Management of the Schneiderian membrane perforation during the maxillary sinus elevation procedure: a case report

Abstract

The maxillary sinus elevation is a standard and predictable procedure allowing the realization of dental implant rehabilitation in patients with severe bone atrophy in the lateral-posterior areas of the maxilla. Despite the presence of validated surgical methods and the broad availability of biomaterials, the procedures aimed at increasing the bone volume by lateral antrostomy still entail complications with different degrees of relevance. The prosthetic and surgical outcome is based on a successful coping with these aspects. The perforation of the Schneiderian membrane is one of the most frequent events for which a variety of protocols and approaches have been suggested by different authors. In this work is presented a case study in which a technique to repair the sinus mucosa laceration occurring during a maxillary sinus elevation procedure has been successfully adopted.

Keywords: Schneiderian membrane; maxillary sinus augmentation; sinus lift complications; underwood septa.

Figure 1

Pre-operative orthopantomogram.

Figure 2

Maxillary sinus membrane perforation

Figure 3

A resorbable membrane of freeze-dried bovine pericardium positioned according to modified pouch technique.

Figure 4

A human-derived bone paste in blocks, called Bioset, containing demineralized bone matrix (DBM).

Figure 5

Plastic consistency and easy manipulation of Bioset.

Figure 6

Maxillary sinus filled with Bioset.

Figure 7

A second resorbable membrane applied above the antrostomy.

Figure 8

Histology of bone neoformation at six months after sinus lift (40x, H&E).

Figure 9

Ortopantomogram at six months after implants placement

Figure 10

Paraxial views of TC dentascan at one year after prosthetic rehabilitation.

Figure 11

Panoramic views of TC dentascan at one year after prosthetic rehabilitation.

Figure 12

Clinical result at two years after implant surgery.