Dental implant clinicians often face concerns regarding the perforation of the maxillary sinus during dental implant procedures. Maxillary sinus floor elevation (SFE), performed through either a trans-alveolar or lateral approach, is commonly used to augment insufficient alveolar bone in the maxillary posterior region. However, membrane perforation is the most common complication during SFE, with reported prevalence ranging from 8% to 32%. Risk factors for perforation include sinus septa, low residual bone height, and smoking. Membrane perforation can increase the risk of sinusitis and may lead to graft or implant failures. To address this, various methods have been developed for repairing perforated membranes, such as suturing and the use of adhesives and collagen membranes. However, most of these repair procedures are performed via a lateral approach for SFE.
Membrane perforation during SFE can be a challenging complication, as it often requires a second surgical site and increases patient discomfort. The prevalence of maxillary sinusitis after SFE is reported to be around 8.4% to 9.8%, with a lower incidence rate for the crestal approach compared to the lateral approach. Sinus membrane perforation is a risk factor for postoperative sinusitis, which can negatively impact implant survival rates.
Complications during sinus membrane elevation surgery are sometimes unavoidable, despite preventive measures being the best approach. In cases where complications do occur, it is important for the clinician to understand the cause, explain the issue to the patient, and provide appropriate treatment. Serious complications should be promptly referred to a specialist. Sinus membrane perforation is the most common complication during surgery and can increase the risk of postoperative infection and graft or implant failure. Therefore, it is crucial to be familiar with various methods for closing perforations. Infections are another common complication after surgery, and early diagnosis and treatment, such as antibiotics and incision drainage, are vital for preventing severe complications.
To minimize complications like bleeding and sinus membrane perforation, it is important to identify and diagnose normal anatomical structures and pathological findings before surgery. Collaboration with an otorhinolaryngologist should be considered in cases of asymptomatic maxillary sinus lesions, chronic maxillary sinusitis, nasal septum deviations, and other related conditions. Sinus lateral wall thickness can vary significantly among individuals, and extreme thickness or thinness can increase the risk of membrane perforation during the procedure. Asymptomatic mucous retention cysts and antral pseudocysts are not contraindications, but extensive and destructive mucoceles are. Sinus septums are present in a significant percentage of patients and can increase the risk of membrane perforation. Other factors to consider before surgery include maxillary ostium patency, which affects the maxillary sinus drainage system, and nasal septum deviations and mucosa inflammation or injury, which can increase the risk of postoperative complications.
In a case study, a 45-year-old male patient with a missing upper left first molar underwent a crestal sinus lift using the Crestal Approach Sinus Kit (CAS Kit) and subsequent implant placement. The procedure was minimally invasive, and the sinus membrane was successfully lifted without any trauma. Another case involved a 20-year-old female patient with a congenitally missing upper right back molar and pain around the wisdom tooth. The patient opted for the extraction of the wisdom tooth and placement of an implant with a sinus lift for the missing molar. The sinus was pneumatized, and the procedure was performed without any complications.
In summary, perforation of the maxillary sinus membrane during dental implant procedures is a common concern. Membrane perforation can lead to complications such as sinusitis and graft or implant failures. However, various methods for repairing perforated membranes have been developed. It is important for clinicians to be aware of the risk factors for membrane perforation and to take preventive measures. Collaboration with specialists and proper diagnosis of anatomical structures and pathological findings before surgery can help minimize complications.