R lateral sinus wall defect

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Posted on By David Crawford In Sinus Augmentation

Right sinus Lateral wall defect from prior tissue/material reaction to Maxxeus graft material (PT had hives too ) resulting in rejection/ejection of graft material and some necrosis around access "window". Crestal approach won't work due to morphology. What's best way to repair and sinus graft here?

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Tough situation. Do you have clinical images? Tissue quality remaining.
This is a more advanced posterior reconstruction now as it will require sinus grafting and horizontal GBR. Would do 1 at a time. Incision towards palate and bring over FULL thickness flap to labial fo expose lateral wall opening. Lift remaining membrane and place collagen membrane to protect sinus graft. Use membrane tacks to stabilize. Gain complete primary closure and wait 5 months. Come back and place implants and perform horizontal GBR at same time. good luck. Tough case. Dr. Salama


The tissue quality is OK but there is mostly mucosa, not keratinized tissue, along with a muscle attachment extending toward crest from repair surgery to cover defect on buccal aspect. I noticed you typed FULL thickness in all caps. I have had recommendation to go full thickness to edge of defect then partial thickness over defect (erring on preserving buccal gingival tissue) and reflecting inward as part of membrane. I am aware of Mike Pikos' technique of membrane reconstruction and have used it a few times (that was my back-up plan). Thoughts?


David; Then perform FGG first....then Full-Split flap.
Dr. S


Can you please upload panoramic view and intraoral photo as well?
Recently I did similar case, defect was smaller but the idea is the same.
You have already mentioned that.

I'd make computer planning. If the amount of bone I have now is enough, I'd do sinus augmentation, horizontal gbr and implant placement in one surgery.
Of course this is the case if schneiderian membrane is elevated successfuly. If not then Dr. Salama's protocol.
Soft tissue second stage.
That's IMHO.