Effects of Sealing the Perforated Sinus Membrane with a Resorbable Collagen Membrane: A Pilot Study in Humans

Abstract

The effects of repairing the perforated sinus membrane with collagen membrane are unknown. The purpose of this pilot study was to clinically, histologically, and histomorphometrically evaluate the results of repairing the perforated sinus membrane with resorbable collagen membrane. A split-mouth design was followed in the current study. Five subjects requiring bilateral sinus grafting were included in the study, where one site was accidentally perforated during sinus augmentation procedures and the other site was not perforated. The perforated sites were repaired with a resorbable collagen membrane. Dental implants were placed at a second stage and biopsies were harvested from both sinuses. New bone formation was measured for all sites. Implant survival was recorded at second-stage surgery. Nonperforated sites demonstrated significantly more bone formation (34.40%) than perforated sites (12.80%) (P = .016). Implant survival at second-stage surgery was significantly inferior in perforated sites (54.5%) when compared with nonperforated sites (100%) (P = .0146). The study demonstrated that perforation and repair of the Schneiderian membrane can compromise new bone formation and implant survival rate.

An Alternative Strategy to Manage a Large Perforation of the Schneiderian Membrane by Staged Re-entry into the Maxillary Sinus: Observed Clinical and Histological Changes of the Regenerated Schneiderian Membrane

“…A critical objective of sinus membrane repair is to prevent extravasation of the graft material into the sinus cavity. Schneiderian membrane perforations can be repaired with use of a bioresorbable collagen membrane (Figure 2A) autologous fibrin glue, demineralized freeze-dried human lamellar bone sheet, oxidized regenerated cellulose, sutures and with platelet rich plasma [9,[11][12][13][14][15]17,18,23,30,31,[35][36][37].…”

“…The most common intraoperative complication reported with grafting of the maxillary sinus is a perforation of the Schneiderian membrane ( Figure 1) that is often managed at the time the perforation is observed [10][11][12][13][14][15][16][17][18]. The incidence of sinus membrane perforation reported in the literature ranges from 7 to 56% [10,11,12,16].…”

“…If the sinus infection is not identified and managed early in the course of treatment, such a complication can lead to the development of acute and chronic sinusitis, displacement of the graft material into the sinus cavity, loss of the graft material and oroantral communication [19][20][21][22]. Perforation of the sinus membrane may also effect homeostasis of the maxillary sinus and bacterial colonization into the maxillary sinus [12,[16][17][18][20][21][22]. In more severe cases, the infection may progress to involve other anatomic structures of the maxillofacial region, such as the other paranasal sinuses, orbit and anterior and middle cranial fossae [24][25][26].…”

The Use of Cancellous Bone-Block Allograft for Reconstruction of the Atrophic Alveolar Ridge

“…Membrane perforations can lead to the loss of graft particles into the air chamber of the sinus and have a reported incidence of 10% to 56% (Fugazzotto & Vlassis, 2003;Jensen et al, 1994;Pikos, 2008;Shlomi et al, 2004;van den Bergh et al, 2000;Wallace et al, 2007). A split-mouth study of perforated sinus membrane repair with a resorbable collagen membrane (Proussaefs et al, 2004) found that when bone particles were use, nonperforated sites demonstrated significantly more bone formation (33.58%) than perforated sites (14.17%), with a higher implant survival rate at second-stage surgery (100% vs 69.56%). The authors suggested that the technique or materials be changed to lessen the risk posed by perforation and repair of the sinus membrane.…”

Repair of the Perforated Sinus Membrane with Platelet Rich Fibrin: A Case Report

“…Rezorbe olabilen kollajen membranlar, fibrin yapıştırıcılar, sütur ve bukkal yağ grefti uygulamaları membran tamirinde önerilen yöntemlerdendir. [8][9][10] Trombositten zengin fibrin (TZF) ilk defa Choukroun ve ark. …”