Concerned with membrane perforation: surgical approach?

Hi Maybe make the window more mesially with Dask and place the Implant more mesially being careful on lifting also use wider ( 5 mm ) 8mm long Implant ... Using Dask I have not torn a lateral window in over 5 years....so with care can be the way. Peter

In my experience that septum is a great anchor for the base of the implant. I would use a guided stent and place the base of the implant right thru it. It is good cortical bone. Probably a Nobel active would work well.

Peter: Do you really think the membrane can be lifted off the spike/septum without tearing? CRS: Are you suggesting a sinus lift or simply placing an implant with membrane perforation along the lines of studies (i.e. The Laryngoscope Volume 123, Issue 12, pages 2958–2961, December 2013) that show no adverse sequelae with 3mm or less of sinus intrusion by the implant. All input is greatly appreciated.

Placing the implant in the septum is certainly a viable option! An 8 to 10 mm. long implant is doable. You may want to consider a 4.2 wide by 8 or 10 mm. long AB dental I5 implant. This implant is tapered and yields excellent primary stability. The bone most likely will grow over the implant, if there is a perforation. I have done this in the past with great success.

Place the implant normally, use a piezo or a Versah drill to raise the membrane. Place a small piece of collagen in the osteotomy and put in the implant.

I would suggest doing a lateral wall mesial of septum using DASK Kit. Place 6.0 X 10 or 4.7 X 11.5 Zimmer screw vent implant. Also try Zimmer trabecular metal implant. You need not touch the distal of septum as then the implant would be too distal for good restoration. What do you think?

Hi Bennet , as I said you do not need to fill the sinus so 8mm long Implant great as can be 5 mm wide and care with the lift will not tear can then run the implant mesial to the septum and graft the surface area as well . but as the esteemed surgeons mentioned above you could place into the septum and graft . Peter

Check this out........new invention out of Israel The iRaise Sinus Lift System allows you to immediately perform minimally invasive sinus augmentation procedures at your practice. All phases of the iRaise sinus lift procedure are performed through the implant itself – including hydraulic elevation of the Schneiderian membrane and insertion of bone graft material. The result? An extremely fast and safe procedure, with fewer complications, fewer patient complaints and fewer follow-up visits than with the open sinus lift procedure. And this results in more satisfied patients. As compared to the open sinus lift procedure, iRaise allows a shorter time from the augmentation procedure to crown placement, while dramatically reducing surgical complexity and trauma. Since the implant is inserted with the bone graft in the same session, overall treatment duration is shortened from 13-months to a total of about 9-months. iRaise is ideal both for specialists who already perform sinus augmentation surgery as well as for general practitioners who currently place dental implants and would like to add sinus lifts to their offerings. Learning this technique is fast: it takes just a single onsite training session to start using iRaise. I don't know where you are located but contacting the company will put you in touch with a local distributor. Good Luck Gerry Rudick Montreal, Canada

2 windows

Drg mentions " two windows" With the iRaise system, two separate sinus lifts can be done at the same appointment ....one mesial to the septum, and the other distal to it. Try it, and in a year publish it, we all look forward to see it. Gerry Rudick Montreal, Canada

I would recommend a Bicon 4.5 or 5 dia x 6 or 8mm in length. I don't understand why no one is mentioning a shorter implant. In our practice we have been placing short implants (less then 8mm) for over 20 years with excellent results. If I feel there might be a sinus wall perforation we will placed some PRF mixed with AllOss/Synthograft. If one places nothing a small perforation will fill with bone by itself. This saves the patient not only financially but has minimal complications and discomfort. In my opinion ...longer is not always better!

I just had an 8mm tapered Zimmer come loose from the #14 area. In my case there was plenty of bone-well-just more than necessary for this implant--The patient was taking Procardia--net result was gingival hyperplasia with the height of the gingival crest coming near the occlusal surface of the implant crown. This patient's homecare was poor--at best, but for 5 years the implant was very successful. Does anyone have any information contraindicating implant placement on a patient taking Procardia. I strongly feel that the implant failed because of the gingival hyperplasia resulting in impossible hygiene hurdles. Anyone like to comment This is my first attempt to ask a question, so pardon me if I am using the wrong protocol to post this question

If this patient came into my office I would probably recommend doing a bone graft using i-PRF, A-PRF and allograft to gain vertical height. There is already 4 mm of bone, and if we can graft on another 3-4 mm I would then use an 8 mm Implant. Short implants work just as well as longer ones in my experience, as long as you very carefully keep occlusal forces to a minimum. It's a little hard to be sure about this approach not knowing the width of the bone, but on the lower film it looks adequate. I might even consider placing the implant and bone grafting it the same day, depending on the patient, their age and health, and their informed decision. This way the sinus is avoided completely.

If you enter the lateral sinus wall at the level of the base of the septum, the entire septum should lift up with your 'window' and you don't have to worry about lifting the membrane up and over the septum???

May be try ridge augmentation first and see if you can gain some vertical height. You've good medial & distal bone height. All you need is another 3mm to tap that sinus up. Thoughts? Nauman

Did one like this yesterday but with a thin ridge and only 2 mm residual bone .... did as I suggested in fact initial window touched on the septum so moved it forward a bit .... lifted carefully and placed a 3.8 by 10 mm Implant , no issues looks good .. Careful with the septum area and lifted more mesially to create space . Peter

Expect a membrane tear [not the end of the world], place collatape over tear place bone and lastly do implant,

Tear in the membrane.... I would trust a PRF natural autogenous membrane more than the fragile collagen membrane that will fall apart before you have the time to place it.........PRF is also sticky and will bind with the Schneiderian membrane. After having placed it...wait a couple of minutes, and have the patient force air in his/her nose with the nostrils closed....the hiss is gone........ Good luck Gerry Rudick Montreal Canada

I like bicon but be very wary under a sinus as the square shape combined with desire to place deeply increases the risk of losing the implant in the sinus . Whether short or long implant , using a tapered implant will reduce that risk .