A Classification System for Sinus Membrane Perforations During Augmentation Procedures With Options for Repair

Abstract

A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results.

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

“…The previously mentioned techniques for membrane repair can be problematic and unpredictable for both large perforations and membranes with complete tears. [27][28][29][30][31][32][33][34][35][36][37] Suturing is not possible because the membrane edges cannot be approximated. In addition, these membranes can be thin and will tear upon suturing.…”

“…8,9,24 -26 A variety of techniques have been proposed to manage these perforations. These include suturing, 27,28 the use of collagen membranes, 9,27-31 fibrin sealants, [32][33][34][35] freeze dried human lamellar bone sheets, 27,28,36 and oxidized regenerated cellulose. 37 All these techniques involve repair of sinus membrane perforations that range in size from 2 mm to approximately 1.5 cm with one exception.…”

A Novel Technique to Close Large Perforation of Sinus Membrane

“…When the perforation is small and located in an area where the elevated mucosa is folded together, it will be healed by itself (9,10). If the perforation is large and located in an unfavorable area, the perforation needs to be closed in order to prevent loss of the bone graft (9,10).…”

“…If the perforation is large and located in an unfavorable area, the perforation needs to be closed in order to prevent loss of the bone graft (9,10). In such these cases sinus floor is usually managed by use of a collagenous membrane, fibrin adhesive, use of a block graft or, at least, one have to abandon the procedure (9,10). If adequately repaired, perforations have no effect on the ultimate survival of the implants placed in the affected sinuses (5).…”

Surgical Alternative in Sinus Lift Reoperation

“…sinus lift in areas with Schneiderian membrane perforation [29]), the treatment should divide the buccal flap in order to provide sealing with the periosteum, conventional membrane lift and insertion of particulate material.…”