Sinus Membrane Perforation Repair

1. Open Sinus Lift Healing Comparison between a Non-Perforated Schneiderian Membrane and a Perforated Schneiderian Membrane Repaired with Amnion-Chorion Allograft Barrier: A Controlled, Split Mouth Case Report By Dr. Dan Holtzclaw

Pneumatization of the maxillary sinus is a common finding with edentulism of the posterior maxilla and often requires augmentation to facilitate the placement of dental implants.1 Perforation of the Schneiderian membrane is the most common complication associated with maxillary sinus augmentation procedures2 with rates ranging from 11% to 56%.3,4 Multiple techniques have been presented in dental literature for repair of perforated sinus membranes including the use of palatal flaps,5 buccal fat pads,6 Lambone,7 specialized suturing techniques,8 and
fixed membrane pouches.9,10 With excessively large perforations, however, reparative techniques are sometimes not feasibly and the procedure must be aborted. When sinus membrane repair is achievable, these studies, and multiple other conformational studies,11-13 show that perforation and subsequent repair of the Schneiderian membrane does not compromise the final success of dental implant survival. None of these studies5-13 however, show any cases with direct split-mouth intrapatient healing comparisons of repaired perforated sinus membranes versus non-perforated sinus membranes. This Case Report presents a situation in which a patient receiving bilateral maxillary sinus lifts had perforation and repair of one sinus membrane while the other side remained intact. With these sinus lifts being performed in the same patient at the exact same time, a unique opportunity presented itself for direct observation and comparison of healing results for a repaired versus a non-perforated sinus lift and the dental implant survival that followed.

2. Implant Placement Emulating Natural Esthetics: Appropriate Diagnosis, Treatment Planning and Communication By Tak On Ryan Tse

Achieving excellent esthetic outcomes after extraction and implant replacement in the esthetic zone is one of the biggest challenges for the cosmetic dentist. The problem is amplified in cases where immediate implant placement is indicated after extraction of the failing tooth as the resorption of the bundle bone can result in mucosal recession after immediate implant placement. The margin of error has to be decreased by meticulous planning. Accurate diagnosis and treatment planning with 3D implant placement and close communication with the ceramist are keys to a successful outcome.
In this article implant placement and immediate provisionalization as well as laboratory communication and final restoration are discussed.

3. Expectations and Satisfaction: The Psychology of Antibiotics By Paul J. Flaer, Jai Parkash

Patients with a somatic malady usually seek care from a health professional. Treatment often includes a written or computer-generated prescription for medication(s). Most of the time, a medication prescribed is for an antibiotic, often one from the Penicillin family (e.g., Penicillin V, Ampicillin, Amoxicillin) or from the Macrolide/mycin family (e.g., Clindamycin, Azithromycin, Clarithromycin). However, the antibiotic prescription may itself be a placebo,
especially when prescribed for a viral or fungal infection (e.g., treatment of upper respiratory infections which are usually viral in origin). It is generally a patient expectation (and part of the satisfaction with healthcare treatment) to receive an antibiotic prescription when presenting with most illnesses. The health care professional,
practicing in this person-to-person and treatment environment of the doctor-patient relationship, will often accede to this expectation by the patient for an antibiotic prescription (i.e., even though the doctor deems it unnecessary).

4. Soft Tissue Management of a Complicated Case in the Esthetic Zone By Taeheon Kang, Matthew J. Fien, Nina Cunningham

Treatment with dental implants in the esthetic zone can be complicated especially when there is a deficiency in the normal anatomic hard and soft tissue contours as a result of a history of periodontal disease or trauma. When a patient presents with severe vertical bone loss with subsequent soft tissue recession and shrinkage, it is necessary to perform multiple procedures to augment the hard and soft tissue contours to recreate natural anatomy and provide a framework for subsequent rehabilitation and an esthetically pleasing result. The following case report demonstrates the treatment of such a complicated case where an extensive amount of vertical bone loss as well as a significant soft tissue deficiency was present in the esthetic zone prior to treatment.