Sinus Membrane Tear during Closed Sinus Lift: How do you repair?

Wed, 01/06/2010 - 06:05 — hawkeye

There are a whole host of articles on how to repair a sinus membrane perforated during open sinus lift: Loma Linda Pouch, Pikos Membrane, Suturing, etc, etc, etc.

However, I have not seen any literature on how to handle a sinus tear during a close sinus approach? Can it be repaired? How do you repair it? How do you even know if it is perforated?

Comments

Thu, 01/07/2010 - 22:16 — Richard Hughes DDS

Sinus tear repair

One can lay colla tape over the tear and mix your graft with prp.

Fri, 01/08/2010 - 06:19 — zivmazor

indeed there is no data on membrane repairs via closed approach in the literature.The problem is predictability of the repair.
From my own experience the best method which worked in my hands is using PRF first in the osteotomy and then mixing my graft with en membrane tacked on PRF. Thye advantage of using the PRF is keeping the graft particles together.
Another method I've used is a modification of the Loma Linda pouch- a large collagen membrane tacked to the occlusal crest .

Mon, 01/11/2010 - 09:28 — sinuslifter

Sinus Membrane Perforation Repair

If you do sinus lifts, at some point you will have to deal with a torn Schneiderian membrane. Simple fact.

There are many ways to deal with a torn membrane.
1. Enlarge access window around perf and continue the lift. In most cases, small perfs will close as the membrane folds upon itself during the lift.

2. Use a membrane (resorbable collagen or PRF) to occlude the perf and graft as normal.

3. If your perf is huge, you can use the pouch technique to enclose your graft within a collagen membrane. Be sure not to limit the graft's access to bony walls with the membrane.

These techniques work very well. The most severe cases I have dealt with involved complete and utter destruction of the membrane. In these cases, I simply use a curette to push any remaining membrane up the medial aspect of the wall. This leaves the floor, lateral wall, and medial wall available to the graft. Please note that I am not removing the membrane, I am basically moving it cranially. With such a large perf, there is no membrane left except for that which you have reflected up the medial wall. At this point, you need to contain your graft within a very large membrane. This technique has worked very well for me. The trick is containing the graft within the membrane while securing the membrane within the sinus.

Wed, 01/20/2010 - 19:41 — Tim Grant

Closed Sinus lift Repair

First off its difficult to determine when you have a perf on a closed sinus lift. When I do see a perf when doing a closed sinus lift I usually try and repair with PRP/Collatape or use PRP and a bioguide membrane which I push in the osteotomy with a osteotome.

Thu, 01/21/2010 - 19:30 — Dr Chace Heatly

Closed Sinus perf repair

I will use collatape soaked in PRP and push it through the osteotomy site. I will pack a little bone and take PA to ensure integrity of the membrane and perf repair.

Thu, 01/21/2010 - 22:56 — GV Black

PRP? I did not think anyone was using that anymore.

Why use PRP? Current Lit shows that it does not really do that much. Why not use PRF instead?

Sun, 01/24/2010 - 15:41 — Dean Spivey

Perforating during a closed sinus lift: Protocol

If I perf during a closed sinus lift I will try and repair with prp and a collagen membrane. If I cant I may do a lateral window to better visualize the tear and do a loma linda repair technique.

Mon, 02/08/2010 - 18:59 — Gregori M Kurtz...

Closed sinus lift membrane tear

I am assuming your referring to a Summers approach. Typically I place a peice of Collatape into the site before placing the graft so that this will stick to the membrane or seal a tear and not allow the graft to dispurse. a tear in this type approach is not a big isue like with a lateral window approach. the worse case it is torn and the implant plugs the site and the membrane restablishs over the apical area.