• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.281-285
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• 2011

Sinus floor elevation is a predictable and standard procedure for the treatment of the posterior maxilla before insertion of dental implants. Although overall complication rates are low, complications can occur including sinus membrane perforation, infection of sinus, swelling and hemorrhage. The most common complication is membrane perforation. Recently, various techniques and materials for repair of perforation to the sinus membrane have been proposed. The purpose of this article is to report on various techniques and materials that can be used for repair of perforations to the sinus membrane. The search protocol used was the following electronic database: Pubmed, with a time limit from 1998 to 2009. The key words such as 'sinus lift', 'sinus augmentation', 'sinus floor elevation', 'sinus graft', 'sinus perforation', 'repair of sinus perforation' and 'repair of sinus membrane' were used, alone and in combination, when searching the database. Various techniques have been proposed to manage of perforation of sinus membranes. These include that the use of collagen membranes, demineralized freeze-dried human lamellar bone sheets, processed human allografts, lamella bone, buccal fat pads and suturing. Implant success rate ranges from 69.9% to 98.9%.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.526-529
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• 2004

Aim: To assess the efficacy of cyanoacrylate adhesive in the management of large perforations of the maxillary sinus membrane during sinus lifts. Material and methods: Eight rabbits were used in the study. Sinus membrane perforation(about 1.5cm) was repaired with cyanoacrylate adnesive on one side of the maxillary sinus and the opppsite side was used as a control. Histological evaluation was performed 4 weeks after the operation. Results: Histological studies showed normal healing of the sinus membrane across the site of previous perforation and no evidence of inflammation. Conclusion: Our results support the clinical use of cynoacrylate adhesive for repairing sinus membrane perforation.

• Journal of Korean Dental Science
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• v.9 no.1
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• pp.28-34
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• 2016

Purpose: The purpose of the present retrospective cohort study was to investigate the incidence of sinus perforation during endodontic microsurgery and to assess healing of cases with sinus perforation. Materials and Methods: Clinical and radiographic records were collected from patients who were treated with endodontic microsurgery in the Microscope Center of the Department of Conservative Dentistry at Yonsei University College of Dentistry, Seoul, Korea, between March 2001 and January 2016. To determine the incidence of sinus perforation, all cases involving maxillary premolar and molar teeth were assessed, and cases with perforation of maxillary sinus during the procedure were counted. To assess the outcome of the endodontic microsurgery, cases with sinus perforation were recalled at least 1 year after surgery. Result: Two hundred and forty-nine maxillary premolars and molars were treated with endodontic microsurgery. Among these cases, 16 cases had sinus perforations. Overall incidence of sinus perforation was 6.4%. Thirteen cases with sinus perforation were followed up for 1 year after endodontic microsurgery. Outcome assessment revealed that 2 of 13 cases with sinus perforation had failed. The success rate of endodontic microsurgery with sinus perforation was 84.6%. Conclusion: Endodontic surgery performed using microsurgical techniques decreases the risk of sinus perforation. Predictable outcomes of endodontic microsurgeries and healing of sinus membrane can be expected with adequate treatment steps and careful periodic follow-ups in cases with maxillary sinus perforations.

• Imaging Science in Dentistry
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• v.47 no.4
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• pp.261-267
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• 2017

Purpose: Analyzing different patterns of maxillary sinus septa in cone-beam computed tomography (CBCT) images and predicting maxillary sinus membrane perforations. Materials and Methods: In this cross-sectional study, CBCT images of 222 patients ranging from 20 to 81 years old were evaluated. One hundred fifty-two patients (93 females and 59 males) who had maxillary sinus septa in axial views were included in this study. Cross-sectional images were used to determine classifications of sinus septa and the risk of membrane perforation using a method modified from Al-Faraje et al. Variables of sex, age, and dental status were considered. Chi-squared and Kruskal-Wallis tests were used for data analysis(P<.05). Results: In this study, 265 maxillary sinus septal patterns were found. The mean age of the patients was $44.1{\pm}14.7$ years old. The Class I and VII-div II patterns had the greatest and least prevalence, respectively. Furthermore, there was a significant relationship between the location of septa and the frequency of membrane perforation risk (P<.05). In this study, the relationship of different patterns of septa with dental status did not differ significantly (P>0.05). Conclusion: A higher prevalence of moderate risk of membrane perforation in the molar region relative to the premolar region was observed. Furthermore, maxillary sinus septa occur most frequently in the molar region, demonstrating the importance of paying attention to this region during sinus lift surgery. This study did not show any relationship between tooth loss and the presence of septa.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.5
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• pp.297-303
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• 2023

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.3
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• pp.241-249
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• 2007

An augmentation of the maxillary sinus floor facilitates placement of dental implants in the posterior atrophic maxilla. However, a maxillary sinus augmentation has potential complications that can lead to early failure and loss of the bone graft. One specific complication is sinus membrane perforation. Especially, large perforations may cause loss of the graft materials into the sinus and infection, so, early failure of the sinus lift. Attempts at managing sinus membrane perforations are difficult because of the limited access to them and friability of the thin Schneiderian membrane. Repair of sinus membrane perforations intraoperatively may be performed using a variety of techniques and materials, including sutures, collagen membranes, fibrin glue. Inspite of various repair technique, as has been reported extensively in the literature, large perforations represent an absolute contraindication to the continuation of surgery. But, we obtained clinically favorable results in cases that show repair of the perforated sinus membrane with a micro-suture technique by 4X Loupe ($Surgitel^{(R)}$ Loupe, General Scientific Corporation) in large perforation. The objective of this presentation is to report of several cases of repair of the perforated sinus membrane with micro-suture technique using 7.0 or 8.0 suture materials, to make a brief review of the literature about various technique managing perforated sinus membrane.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.50.1-50.6
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• 2016

Background: The aim of this study was to evaluate the clinical outcomes of implants that were placed within the maxillary sinus that has a perforated sinus membrane by the lateral window approach. Methods: We examined the medical records of the patients who had implants placed within the maxillary sinus that has a perforated sinus membrane by the lateral approach at the Department of Oral and Maxillofacial Surgery of Chonnam National University Dental Hospital from January 2009 to December 2015. There were 41 patients (male:female = 28:13). The mean age of patients was $57.2{\pm}7.2years$ at the time of operation (range, 20-76 years). The mean follow-up duration was 2.1 years (range, 0.5-5 years) after implant placement. Regarding the method of sinus elevation, only the lateral approach was included in this study. Results: Ninety-nine implants were placed in 41 patients whose sinus membranes were perforated during lateral approach. The perforated sinus membranes were repaired with a resorbable collagen membrane. Simultaneous implant placements with sinus bone grafting were performed in 37 patients, whereas delayed placements were done in four patients. The average residual bone height was $3.4{\pm}2.0mm$ in cases of simultaneous implant placement and $0.6{\pm}0.9mm$ in cases of delayed placement. Maxillary bone graft with implant placement, performed on the patients with a perforated maxillary sinus membrane did not fail, and the cumulative implant survival rate was 100%. Conclusions: In patients with perforations of the sinus mucosa, sinus elevation and implant placement are possible regardless of the location and size of membrane perforation. Repair using resorbable collagen membrane is a predictable and reliable technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.54.1-54.3
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• 2019

Background: The presence of septa increases the risk of Schneiderian membrane perforation during sinus lift procedure, and therefore, the chance of graft failure increases. We present a safe method of managing septa and, in particular, overcoming small and palatally located septa. Methods: After the elevation of the flap and the creation of a small bony window positioned anterior to the septum, the Schneiderian membrane is lifted carefully. A thin and narrow osteotome is then placed at the indentation created at the base of the septum, and mobilization of the septum is achieved by gentle malleting. The membrane is again carefully lifted up behind the septum. Results: There was one small membrane perforation case in all 16 cases, and none of these patients showed postoperative complications such as implant failure, infection, or maxillary sinusitis. Conclusions: This technique is useful for overcoming the problem of maxillary sinus septa hindering the sinus floor elevation procedure, leading to fewer complications.

• Journal of Periodontal and Implant Science
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• v.43 no.6
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• pp.308-314
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• 2013

Purpose: The purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit. Methods: Thirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit. Results: A total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation. Conclusions: From the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

• The Journal of the Korean dental association
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• v.44 no.1 s.440
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• pp.45-54
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• 2006

Piezosurgery uses modulated ultrasonic vibration to allow controlled cuting of bony structures. delicate bony structures can be cut easily and with great precision without destruction of soft tissue. Piezosurgery can be used to harvest the chin bone for intra-oral augmentation. Maxillary sinus membrane perforation is the most common complication that occurs with the sinus elevation augmentation procedure. This complication can occur during the osteotomy, which is performed with burs, or during the elevation of the membrane using manual elevators. The purpose of this study is to introduce new surgical technique that simplifies chin bone graft and maxillary sinus surgery, thus avoiding perforating the membrane.