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Endoscopic management of the schneiderian membrane perforation during transcrestal sinus augmentation: a case report
M Andreasi Bassi1, C Andrisani2, S Lico3
1Private practice in Rome, Italy.
Purpose:
In this article the Authors describe a procedure aimed to restore under endoscopic control, the continuity, of the Schneiderian membrane (SM) incidentally teared during a sinus lift with transcrestal approach.
Materials E Methods:
In a 44-year-old male, due to aforementioned complication, the SM was gently detached via transcrestal approach, with a customized small ball burnisher, in order to facilitate the placement of a collagen sponge, to close the communication with the sinus, followed by the subsequent insertion of a graft material. All the procedure was endoscopically controlled and, considering the successful grafted area elevation, was simultaneously followed by implant placement. After 6 months the second stage was performed always under endoscopic control.
Results:
The endoscopic view of the grafted area showed a dome-shaped elevation sited on the top of the implant, the SM was apparently normal with no signs of inflammation, the antrum was empty and normally functioning. Periapical X-rays were performed: immediately after the surgery; at both 14 days and 6 months post-operative; at 6 months post prosthetic finalization. The volume of the grafted area progressively decreased over the time while its radiopacity, on the contrary, gradually increased, as expected after graft integration and remodelling. The implant was submitted to no functional load for 4 months by means of a temporary screwable acrylic crown inserted on a peek abutment and then finalized with a cementable metal-ceramic crown on a preformed titanium abutment.
Conclusion:
The Authors recommend the use of endoscope to repair the SM incidentally teared during transcrestal sinus lift.
Insights
This study presents an endoscopic technique to repair incidental tears of the Schneiderian membrane (SM) during transcrestal sinus lifts. The method successfully facilitated bone grafting and dental implant placement, ensuring a stable outcome.
Area of Science:
- Dentistry
- Oral Surgery
- Regenerative Medicine
Background:
- Sinus lift procedures, particularly the transcrestal approach, carry a risk of incidental Schneiderian membrane (SM) tears.
- Tears in the SM can compromise the success of bone grafting and subsequent dental implant placement.
- Effective management of SM perforations is crucial for predictable outcomes in sinus augmentation.
Observation:
- A novel endoscopic technique was employed to repair an incidentally torn SM during a transcrestal sinus lift.
- The repair involved detaching the SM, placing a collagen sponge, and inserting graft material, all under endoscopic visualization.
- Simultaneous dental implant placement was performed following successful graft elevation.
Findings:
- Post-operative endoscopic examination revealed a normal-appearing SM with no inflammation and a clear sinus.
- Radiographic analysis showed progressive radiopacity increase and volume decrease in the grafted area, indicating successful bone integration and remodeling.
- The dental implant achieved osseointegration, leading to successful prosthetic restoration.
Implications:
- Endoscopic repair of SM tears offers a minimally invasive and effective solution during transcrestal sinus lifts.
- This technique can help salvage procedures complicated by membrane perforations, improving graft success rates.
- Routine use of endoscopy for SM repair may enhance predictability and reduce complications in sinus augmentation surgery.
