The elimination method of total Schneiderian membrane perforation during subantral augmentation by lateral aproach. Clinical case

Abstract

The aim was to show the possibility of using the technique to eliminate the total Schneiderian membrane rupture during sinus lifting with lateral approach surgery by fixing the collagen membrane to the medial parts of the maxillary sinus (MS) combined with bone-plastic material augmentation.
Materials and methods.
Preoperative medication included 2000 mg of amoxicillin clavulanate per os, intramuscular injections of dexamethasone (8 mg), ketorolac (30 mg), and etamsylate (500 mg). sinus lifting with lateral approach was performed using the grind-out technique with a piezo-surgical handpiece. Cortical bone powder was taken in the place where the bone window was formed. To eliminate the mucous membrane defect, 2 artificial perforations were made in the palatine process of the maxilla, through which a collagen membrane Bioplast-Dent 30×40 mm was fixed with resorbable suture material Vicryl 4-0. One-stage split-osteotomy was performed to increase the width of the alveolar ridge. The subantral space and split area were filled with a mixture of bone powder and Bioplast-Dent bone collagen in a 1:1 ratio. The wound was hermetically sutured. Postoperative appointments and recommendations were given taking into account the risk of sinusitis development.
Results.
A control CT scan 12 months after surgery confirmed absence of inflammatory changes in the MS and migration of the bone-plastic material. The density of the newly formed bone did not differ from the normal cancellous bone. The alveolar height in the area of teeth 2.4, 2.6 and 2.7 was at least 11.2 mm and the alveolar width from 6.4 mm, which proved to be sufficient for implantation. The control OPG examination 24 months after implant placing demonstrated the stability of the achieved bone parameters at the routine check-up.
Conclusions.
The proposed technique for elimination of extensive mucosal defects of the maxillary sinuses confirmed its effectiveness even 3 years after surgery. However, this clinical case should be considered as a special case due to the lack of statistical data.