IMPLANT DENTISTRY / VOLUME 20, NUMBER 1 2011 Effect of Sinus Membrane Perforation on
Dental Implant Integration: A Retrospective
Study on 128 Patients
Eric Oh, DDS,* and Richard A. Kraut, DDS† Sinusaugmentationasreportedby Acommoncomplicationofsinus patient who had an intact sinus. All augmentation is perforation of the four infections resolved after culture sensitivity and placement of the pa- tion and/or implant placement. This tient on an appropriate antibiotic for retrospective study examines the ef- fect of sinus membrane perforation with regard to graft survival and im- the augmented sinuses, five implants with periosteum and Schneiderian mem-brane, which is a pseudostratified plant integration. A total of 175 si- failed, four of which were associated ciliated epithelium that functions by re- with perforated sinuses and and which the membranes being reported intact was not associated with a perforated at the time of surgery. A total of grafted sinus. (Implant Dent 2011;20: three infections occurred in patients Key Words: sinus membrane, perfo-
ration, osseointegration
membrane has been reported as a com-plication occurring 10% to 60% of the patients were completely edentulous.
allergic patients). A full thickness buc- PATIENTS AND METHODS
*Chief Resident, Division of Oral and Maxillofacial Surgery,Montefiore Medical Center, Bronx, NY.
†Chairman, Department of Dentistry, Director of Oral andMaxillofacial Surgery Residency Program, Montefiore Medical Reprint requests and correspondence to: Richard A.
Kraut, DDS, Montefiore Medical Center, 111 East 210th
Street, Bronx, NY 10467, Phone: (718) 920-5993, Fax:
(718) 515-5419, E-mail: [email protected]
MA) was used to repair large perfora-tions. Implant Direct or Nobel BioCare Copyright 2011 by Lippincott Williams & Wilkins SINUS MEMBRANE PERFORATION EFFECT ON DENTAL IMPLANT INTEGRATION • OH AND KRAUT the flap closed primarily with 3-OChromic gut and 3-O Vicryl sutures.
tients received sinus augmentation anddental implants in 2007. There was atotal of 175 sinus augmentations: 47were bilateral (Figs. 1 and 2) and 81were unilateral (Figs. 3 and 4). Thesurgeon noted 115 intact sinuses and Fig. 1. Panoramic of intact bilateral sinus membrane.
60 (34%) perforated sinuses (Figs.
5– 8) during the surgeries. There werefour (2.2%) sinus infections (Table 1).
Three infections occurred in patientswho had sustained a perforated sinusand one in a patient who had an intactsinus. All four infections resolvedafter culture and sensitivity and place-ment of the patient on Avelox (moxi-floxacin Wayne, NJ), 400 mg daily for 10 daysplus Flonase (fluticasone propionate)(Glaxo Smith Kline, Triangle Park,NC), two sprays in each nostril daily Fig. 2. Panoramic of intact bilateral sinus membrane.
plants placed in the bone-augmented si-nus. Three hundred four implants wereplaced in intact sinuses, and 134 im-plants were placed in perforated sinuses.
A total of five implants failed: four im-plants from perforated sinus and oneimplant from an intact sinus. These dataresult in a 99% success rate of implantintegration in intact sinuses comparedwith 97% success rate in perforated si-nuses (Table 2).
were Noble Biocare Replace Selectand 190 were Implant Direct. Noble Fig. 3. Panoramic of intact left sinus membrane.
Biocare had two (1%) failures com-pared with three (2%) failures for Im-plant Direct (Table 3).
were compared. There were 47 im-plants placed in augmented sinuses, 36implants placed in intact sinuses, and11 implants placed in perforated si-nuses. Nineteen implants were Im-plant Direct and 28 implants wereNobel Biocare. One implant (NobelBiocare) failed from an intact sinus(Table 4).
Fig. 4. Panoramic of intact right sinus membrane.
IMPLANT DENTISTRY / VOLUME 20, NUMBER 1 2011 mentation, including perforation ofsinus membrane, acute or chronic si-nusitis, cyst, mucocele, delayedwound healing, hematoma, and loss/sequestrum of bone. The most fre-quently occurring complication is per-foration of the sinus membrane, whichis reported in from 10% to 60% ofcases.4–7 Perforation of the sinus mem-brane by itself may cause further com-plications such as increased risk ofinfection due to communication withother sinuses or risk of migration of Fig. 5. Panoramic of right perforated sinus membrane.
graft particles into the sinus wherethey induce polyps or other sinus dis-eases.12,13 Some studies report aban-doning sinus lifting procedure becauseof the wide perforation8,14–18 However,Schneiderian membrane perforation isnot an absolute indication for aban-doning the procedure unless the mem-brane is largely destroyed.12,19 ing perforation of the Schneiderianmembrane. The most common methodis the placement of resorbable mem-brane under the perforated Schneide- Fig. 6. Panoramic of left perforated sinus membrane.
rian membrane.13,19,20,21 Other methodsfor treating perforation include foldingthe membrane up against itself,22 usingsutures,12 or using fibrin glue10,23 toclose the perforation. At our institu-tion, we routinely use Surgicel tocover small to moderate size perfora-tions. Surgicel is an absorbable hemo-static agent made of an oxidizedcellulose polymer, and it is usuallyused to control bleeding. Previous re-ports indicate that using Surgicel istechnically simple, fast, reliable, andeconomical. It shows limited bacteri-cidal qualities, and has no contraindi- Fig. 7. Panoramic of right perforated and left intact sinus membrane.
chance of Schneiderian membraneperforation include anatomical varia-tions, surgeon’s experience, and pre-vious sinus infection or surgery.
Anatomical factors consist of thick-ness of the lateral maxillary sinuswall, convex lateral sinus wall, con-nection between Schneiderian mem-brane and oral mucosa, narrow andwide sinus, maxillary sinus septa, lon-gitudinal septum, and root-shape con-figuration.3,9–11 It is also suggested that Fig. 8. Panoramic of right perforated sinus membrane.
previous sinus surgery and absence ofalveolar bone are risk factors for a SINUS MEMBRANE PERFORATION EFFECT ON DENTAL IMPLANT INTEGRATION • OH AND KRAUT materials. Int J Oral Maxillofac Implants.
Table 1. Infection Rate on Condition of Sinus Membrane
simultaneous implantation: A 6-year clini-cal investigation. Int J Oral Maxillofac Im-plants. 1999;14:557-564.
Table 2. Implant Success Rate on Condition of Sinus Membrane
conference of 1996. Int J Oral Maxillofac Table 3. Implant Success Rate on Implant Brand
placement of hydroxylapatite-coated im-plants. J Oral Maxillofac Surg. 1989;47: the maxillary sinus with intraorally har-vested autogenous bone prior to implant Table 4. Immediate Loaded Implant Success Rate on Condition of
placement. Int J Oral Maxillofac Implants.
al. Augmentation of the maxillary sinus floor with particulated mandible: A histologic andhistomorphometric study. Int J Oral Maxillo- fac Implants. 1996;11:760-766.
of maxillary sinus floor augmentation: A ra- diographic assessment. Int J Oral Maxillo- floor augmentation at the time of maxillary fac Implants. 2004;19:559-562.
molar extraction: Success and failure rates repair: Report of a technique for large per- years. J Periodontol. 2002;73:39-44.
forations. Implant Dent. 1999;8:29-34.
6. Proussaefs P, Lozada J, Kim J, et al.
BS. Histologic and clinical observations of CONCLUSION
human study. Int J Oral Maxillofac Im- containment. Int J Oral Maxillofac Im- et al. The clinical significance of sinus fects of sealing the perforated sinus mem- tion of the maxillary sinus. J Oral Maxillofac membrane: A pilot study in humans. J Oral Effects of sinus membrane perforations on omy, physiology, surgery, and bone graft- ing related to implantology—Eleven years Disclosure
the augmented sinus. J Periodontol. 2006; of surgical experience (1979–1990). J Oral 23. Choi BH, Zhu SJ, Jung JH, et al.
the products mentioned in this article.
et al. Chronic sinusitis complicating sinus The use of autologous fibrin glue for clos- lift surgery. Am J Rhinol. 2001;15:181- ing sinus membrane perforations during si- nus lifts. Oral Surg Oral Med Oral Pathol EFERENCES
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