Background: The maxillary sinus augmentation procedure, is an excellent alternative to oral implantology and present a 90% of success level. However, the complications of sinus lift surgery sometimes perform consequences with very difficult management and solutions. Perforations of the Schneiderian membrane represent the major intraoperative complication and procedures of sinus with irregular mucosal thickening or presence of antral pathology are controversial.
Purpose: The present study is to evaluate retrospectively the treatment options of large perforations in schneiderian membrane during the sinus graft procedure in cases with mucosal thickening >10 mm.
Patients and methods: Patients of author clinic that were submitted to sinus augmentation surgery and presented sinus membrane perforation > 10 mm with implants placed simultaneously or in a second stage surgery after 6 months. The surgical techniques used were: iliac autogenous blocks, mandibular autogenous blocks and biomaterials graft mixed with platelet rich plasma (PRP) combined with a buccal fat pad flap.
Results: From March 2001 to December 2009, 18 patients (12 men and 6 women) were studied, on whom 25 sinus floor augmentation with a total of 54 dental implants were placed under repaired membrane perforations Eighteen sinuses presented mucosal thickening > 10 mm and seven mucosal thickening < 5 mm previously detected in a CT scan. In eleven sinuses were used iliac blocks, in five mandibular blocks and in nine biomaterials mixed with PRP combined to buccal fat pad flap. Three sinuses with iliac blocks presented complications and the blocks were removed and a total of three implants presented fail. Patients were followed up in a period of 120–20 months.
Conclusions : Sinus augmentation procedures with large membrane perforations in a presence or not of antral pathology may be adequately reconstructed and covered, and therefore are not an absolute contraindication.