Elevation in the presence of an antral pseudocyst and simultaneous implant placement
Clinical Challenge
A middle-aged male came to the clinic for dental implant placement. The panoramic radiography showed a hazy shadow in the right maxillary sinus. A CBCT scan was taken for further evaluation and revealed a dome-shaped radiopacity. The radiographic impression was an antral pseudocyst. In the region of the 1st molar the residual bone height was enough to avoid a lateral window approach. But the morphology of the residual ridge in the 1st molar area and the presence of an antral pseudocyst were not favorable indicators for a transcrestral sinus floor elevation.
Preoperative intraoral view showing the clinical situation.
In the preoperative CBCT scan, an antral pseudocyst was observed.
After lateral window preparation, a perforated Schneiderian Membrane was visible.
Careful membrane elevation was performed from the opposite side of the perforation.
The elevation around the perforation was performed without propagation of the perforation.
The antral pseudocyst was aspirated with a needle through the perforated membrane.
Geistlich Bio-Gide® was trimmed to repair the perforation. Two horizontal cuts were made at the upper ¼ of the part. This ¼ upper part was placed outside the sinus cavity on the lateral wall.
The trimmed Geistlich Bio-Gide® was placed to cover the perforated Schneiderian membrane. The upper ¼ of Geistlich Bio-Gide® was outside of the cavity and the lower ¾ part was inserted inside.
Easy and fast application of Geistlich Bio-Oss Pen® into the cavity. Please note the upper ¼ part of Geistlich Bio-Gide® was kept in place by the tip of the Geistlich Bio-Oss Pen®.
The bony window was relocated to its original position for covering the lateral window.
Postoperative panoramic radiographic image. Site with augmented sinus floor and 2 dental implants placed simultaneously are visible.
Clinical outcome at a glance
Objectives
- Lateral sinus floor elevation using Geistlich Bio-Oss Pen® and Geistlich Bio-Gide®.
- Augmentation is simultaneous with implant placement in sites 16 and 17.
- Aspiration of a small systic lesion in the sinus cavity.
Conclusions
- One-stage sinus floor elevation treatment.
- Very promising clinical outcome with the use of Geistlich Bio-Oss Pen® and Geistlich Bio-Gide®.
- Geistlich Bio-Gide® is very suitable for repairing a perforated Schneiderian membrane.
Aim / Approach
In order to ensure that the radiopacity would be nothing but a non-symptomatic antral pseduocyst, sinus floor elevation via the lateral window technique was planned. After opening up a bony window, I was able to aspirate the small cystic lesion with yellowish mucus. During the procedure, a perforation was found and successfully repaired with a Geistlich Bio-Gide®.
Conclusion
Geistlich Bio-Gide® is because of its easy manipulation and its good adhesion to the Schneiderian membrane a great product for the perforation repair and should be properly trimmed and placed to ensure it spreads sufficiently to completely cover the perforation.
- Dr. Neel Bhatavadekar - Management of a thin Schneiderian Membrane with a pouch technique
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