RADIOGRAPHIC ASSESSMENT OF MAXILLARY SINUSES AND BONE REGENERATE FOLLOWING THE CLOSURE OF SCHNEIDERIAN MEMBRANE PERFORATIONS USING VARIOUS TECHNIQUES DURING SUBANTRAL AUGMENTATION

Abstract

Surgical closure of a Schneiderian membrane (SM) perforation occurring during an open sinus lift procedure prevents the migration of bone graft material into the maxillary sinus lumen and the subsequent development of inflammation. The use of blood plasma components with adhesive properties (such as PRF or fibrin glue) significantly enhances the efficacy of local repair using a collagen membrane and reduces the risk of postoperative complications. Research objective. To evaluate, using radiographic examination, the condition of the maxillary sinuses and subantral bone regenerates in patients who underwent surgical closure via various techniques of Schneiderian membrane perforations sustained during open sinus-lift procedures. Materials and methods. Radiographic examinations of the maxillary bones were performed on 20 patients (men and women aged 40 to 65 years) who had sustained medium- or large-sized Schneiderian membrane perforations during open sinus-lift surgery. All patients underwent radiographic monitoring of the maxillary sinuses and subantral bone regenerates using dental cone-beam computed tomography at 7 days, 3 months, and 6 months post-surgery. Based on the methods used for the plastic closure of maxillary sinus perforations, the patients were divided into two clinical groups: in the first group (9 individuals), defects in the maxillary sinus floor mucosa were closed using the resorbable collagen membrane “Ossix Plus” (Dentsply Sirona, USA), and the subantral regions of the maxillary bones were filled with the xeno-osteoplastic material “Cerabone.” In patients of the second clinical group (11 individuals), the surface of the “Ossix Plus” membrane was coated with autologous fibrin glue, and PRF was incorporated into the osteoplastic material at a 1:1 ratio. Results and Discussion. At 3 and 6 months postoperatively, radiographic imaging revealed thickening of the damaged maxillary sinus mucosa– varying in size–in 5 patients from the first clinical group who had undergone repair of large oroantral perforations. At this stage, slight thickening of the Schneiderian membrane was detected in only two patients from the second clinical group. The intergroup radiographic differences in membrane thickness at the 6-month follow-up mark approached statistical significance (χ²=3.0392, p=0.0813). Six months postoperatively, the intergroup difference in the incidence of marked vertical resorption (exceeding 20% of the baseline level) of the subantral bone regenerates was statistically significant (χ² = 6.1111, p=0.0134). Conclusions. Longitudinal radiographic monitoring of the maxillofacial region in patients who underwent open sinus lifting revealed that the severity of the postoperative inflammatory response in the maxillary sinuses is influenced by the method used to repair Schneiderian membrane perforations, while the efficacy of subantral bone regeneration in complex cases depends on the properties of the osteoplastic materials employed. The use of autologous fibrin glue and PRF for local reconstruction during maxillary bone augmentation– even in complex cases involving significant tears of Schneiderian membrane–enables the achievement of the necessary hemostatic and anti-inflammatory effects and ensures optimal conditions for reparative osteogenesis