elevation is a method to overcome this problem. In this study, we evaluated the implant survival rate and the relationship between implant survival in patients with sinus elevation by the lateral approach. Materials and Methods: A total of 48 patients were consecutively treated with sinus elevation by the lateral approach between February 2003 & August 2006 at the dental hospital of Chonbuk National university. A total of 113 implants were placed. The mean healing period was 7.1 months and implants were placed after a mean period of 5.6 months. The mean observation period was 21.8 months. Results: Out of the 113 implants placed, fifteen failed, resulting in a survival rate of 86.7%, 18 cases of sinus membrane perforation were observed out of 65 sinuses treated. 33 implants were placed in a perforated site and 10 failed, representing a 60.7% implant survival. 80 implants were placed in a nonperforated site and 5 failed, representing a 92.6% implant survival. Conclusions: Implant placement with sinus elevation is an acceptable treatment for short term results. Sinus membrane perforation and postoperative complications, however, may have an effect on implant failure. (J Korean Acad Periodontol 2008;38:589-594)

Prevalence and management of Schneiderian membrane perforations during sinus‐lift procedures

This clinical study was undertaken to evaluate the prevalence of surgical complications of the sinus graft procedure and to set a protocol to repair sinus membrane perforations intraoperatively using a variety of techniques and materials. From January 2000 to May 2005, 338 patients were studied, on whom 474 sinus floor augmentation procedures were performed, and a total of 1166 dental implants were simultaneously placed. A total of 104 perforations of the sinus membrane were observed (19 were bilateral). In group number 1, sinus membrane perforations of <5 mm were observed in 56 sinus augmentation procedures (53.85%), 44 were treated using a resorbable collagen membrane and 12 were sutured with a resorbable material. In group number 2, 28 sinus membranes had a perforation size between 5 and 10 mm (26.92%) and were treated using lamellar bone combined with a resorbable membrane. Group number 3 consisted of 20 sinus membrane perforations>10 mm (19.23%), 10 were covered with lamellar bone combined with a buccal fat pad flap, six were treated with a mandibular block graft and four perforations were treated with only a lamellar bone sheet. Two-hundred and seventy-eight implants were placed under repaired membrane perforations and 247 implants survived. Interestingly enough, all the 25 implants that failed to integrate were placed under perforated and reconstructed membranes during the sinus lift procedure. Based on the results of this study, the survival rates of implants placed under reconstructed membranes correlate inversely with the size of the perforations.

The use of ultrasonic bone curette (SONOPET) in oral and maxillofacial surgery

Ultrasonic bone curette (SONOPET, Miwatec Co., Kawasaki, Japan), which can prevent an injury of surrounding soft tissues including nerves and vessels, has been introduced in cranial base and spinal surgery. We used SONOPET in various oral and maxillofacial surgeries such as orthognathic surgery, sinus lift and necrotic bone removal. The use of SONOPET can reduce the risk of nerve injury and also prevent the perforation of sinus membrane. SONOPET is useful for procedures performed near important vital structures without excessive heat production and mechanical injury.

A new technique for the transcrestal sinus floor elevation and alveolar ridge augmentation with press-fit bone cylinders: A technical note

The minimally invasive sinus floor elevation as first described by Summers is limited in the volume of augmentation that is possible. In contrast, the more invasive approach is the sinuslift of Tatum which is indicated for greater bone deficiencies. Therefore, a new technique was developed for transcrestal elevation of the sinus floor and alveolar ridge augmentation with bone dowels in press-fit technique. The crestal cortical bone is cut with a hollow grinder followed by an indirect sinus floor elevation with a plunger. The cylindrical defect is then filled with a cylindrical bone transplant with the press-fit technique. The method was tested in ten fresh porcine skulls and was successful when applied subsequently in two fresh human cadavers (both female, age 60 and 92 years). This was followed by the insertion of another cylinder in overlapping mosaic manner with the dowel-lift technique in the left maxilla in one cadaver. A sinoscopy of the second cadaver experiment showed no perforation of the maxillary sinus membrane. The result was convincing. A new method for transcrestal elevation of the maxillary sinus floor and alveolar ridge augmentation with bone cylinders in press-fit technique was developed. The operation combines the minimally invasive approach of Summers with a large augmentation volume otherwise requiring the direct technique of Tatum. These results should encourage further preclinical experiments.

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

11th International Dental Congress on Modern Pain Control The Essential Role of Dental Anesthesiology in the 21st Century Safe and Comfortable Dentistry 4th–7th October, 2006

Cyanoacrylate adhesive for closing sinus membrane perforations during sinus lifts

Sinus lift procedures depend greatly on fragile structures and anatomical variations. The procedure may cause sinus membrane perforations, which can lead to graft infection and early failure. To assess the efficacy of cyanoacrylate adhesive in the management of large perforations of the maxillary sinus membrane during sinus lifts. Six rabbits were used in the study. Sinus membrane perforations (about 1.5 cm in length) were repaired with cyanoacrylate adhesive on one side of the maxillary sinus. On the contralateral side, an identical laceration was not repaired. Histological evaluation was performed 2 weeks after the operation. Wounds repaired with cyanoacrylate adhesive showed newly formed continuous epithelium across the previous perforation site and there was sinusitis on the contralateral side. These results support the clinical use of cyanoacrylate adhesive for repairing sinus membrane perforations.

Effects of Sinus Membrane Perforations on the Success of Dental Implants Placed in the Augmented Sinus

Maxillary sinus lifting procedure enables clinicians to place implant-supported prostheses even in cases with very limited vertical bone height of the maxillary sinus. The aim of this study was to evaluate the implant success with regard to effects of the sinus membrane perforations that occurred during sinus lifting surgery. The study group consisted of 91 patients (29 females and 54 males) with edentulous posterior maxilla. Implant placement combined with sinus lifting surgery was performed, and 259 implants were inserted. Sinus membrane perforations were detected in 12 sinus sites. After proper treatment of perforations, 26 implants were placed into perforated sinus areas. Baseline panaromic radiographs were taken before the beginning of prosthetic treatment. Panaromic radiographs taken at the last recall were used for evaluation and compared to the baseline panaromic radiographs using image analysis software to reveal the peri-implant resorption rate for the implants placed in perforated and non-perforated sinus area. The modified sulcus bleeding index and plaque index were used for the assessment of soft tissue conditions. Eleven implants were lost during the follow-up period, resulting in an overall survival rate of 95.9%. Two failures occurred in the group with sinus perforations. There was no statistically significant difference regarding peri-implant bone resorption (P = 0.778) and soft tissue conditions for implants placed into perforated-augmented sinus areas and augmented sinus areas. Within the limits of this study, perforation of the sinus membrane did not compromise the osseointegration process or the success of dental implants placed in the augmented maxillary sinus.

Maxillary sinus augmentation in the presence of antral pseudocyst: a clinical approach

The objective of this study is to present patients with sinus augmentation in the presence of an antral pseudocyst and the surgical procedure, complications, and outcome. From 2002 to 2005, 109 patients were scheduled for 1- or 2-stage maxillary sinus floor augmentation (n = 129) because of inadequate alveolar bone height for implant placement. Radiographically, a significant antral pseudocyst was shown. In 8 (7.3%) patients, an antral pseudocyst was diagnosed, and in 2 a history of inactive sinusitis was found preoperatively. A faint dome-shaped radiopacity was found at the lower border of the maxillary sinus. Average lesion size was 5.09 cm2. All implants functioned well at follow-up (mean 20 months). A pseudocyst of the maxillary sinus is not a contraindication for sinus augmentation. The low frequency of sinus membrane perforation and postsurgery sinusitis make the operation safe. In large lesions and in cases with an unclear diagnosis, further evaluation is needed before sinus augmentation.

Evaluation of clinical results on osteotome sinus floor elevation and dental implant placement (122 cases report)

To evaluate the clinical results of osteotome sinus floor elevation technique in the posterior maxillary region. A total of 122 patients underwent osteotome sinus floor elevation from July 1998 to July 2004. Forty-eight cases were male and 74 were female. The mean age was 46.5 years (between 20 and 69). A total of 157 implants were placed and restored. The mean follow-up time was 29.7 months (between 14 and 84 months). Clinical examination and radiographs were conducted. All the patients with 8 - 11 mm height of residual bone in the posterior maxilla underwent sinus floor elevation and implant placement using osteotome without any bone grafts simultaneously. The elevation height was 2 - 5 mm. Healing abutments were connected at the same time of implant placement with insertion torque over 0.25 N.m and the final prostheses were restored after 3 - 4 months. Implants were submerged if the insertion torque was less than 0.25 N.m. Second-stage operation was conducted 3 - 4 months later and the implants were restored afterwards. Sinus membrane perforation was observed in 12 cases, no sinus complication was observed during the follow-up. All of the 157 implants gained osteointegration and were restored. No implant lost was observed during the follow-up. All the patients were satisfied with the final prostheses. Osteotome sinus floor elevation without any bone graft was a predictable and safe technique. It could be used in the maxillary posterior area implant placement with residual bone volume of 8 - 11 mm.

The Clinical Significance of Sinus Membrane Perforation During Augmentation of the Maxillary Sinus

Augmentation of the maxillary sinus floor is a well-documented technique and is generally accepted as a pure implantology procedure to facilitate placement of dental implants in the posterior atrophic maxilla. The objective of this report was to evaluate the significance of the sinus membrane perforations on the incidence, complications, and success rate of this procedure. Patients who received sinus floor augmentation and simultaneous placement of dental implant were included in this study. Subgroup I consisted of patients who had their sinus membrane perforated and repaired during the procedure with resorbable membrane. Subgroup II consisted of patients whose Schneiderian membrane was not perforated during the procedure. The patients were followed between 1 to 4 years after augmentation. All perforations were classified as class II or III. The success rate of the implants in the perforation group was 94.4%, and that for the nonperforation group was 93.9%. The difference between the 2 study groups was statistically not significant. A significant statistical correlation was found between the residual ridge height and the membrane perforation (P < .01). Mainly due to technical difficulties, maxillary sinus membrane perforation occurs more frequently with a small height of residual alveolar bone. In this study, no statistical difference was observed in the success rate of the immediate implants placed with sinus bone grafting in patients whose membrane was perforated versus those patients in whom an intact membrane was maintained.

A Method of Sealing Perforated Sinus Membrane and Histologic Finding of Bone Substitutes: A Case Report

To augment the atrophic posterior maxilla, a sinus bone graft has been widely used for sinus floor augmentation. Various bone substitutes have been developed and grafted in the maxillary sinus with and without membranes perforation, although autogenous bone is recommended as a gold standard of grafting materials. Membrane perforation is the most common complication associated with sinus bone graft. To repair a perforation, various methods have been developed. This case report is focused on histologic findings of 1 bovine hydroxyapatite (Bio-Oss; Geistlich Pharma AG, Wolhusen, Switzerland) and 2 kinds of human mineral allograft- Tutoplast cancellous microchips (TutoGen Medical GmbH, Neunkirchen am. Brand Germany), and irradiated allogeniccancellous bone and marrow (ICB; Rocky Mountain Tissue Bank, Aurora, CO) used for sinus graft in the same patient with membrane perforation after various healing periods. Mineral allograft showed favorable new bone regeneration with the repair of membrane perforation. This case report also describes a technique regarding how to repair completely perforated sinus membrane after the removal of a mucocele using human collagen membrane (Tutoplast pericardium; TutoGen Medical GmbH) and fibrin adhesive (Greenplast; Green Cross Co., Youngin, Korea) to stabilize collagen membrane.

Dental implants placement in conjunction with osteotome sinus floor elevation: a 12‐year life‐table analysis from a prospective study on 588 ITI®implants

The purpose of this prospective study was to evaluate the clinical success of placing ITI dental implants in the posterior maxilla using the osteotome technique. All implants were placed following a one-stage protocol (elevating the sinus floor and placing the implant at the same time). Five hundred and eighty-eight implants were placed in 323 consecutive patients with a residual vertical height of bone under the sinus ranging from 6 to 9 mm. The mean observation follow-up period was 59.7 months (with a range of 12-144 months). This prospective study not only calculated the 12-year cumulative survival and success rates for 588 implants by life-table analysis but also the cumulative success rates for implant subgroups divided per implant length and the percentage of sinus membrane perforation were evaluated. The 12-year cumulative survival and success rates were 94.8% and 90.8%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93.4%) compared with 10 and 8 mm long implants (90.5% and 88.9%, respectively). During the study period, only 13 perforations of the Schneiderian membrane were detected with a perforation rate of 2.2% (13 perforations/601 treated sites). Ten perforations out of 13 were caused during the first half of the study period and of these, seven were detected during the first 3 years of this prospective study. Based on the results and within the limits of the present study, it can be concluded that ITI implant placement in conjunction with osteotome sinus floor elevation represents a safe modality of treating the posterior maxilla in areas with reduced bone height subjacent to the sinus as survival and success rates were maintained above 90% for a mean observation period of approximately 60 months. Shorter implants (8 mm implants) did not significantly fail more than longer ones (10 and 12 mm implants): the differences were small compared with the number of events; hence, no statistical conclusion could be drawn. But, from the clinical point of view, the predictable use of short implants in conjunction with osteotome sinus floor elevation may reduce the indication for complex invasive procedures like sinus lift and bone grafting procedures.

The use of autologous fibrin glue for closing sinus membrane perforations during sinus lifts

Sinus lift procedures depend greatly on fragile structures and anatomical variations. These procedures may cause sinus membrane perforations, which can lead to graft infection and early failure. The aim of this study was to assess the efficacy of autologous fibrin glue in the management of large perforations of the maxillary sinus membrane occurring during sinus lifts. After elevating the sinus membrane in the bilateral maxillary sinuses of 6 adult female mongrel dogs, a laceration (about 2.0 cm in length) was made in the membrane and either repaired with autologous fibrin glue or covered with a bioabsorbable collagen membrane as a control. Wounded areas were biopsied 2 weeks after the operation. Wounds repaired with autologous fibrin glue showed newly formed continuous epithelium across the previous perforation site. However, extensive fibrosis, inflammatory infiltration, and absent epithelium were observed in wounds treated with the collagen membrane control. Our results support the clinical use of autologous fibrin glue for repairing sinus membrane perforations.

Radiographic Evaluation of Dental Implants Placed Using an Osteotome Technique

The osteotome technique has been successfully used for implant placement when a limited vertical height is available at posterior maxilla. However, it is not clear if new bone is formed at the apical portion of the implant placed by this technique without any bone graft. The aim of this study was to radiographically evaluate bone formation around dental implant surfaces exposed to the space created at the sinus floor without the presence of any graft material. Forty patients (21 male, 19 female; mean age 46.7 years) who received a total of 75 dental implants together with indirect sinus lifting procedure were included. Initial and 6-month postoperative panoramic films were scanned and analyzed using a commercially available software program. Implants were divided into two groups: initial alveolar bone height <9 mm or > or =9 mm. This helped determine the effect of available bone and exposed implant surface on bone formation in a system where the shortest implant was 8 mm. The mean implant length placed at locations with <9 mm initial bone height (mean 7 +/- 1.3 mm, N = 29 implants) was 11 +/- 1.7 mm; gain in bone height was 3.9 +/- 1.9 mm. At locations where minimum bone height was 9 mm (mean 10.4 +/- 0.7 mm), 44 implants were placed with a 13.5 +/- 1.06 mm mean length. Mean gain in bone height was 2.9 +/- 1.2 mm at these sites. Two implants were lost at stage 2 surgery. The success rate after 25 months of loading was 97.3%. It is possible to radiographically observe a gain of approximately 3 to 4 mm of bone from the sinus floor to the implant apex. The amount of initial alveolar bone height, presence of sinus membrane perforation, and the amount of exposed implant surface appear to play a role in the presence or absence of radiopacity within the elevated sinus floor, following 6 months of healing.

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