Correlation between Schneiderian membrane perforation and sinus lift graft outcome: a retrospective evaluation of 359 augmented sinus.
OBJECTIVE
The aim of this study was to estimate the incidence of sinus membrane perforation in maxillary sinus augmentation surgery using a lateral approach and the impact of sinus integrity on incidence of sinusitis and bone graft survival in the maxillary sinus.


METHODS
A total of 359 sinus augmentation procedures (208 patients) were evaluated retrospectively for sinus integrity during augmentation, complications, graft failure, and implant loss.


RESULTS
The incidence of sinus membrane perforation was 41%. There was an overall sinus graft failure rate of 6.7%; of the failed sinus grafts, 70.8% had a perforated sinus membrane at augmentation. There were 11.3% of sinuses with perforated membranes at graft placement that failed compared with 3.4% of sinuses with intact membranes failing (general linear model [GLM], P = .003). Age, gender, and provider type were not significantly associated with sinus integrity at 1 year. Overall, 11.3% of sinuses with perforated membranes at graft placement required secondary antibiotics for sinusitis and infection compared with 1.4% of sinuses with intact membranes (GLM, P < .0006). Of the sinuses requiring secondary antibiotics, 30% failed compared with 5% of untreated sinuses (GLM, P = .0071). Of the sinuses developing sinusitis or secondary infection requiring antibiotics, 85% had a membrane perforation during augmentation compared with 39.2% of those not requiring antibiotics; gender, age, and provider were not associated with antibiotic use.


CONCLUSIONS
In the present study, antibiotic use for postoperative sinusitis and infection and graft failure were shown to be statistically higher in sinuses with perforated membranes at augmentation.
Attending Surgeon, Division of Oral and Maxillofacial Surgery, Montefiore Medical Center, Bronx, NY.
Patrick J
PJ
Nolan
President, EXTRAPOLATE, LLC, Delray Beach, FL.
Katherine
K
Freeman
Chairman, Department of Dentistry; Director, Oral and Maxillofacial Surgery Residency Program, Montefiore Medical Center, Bronx, NY. Electronic address: chrclark@montefiore.org.
Richard A
RA
Kraut
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000637:transplantation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D019232:Dental Restoration Failure; D017886:Durapatite / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D015523:Maxillary Sinusitis / Q000209:etiology; D008875:Middle Aged; D009297:Nasal Mucosa / Q000293:injuries*; D053657:Platelet-Rich Plasma / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D059546:Sinus Floor Augmentation / Q000009:adverse effects* / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D018786:Bone Substitutes; D015921:Dental Implants; D017886:Durapatite