J Korean Assoc Oral Maxillofac Surg.  2023 Oct;49(5):297-303. 10.5125/jkaoms.2023.49.5.297.

Intra-sinus rigid fixation of a resorbable barrier membrane to repair a large perforation of the sinus membrane: a technical note

• Joung WJ
• Yun SH
• Kim Y
• Cho YS
• Lee WW
• Seo JW
• Tallarico M
• Hwang KG
• Park CJ

• KMID: 2547575
• DOI: http://doi.org/10.5125/jkaoms.2023.49.5.297

Abstract

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

Keyword

Bone substitutes; Dental implants; Maxillary sinus; Membranes; Sinus floor augmentation

Figure

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  Fig. 1 Preoperative panoramic radiograph. The implants in the maxillary right second premolar and second molar regions were affected with severe peri-implantitis, and the implant in the maxillary right first molar region exhibited osseointegration failure and was displaced into the maxillary sinus cavity.

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  Fig. 2 Intraoperative clinical photos. A. The implant, which was displaced into the sinus cavity, was removed using hemostats through the perforated sinus membrane. B. A large perforation on the sinus membrane was identified and was measured to be approximately 1.5 cm at the largest diameter.

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  Fig. 3 Intraoperative clinical photo showing the repair of a large perforation using intra-sinus rigid fixation and stabilization of a resorbable barrier membrane with a titanium screw.

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  Fig. 4 After fixation of the resorbable barrier membrane, bone graft materials were inserted into the sinus cavity. A. Bone grafting through the implant drilling site. B, C. Schematic drawings of the design of the resorbable barrier membrane and its intra-sinus rigid fixation with a titanium screw. D. Bone grafting through the lateral window.

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  Fig. 5 Dental implant placement after bone grafting. A. A resorbable barrier membrane extended beyond the upper boundaries of the lateral window osteotomy. Additional bone grafting was performed and the detached lateral bony window was repositioned. B. A tension-free suture was placed.

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  Fig. 6 Postoperative radiographs showing that the resorbable barrier membrane, which was internally fixed and stabilized by a titanium screw, maintained its proper position and prevented the loss of graft material into the sinus cavity. Panoramic radiograph (A) and cone-beam computed tomography (B) images showing the titanium fixation screw at the medial bony wall of the sinus.

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  Fig. 7 Panoramic radiograph obtained after delivery of the final restoration.

Reference

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