The clinical and radiographic outcomes of Schneiderian membrane perforation without repair in sinus elevation surgery

Abstract

Background The aim of this comparative study was to evaluate the clinical outcome of nonrepair of the perforated maxillary sinus membrane compared to the nonperforated cases. Materials and Methods A retrospective comparative study was performed by identifying all lateral window sinus augmentation procedures, which were done during a defined period. Demographic data, systemic diseases, and smoking habits of patients were recorded. Thickness of the Schneiderian membrane and the amount of residual bone before surgery were measured by cone‐beam computed tomography (CBCT). In case of perforation, no attempt was made to repair the membrane. Alloplast was used for bone augmentation. The thickness of the Schneiderian membrane and gained bone height were recorded using CBCT at the time of prosthesis delivery. Results Sixty‐three patients with 65 sinuses were included in this retrospective study. The rate of sinus perforation was 39%. There was a significant association between the presence of sinus pathoses before surgery and the occurrence of Schneiderian membrane perforation (P = 0.03). The Schneiderian membrane was significantly thicker in patients with perforation compared to the patients without perforation (P < 0.001). There was no correlation between the size of the perforation and the thickness of the Schneiderian membrane. Most of the perforations (83%) occurred at the mesial and middle part of the lateral window. The Schneiderian membrane thickness was decreased significantly in both groups after the sinus elevation procedure (P < 0.05). The bone graft height was stable over the follow‐up period in both groups (P > 0.05). There was no implant failure in any of the groups. Conclusions Nonrepair of the Schneiderian membrane perforation did not adversely affect the clinical and radiographical outcomes. There were higher intraoperative and postoperative complications in the nonrepair group.

Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis

“…The mean Schneiderian membrane perforation rate was 30.6% (489 perforations). Different treatments were used to resolve the perforations, including post-perforation clot formation [ 4 ], suturing [ 47 ], use of collagen membranes [ 16 ], Platelet-rich fibrin (PRF) [ 19 ], hemostatic agents [ 49 ], laminar bone [ 50 ], and block grafts [ 50 ].…”

“…The most common post-operative complication found in sinuses with perforated membranes was the appearance of signs of infection. Park et al [ 4 ] reported a greater number of postoperative complications in patients with perforated membranes including bleeding from the perforation site, leakage of cystic fluid or purulent exudate, displacement of the graft into the sinus, nasal bleeding, and facial swelling. Other complications with lower incidence such as pain or tenderness in the treated area were also reported [ 4 ].…”

“…Perforations smaller than 5 mm can be treated by folding the membrane itself [4,47] or with resorbable sutures [4,50]. When perforations are between 5 and 10 mm, the most widely recommended treatment is by means of a slow-reabsorbing collagen membrane [16,[47][48][49][50], which allows it to regenerate while facilitating closure of the communication.…”

“…MSFA achieves implant survival rates similar to those achieved in pristine bone [ 2 , 3 ]. During this surgical procedure, perforations of the sinus membrane may occur due either to iatrogenic causes derived from incorrect surgical handling or to anatomical considerations inherent to the individual patient, which can make the procedure difficult [ 4 , 5 ]. The former include uncontrolled pressure on the membrane or the use of inappropriate surgical instruments [ 6 ]; the latter include reduced thickness of the membrane [ 7 ], reduced friability and elasticity [ 8 , 9 ], greater adhesion to the bone surface [ 10 ], and the presence of the sinus septa [ 11 – 13 ].…”

Microsurgical endodontic treatment of the upper molar teeth and their relationship with the maxillary sinus: a retrospective multicentric clinical study

“…Hauman et al [ 38 ] stated that the sinus mucosa, complete with cilia, regenerates about five months after its surgical removal and therefore the invasion of the maxillary sinus does not appear to cause a permanent alteration of either the sinus membrane or its physiological function and the sinusitis will be resolved once adequate ventilation is restored. It is interesting to note that a recent study has shown that the perforation without repair of the sinus membrane during sinus lift procedure, did not affect the result of bone grafting and implant survival rate [ 39 ]. Few studies have focused on apicectomies of posterior teeth whose success rate ranged from 44 to 88% [ 21 , 40 ] depending on the surgical technique and on the differences in the postoperative evaluation criteria.…”