Schneider Membrane Perforation - What to do?

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Posted on By Bernardo Mira Correa In Sinus Augmentation

What approach do you suggest when facing multiple and extensive sinus membrane perforation?

a - abort surgery
b - Schneider Membrane repair
c - Schneider membrane repair and sinus lift
d - Schneider membrane repair, sinus lift and implant placement




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8 Comments

It really depends on the level of experience and risk that the clinician wishes to take. I would say a large perforation of 5mm or greater is better treated after aborting and re-entry. If very experienced then elevate the schniderian and seal with collagen membrane and continue with graft.


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Completely agree


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Agree!
If grafting I would pin a collagen membrane to the palatal wall. This way there is no risk of membrane displacement.
Bernardo, I bet you have done some PRGF miracle lol!
Best regards
Snjezana


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I bet on PRGF miracle + elevation & if inspired + implants. But perfoming 2 miracles at one time would be already a nice did, with almost zero risk. Risk as Mo pointed out is definitely an issue.


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Snjezana I don't consider it a miracle...just taking advantage of using biological tools!

This is why we believe this ultra dense autologous Fibrin, is one of the best biomaterials we can have in our armamentarium !

We use fibrin as a natural scaffold the retains the agglutinated particulate xenograft within the sinus, benefiting from the Gfs release at the same time!

It's a good treatment philosophy, from the biological point of view, don't you think so?

:D


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Great, Bernardo! But look how deeply we know each other and guess the treatment plans?
I often use PRGF+ Xenograft as sinus graft material and cover sinus membrane perforation with fibrin membranes. For large perforations I feel more comfortable if they are sealed with a palatal pinned collagen memrane.
Thank you so much for sharing, congratulations!
Cheers
Snjezana


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I totally agree Snjezana!! Looking forward to host you here in Oporto!


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I also totally agree Mo!
Expertise really matters in these cases of bigger and/or multiple perforations.
I just want to share another possible and very predictable approach to outcome this type of complication.
Basicly we are taking advantage of Biology, using autologous Fibrin's healing and sealing properties, to repair the pierced Schneiderian membrane and the agglutination effect of the PRGF ENDORET, to keep the particulate xenograft within the sinus, as well as Gfs release to enhance healing.
In this case, due to the scarse residual bone thickness, i decided to delay the implant placement.


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