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Sinus Membrane Perforation: Contraindication for implant?

Sinus membrane perforation (SMP) is a common complication during sinus floor elevation procedures. But is it considered a contraindication to implant placement and what is the survival rate for implants placed after a perforation?

Want to comment on this topic, visit Sinus Membrane Perforation: Risks, Repair Techniques and Implant Survival.

Many Repair Options are Available

Luckily, since the sinus lift procedure is a well-known technique, there are many accepted options for repairing a perforation, including the use of resorbable collagen membranes, periosteal grafts, and innovative suturing techniques. Generally, most clinicians and studies seem to prefer the use of collagen membranes. Recently, however, Platelet-rich fibrin (PRF) has been considered an alternative material for repairing sinus perforations due to its autogenous nature and ease of manipulation. Of course, the decision as to what technique to use should be determined by the classification of the perforation, as shown below. It should be noted that Class I perforations do not even need repair.

Studies Show that Implant Placement is Not Contraindicated

The good news, though, is that may studies support the conclusion that if the proper technique is used to repair the perforation implant placement is not contraindicated. In fact, a recent meta analysis showed that the proportion of implant loss in repaired sinuses membrane sites (independent of the material or implant placement time) was only 4%, suggesting that the materials and techniques used for SMP management seem to securely seal the maxillary sinus, and pose little threat to the survival of the implants placed in the affected areas. Another study, did a 13-year follow up on sinus perforation cases and the percentages were nearly exactly the same, with a success rate of 96.2% for the implants placed in the sinuses in which the membrane was perforated and repaired, regardless of the material used to seal the perforation.

Cases and Images

Classification of the Perforation is Critical for Determining the Proper Plan


Image Source: Schiavo-Di Flaviano V, Egido-Moreno S, González-Navarro B, Velasco-Ortega E, López-López J, Monsalve-Guil L. I[nfluence of Schneiderian Membrane Perforation on Implant Survival Rate: Systematic Review and Meta-Analysis] (Influence of Schneiderian Membrane Perforation on Implant Survival Rate: Systematic Review and Meta-Analysis - PMC). J Clin Med. 2024 Jun 27;13(13):3751. doi: 10.3390/jcm13133751. PMID: 38999315; PMCID: PMC11242322.

Diagram illustrates the classification of the perforations of the maxillary sinus membrane described by Fugazzotto and Vlassis in A simplified classification and repair system for sinus membrane perforations. Fugazzotto and Vlassis proposed a classification for perforations according to size and the difficulty of reparation. Class I perforations are those that occur in the upper part of the osteotomy; the separation of the membrane from the bone will eventually close due to membrane folding upon itself. Class II occurs close to the lateral or lower walls of the osteotomy and its treatment is more complex. Class III perforations are located right in the center of the osteotomy window and are frequently preexisting, either due to a previous traumatic dental extraction or an oroantral fistula, although they can occur during the preparation of the membrane as well; their clinical management is similar to those of class II

Case: Vertical sinus lift after perforation of sinus

Discuss this case at OsseoNews: Vertical Sinus Lift after Perforartion

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This case involved implant placement at #3,14 sites. Teeth #3,14 were previously extracted and grafted due to pain and failed RCT. I forgot #3 site only had 5mm of sinus floor and osteotomy through the sinus floor, which was indicated by the parallel pin in CBCT. I quickly placed a 5x11.5mm Hiossen implant at #14 and proceeded to #3 site. I used Versah burs applying crestal sinus lift protocol 2, which formed a nice white bubble on the sinus floor in which I subsequently placed also a 5x11.5mm Hiossen implant and placed a healing cap and buried the implant. So far pt seems to have normal course of post op symptoms. Although I perforated the sinus membrane, it was still possible to continue with a crestal (vertical) sinus lift and place an implant. However, I still placed pt on PO abx (augmentin).

Study References

Discuss or Comment on Sinus Membrane Perforation: Contraindication for implant? at OsseoNews.com

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