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One complication dental implant surgeons need to avoid and manage is perforation of the maxillary sinus when performing sinus lift procedures or placing implants in the maxillary sinus area.

In the Case of Lateral Window Sinus Lift Procedures

A cone beam CT scan enables the surgeon to see where the sinus septae are located. Typically, the surgeon can avoid perforation of this membrane by using a diamond bur, specialized diamond instrumentation for window preparation or Piezo electric instrumentation (Piezotome, Salvin Dental Specialties).

An inadvertent perforation that occurs during the preparation of the window is easily managed by enlarging the preparation approximately 5mm in all directions beyond the perforation and proceeding with the lift in a standard fashion.

Once the sinus membrane is elevated, a resorbable collagen membrane or CollaCote® (Zimmer Dental) can be used to repair the perforation or tear. This type of repair is greatly facilitated by the use of Platelet Rich Plasma (PRP) (Harvest Technologies), which ensures immobilization of the collagen barrier to the surrounding sinus membrane.

In the Case of Placing Maxillary Implants

Perforations that inadvertently occur during osteotomy preparation or while placing a maxillary implant rarely cause a problem unless:

  • primary implant stability is in question or
  • perforation occurs during tooth extraction and there is to be immediate implant placement.

When primary implant stability is in question, I recommend delaying implant placement and proceeding with a modified site preservation procedure such as the Bio-Col technique, which can also serve as a repair procedure for the perforated sinus using layers of an absorbable collagen plug with blood, or preferably with PRP to repair the perforation. This modification is also applicable to immediate implant placement sites assuming excellent primary stability is achieved.

NOTE: In addition to devoting a full day to the topic of Avoiding and Managing Complications at ISTM 2013, the Sclar Center’s annual comprehensive dental implant surgery training conference on Miami Beach (February 1-5, 2013), we will offer a 1-day seminar on Avoiding and Managing Dental Implant Complications in Charlotte, NC (November 2, 2012), Orlando, FL (May 10, 2013), and the New York City area (August 23, 2013). See our news release about this seminar.



  1. July 30, 2012

    Again, a nice review Dr Sclar. Based upon the your recommendation for the frequent use of PRP, do you regularly draw blood presurgically for patients? The reason I ask is that if you should draw after surgery starts, my understanding is that there is a noticeable decrease in effectiveness of PRP due to platelet degranulation. And, I also agree that there is benefit to using PRP for management of the soft tissue wound (ie, membrane perf or mucosa closure). But my experience with PRP in the actual sinus graft material has been problematic. What have been your experiences? Sincerely, Paul J. Denemark, DDS, MSD, Board Certified Periodontist, Burr Ridge, Illinois.

  2. December 18, 2014

    Helpful information. Thank you for sharing this to us. Thank you so much.

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