Aborted Sinus Lift Procedure Case: Any Ideas?

This is just a septum which is why you took the scan to check for. This is probably not the easiest sinus to start on as the buccal wall is reasonably thick and yes this is probably the reason it tore , it may have just been a very thin lining. But there are numerous ways of dealing with septa and they are case specific maybe stick to less complicated cases initially but good you took the scan.

My advice to beginners: Make Big Windows!!!! - Takes the same amount of time to heal as a small window, and the access and procedure will be much easier. Use Piezo-surgery- Septums are deadly for lateral windows. Piezo-surgery helps you to work around or through the septum in a controlled manner. A hard case as DR. Fairbaum said due to thick buccal wall. Since I have been using piezo-surgery to do these cases, I actually enjoy the challenging ones. At this point, I would refer. I wait at least six months before re-entering a torn membrane case. The literature says you can go in sooner, but what's the rush???

I made the surgery this morning, but with a big window this time, and particularly near from the crest I made all the job around the defect and at the end I made the septum No problem this time The lesson? Make a big window Thanks for your answer

Would not abort the procedure because of a membrane tear. If I have a tear, I place a folded collagen membrane into the window and allow it to unfold, completely covering the defect. It will "self adhere", and you can proceed with your graft. When addressing a buttress, it also helps to use a spoon shaped sinus elevation instrument with the concave surface facing the floor of the sinus. You can carefully work over the butress in most cases. Sinus procedures have to be respected, but it is not sacred. Spend some time in the O.R. with an ENT surgeon and see what they think of membrane patency! Best of luck...you're better than you think! Gordon

Well done , as to ENT veiwpoint it is interesting as they have said that in a catastrophic tear you can go back in at 3 weeks as the linig is healed and the osteotomy is still patent so no need to open a new window . We have done about a dozen cases whilst retrieving material from the sinus where we place at the same time and purposefully destroy the lining scraping the mesial internal walls (at area of placement ) to debride the lining . Then place an inplant and graft directly onto the implant in the sinus and seal the window ( CaSo4 ). All cases have been issue free and loaded at 5 months ( some for 5 years now) . Whilst this is definately NOT protocol the body heals ... Peter

this message is for Dr. Peter Fairbairn regarding the interesting experiment involving the sinus.my question is does a large membrane tear take the same 3 weeks to heal as a small tear and also how did you contain the graft around those implants you placed directly into the sinus following destroying the membrane.please explain the details of the procedure if possible.thank you.

Large window , Use the Dentium Sinus lift system , best one out there for the membrane. The burs will cut the bone and not the membrane have not had a tear since I got it.

Agreed Sr . Linssen once you start with Dask ( Dentium) your tear rate plummets as the saline pressure helps the initial lifting of the lining as well as permits a safe access through the bone. As to the other question from Dr Akop , the lining heals is days and it is the opinion of an ENT to go back at 3 weeks the last time I closed up after a catastrophic tear of the lining was 5 or 6 years ago. As to the grafting of the inplant is by using synthetic graft materials that set . You place a gauze in the back of the sinus after placing the implant then graft direstly onto the implant and the space between it and the adjacent bone which you have denuded of lining. After waiting for it to set you then remove the gauze and seal the window with CaSo4.As I said this is NOT Protocol and we have only done it a dozen times in the last 5 years ( all sucessfully loaded now) but merely showing that the body does heal . I could post a case possibly to show it with the relevant scans. Peter

Dr Peter please post case photos of the CaSo4 case.

There are some informative webcasts re: Summers and Lateral sinus lifts using that system. The gentle hand preparation and the gently rounded short implants can reduce the stress on the operator and the membrane. In the case of a tear, the Bicon short implants ( 5.7 mm long ) can be wrapped in collagen membrane, filled with SynyhoGraft, sort of like a Tootsie Roll Pop and inserted into the sinus site . A special sinus lift abutment with a "T" top is then tapped into the outside edge of the hole, suspending the implant in a sea of graft, similar to how an electrician suspends a ceiling fixture between the ceiling joists.