The use of an innovative technique for perforations of the mucous membrane of the maxillary sinus during the sinus lift operation

Introduction. To date, according to WHO, the number of people with a complete absence of teeth is greater than 8% of all the people worldwide. Loss of teeth due to complications of caries treatment, chronic periodontitis and trauma leads to atrophy of the alveolar ridge and that of soft tissues in this area, which in turn complicates the rehabilitation of the patients. According to the literature, in the first year after tooth extraction, the volume of the bone tissue of the alveolar ridge decreases by 40–60%, which greatly complicates the subsequent orthopedic rehabilitation of the patients. Currently, the «gold standard» for increasing the volume of the bone tissue of the alveolar ridge of the upper jaw in the distal section is the sinus lift operation. However, according to the literature, when sinus lift operation is performed, Schneider’s membrane perforation occurs in 7–23% of cases, which in terms, leads to the inability to complete the operation and complications in cases with total perforations of membrane.Purpose of the study. To evaluate the complex rehabilitation of patients with partial secondary absence of teeth and severe atrophy in the lateral sections of upper jaw using the «envelope technique» during open sinus lifting.Materials and methods. In 2020–2022, during a clinical study at the clinic of the Department of maxillofacial and plastic surgery of the Moscow State Medical University named after A.I. Evdokimov, 54 patients who had a history of PPI interventions in the ENT department were treated. All patients underwent bilateral open sinus lifting using enamel matrix proteins or the «envelope technique» for perforation of the Schneider membrane. After 9–12 months, a comprehensive rehabilitation of patients based on dental implants was carried out.Results. The number of extensive (total) perforations of the Schneider membrane in the study group of patients was 50%. As a result of the use of the patented «envelope technique» with the use of enamel matrix proteins, no postoperative complications were observed in patients with total perforation of the Schneider membrane. Taking into account the planned orthopedic design, 292 dental implants were installed in all patients.Conclusion. The method is effective and safe, allowing to rehabilitate patients with missing teeth and severe atrophy in the lateral part of the upper jaw, in case of intraoperative total perforation of the Schneiderian membrane.