Elevation with large sinus membrane perforation
Clinical Challenge
In this case a long term follow-up of a sinus floor augmentation was carried out. A large Schneiderian membrane perforation was repaired using Geistlich Bio-Gide® and platelet-rich fibrin (PRF), and a sinus floor grafting was performed with Geistlich Bio-Oss® particles. A 61-year old woman came to the dental office and asked for an implant-supported prosthesis in the area of the left 2nd premolar and 1st molar. The edentulous area had a bone height of 4-5 mm. A sinus floor elevation was planned followed after 7 months by implant placement. During the opening of the lateral window to the sinus floor, a Schneiderian membrane perforation occurred caused by the rotary bur due to a very thin Schneiderian membrane. In order to repair the complete perforation site Geistlich Bio-Gide® and PRF were used to cover the perforation. Afterwards the sinus floor was elevated with 1 g of Geistlich Bio-Oss® particles. The implant had been placed 7 months after augmentation with a good primary stability. Prosthesis construction was done 4 months after implant placement. After a 2-year follow-up period, the implant showed no marginal bone resorption, the bone grafting area showed minimal volume change and good support to the implants.
Areas 25, 26 planned for sinus augmentation via lateral approach and later implant placement.
Intraoperative picture shows sinus window and large perforation of sinus membrane size 5x10 mm at the lower border of the window.
Intraoperative picture after membrane lifting and covering sinus membrane perforation with platelet-rich fibrin (PRF).
Geistlich Bio-Gide® covers the PRF before filling the grafting material.
Geistlich Bio-Oss® was used as a grafting material which was mixed with serum from platelet-rich fibrin and filled in the sinus lifted space.
Intra-oral view shows immediate post-operative wound.
Periapical film immediately post-operative shows Geistlich Bio-Oss® grafting material distributed in the augmented area.
Cone beam CT at seven months post-operatively showed better density of augmented area and Geistlich Bio-Oss® granules were aggregated together and confined to the repair zone.
7 months after sinus augmentation the implant placement was planned. The augmented area shows Geistlich Bio-Oss® granules at a higher density compared to the immediate post-op situation.
7 months after sinus augmentation, two implants with primary stability were placed. The augmented area shows well integrated Geistlich Bio-Oss® granules surrounded with newly formed bone.
One year after sinus augmentation a complete crown restoration had been achieved.
Clinical outcome at a glance
Objectives
- Sinus floor elevation using Geistlich Bio-Oss® and Geistlich Bio-Gide®.
- Repairing a large Schneiderian membrane perforation with Geistlich Bio-Gide®.
Conclusions
- Two-stage sinus floor elevation treatment.
- Effective bone support and stable bone volume by using Geistlich Bio-Oss®.
- Effective application of a Geistlich Bio-Gide® in a large Schneiderian membrane perforation.
Aim / Approach
To demonstrate the efficiency of Geistlich Bio-Gide® for repairing a large Schneiderian membrane perforationand good long term stability of Geistlich Bio-Oss® granules in sinusgraft procedures showed minimal volume change.
Conclusion
Geistlich Bio-Gide® is effectively used for repairing major sinus membrane perforation and sinus augmentation with Geistlich Bio-Oss® granules is effective in bone support and stable volume.
