Sinus Membrane Perforation: Contraindication for implant?

This Week in Implants
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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?

Diagram illustrates the classification of the perforations of the maxillary sinus membrane described by Fugazzotto and Vlassis
Diagram illustrates the classification of the perforations of the maxillary sinus membrane described by Fugazzotto and Vlassis696×615 135 KB

Image Source: Schiavo-Di Flaviano V, Egido-Moreno S, González-Navarro B, Velasco-Ortega E, López-López J, Monsalve-Guil L.- PMC (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 with Versah Burs after perforation of sinus

Source:
OsseoNews

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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).

References