Sinus Membrane Perforation: What Else Can I Do?

Authors

Dr. R, a periodontist, asks:

I have done a lateral window sinus lift , during which I had a significant perforation towards the end of the procedure (I have already started packing bone graft). I decided to repair and proceed. I attempted a repair with a collagen membrane and tried to contain the bone graft. I was not very happy with the result as the graft didn’t seem very well contained, but decided to give it a chance. Patient healed without any complications, but I got very minimal bone (appx 5mm) and more distal than intended area.

I waited about 6mo. from initial surgery and re-attempted the sinus lift. When I opened, I realized that the membrane really never healed and window is still patent with some mushy bone. The sinus also has a septum, which is why the original sinus lift got complicated. I also tried using the piezo for the second one, but since there was already no membrane it was not very helpful.

have done several sinus lifts, but this is my first time to have such a big perforation where the whole membrane is gone and I attempted Pikos technique (both times). The containment was much better the second time, and PA revealed a decent looking sinus lift. However, at 3month post op, the area looks very hazy, with islands of denser appearing bone on PA. The was hoping to see a very radio opaque dome shaped area like we normally do with bio-oss. The bone graft and membrane used were bio-oss, biogide. I plan is to wait for anther 3m and send him for a CAT scan.

I am not sure if there is anything else I can do. Assuming it looks the same, is it worth do attmept another sinus lift. Pt is missing #14,15. Would it be better to get an Implant on #15 area, and attempt a bridge (I understand its not advisable to mix implants and teeth for a bridge). Is there a better way to contain the graft than tacking a membrane to the lateral wall?