Is Schneiderian Membrane perforated or not?

I have placed two 5x8mm implants in  the 16 and 17 region.  My initial Crown-Height Space was 5.7mm as measured on the CBCT. I have not placed any graft material and I have used the osteotome technique. Valsalva maneuver was also done but I still feel that the membrane may be perforated in the region of 17. What do you think? what is the chance of success of an implant in this case? potential complications?



27 thoughts on: Is Schneiderian Membrane perforated or not?

  1. Bob Horowitz says:

    The xray is of a very poor diagnostic quality. Do you have a postoperative CBCT? You may have perforated both sites. What about the bone loss and ill fitting crown on the adjacent premolar? What is the treatment plan for that tooth?

    • S Kavil says:

      Its just 24hr after implant placement. I intend to take a scan after one week if there are no signs and symptoms.
      Initial torque for 35Ncm and i have used a calibrated manual ratchet that i have to measure this.
      This is my first sinus lift case. Please let me know if patient has any symptoms then should i reopen the surgical site and remove implant?
      As for the premolar patient will be undergoing root canal followed by new crown, if the tooth structure is sound aftercrown removal.

  2. Terry Trezek says:

    What makes you think it is perforated? Any Sx reported from the patient that leads you to believe perforation? Did you do a follow up scan? At this you will have to wait and see. Could have done a crestal approach sinus lift with the technique that you described. Good luck and post the results.

  3. Craig Wright says:

    Worst case scenario-it is perforated. You have closed the O-A communication with titanium. With 2mm +/- exposure, membrane will probably heal on its own.

  4. Craig Wright says:

    On the other hand, I am not sure how much BIC you will end up with. That could be bigger issue. ISQ reading would be interesting at 3 mo. post op. CBCT would certainly provide more info.

    • S Kavil says:

      Its just 24hr after implant placement. I intend to take a scan after one week if there are no signs and symptoms.
      Initial torque for 35Ncm and i have used a calibrated manual ratchet that i have to measure this.
      I hope so it heals. This is my first sinus lift case. Please let me know if patient has any symptoms then should i reopen the surgical site and remove implant?
      Thank you so much !

  5. David guzman says:

    I have been placing implants since 2005, crestal sinus lift since 2010 and lecturing since 2013 with COPPEL DENTAL ACADEMY. In my experience and in response of you questions, success rate is really high because the bicortical ancorage. If the membrane has a minimum perforation it will regenerate. Any how, this implants and correct me if I am wrong has an active tip wish will keep perforating the membrane. For further treatment think better using a rounded tip implants like nobel replace. I hope I make my self clear and forget my grammar…

  6. Adibo says:

    The perforation and plugging with implant does not have any implication as long as the implants are stable and the sinus has already been free from any pathology. Perforation of the floor of the sinus provides dual cortical fixation for the implant.
    No need to be worry at all. They will be fine.
    With regards to CBCT, is there really any indication or justification for eposing the patient post operatively?
    CBCT is meant to be a diagnostic tool not a magic wand to cure any mishap!

  7. Neil Zachs says:

    Craig Wright took the words out of my mouth…he is on the money with his comments. A small perf will heal as any communication is sealed. The big issue is bone quality in that area

  8. Paul says:

    When for some reason a tooth ends up in the sinus, what will follow is a lateral window opened at a 45 degree angle with a reciprocating saw in a form of a rectangle and right through the membrane. The tooth will be recovered from the sinus, the bony plate that was cut out is placed back over the window, the flap sutured and the patient goes on living a happy life. Does that answer the question?

  9. S Kavil says:

    Its just 24hr after implant placement. I intend to take a scan after one week if there are no signs and symptoms.
    Initial torque for 35Ncm and i have used a calibrated manual ratchet that i have to measure this.
    This is my first sinus lift case. Please let me know if patient has any symptoms then should i reopen the surgical site and remove implant?
    As for the premolar patient will be undergoing root canal followed by new crown, if the tooth structure is sound aftercrown removal.

  10. Dr Satish Bhardwaj says:

    The chances are the implant will stay without any complications, you will be surprised at the healing capacity of Max Sinus. You only realise this after you after placed a few Zygoma implants.

  11. Anon

    Wait and see doc. What was your insertion isq? Also, if you’re doing a sinus lift, get a pre-op cbct. The Schneider Ian membrane is the second most vascular tissue in the boys and will heal. I’m more worried about the BIC than the Sinus membrane. That’s d4 bone back there so you need as much as possible. Nothing to do now other than wait and monitor to see if there are symptoms and to check stability of the implant. Keep us in the loop. Thanks!

  12. kaz says:

    I am not sure why you would take a scan after the first week. An isq would be of more value at insertion and then 4 months later.

  13. Dr. Luis Leon says:

    In my experience when the floor of the breast has a diameter of 4-5 mm we should not place implants, it is necessary to do sinus lift + graft with biomatterials and after 4-6 months place the implants. In relation to the case under study if the osteotomes were used correctly, 3-4 months can be expected for a safe osseointegration.

  14. Raul R Mena says:

    Kavil,
    Leave it alone, looks fine you should see some bone growth at the apex within 3 to 4 month.
    CBCT will not provide you with any answers, and you don’t need to over irradiate the patient.
    Forget about the ISQ at the time of placement , it is a useless concept.
    OK Gurus you have enough ammunition to be critical of my posting, Make My Day

  15. Greg Kammeyer, DDS, MS says:

    Interesting posts: even with a postive Valsalva maneuver, micro perforations occur. It is thin tissue. Watch the implant for a couple more months than usual. I rarely see a problem with implants like this as you have nice apical stabilization. The Active (aggressive threads) was the right choice for the maxilla.

    Since ISQ has come up: I have seen a 1-2 % failure rate decrease in the 7+ years I’ve used it. It’s cheap insurance. It also helps me to know if I can immediately load, one stage or if I need to bury an implant. Peter Moy (Key opinion leader) talks about how it’s affected his practice the same way.

    • Raul R Mena says:

      Greg,
      To each it own, if it benefits you go ahead and keep using it, nothing wrong.
      Implants are either integrated or not. If they are and with proper prosthetics you will get a very high success rate.
      It is only my opinion and I also respects others, so no argument from me

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