Sinus Membrane Removal for Successful Subantral Sinus Augmentation

It is known that the sinus membrane does not contribute to bone production during sinus augmentation procedures. However, it is assumed that the sinus membrane is required to contain the sinus graft material for successful sinus augmentation procedures. Like so many of our assumptions about bone, this is another false assumption. The sinus membrane is not needed for predictable successful sinus augmentation with same day implant placement.

We had previously published a case where sinus augmentation was performed immediately before a diagnosis of oral squamous cell carcinoma of the throat.. Sinus bone regeneration was occurring during radiation and chemotherapy with a successful sinus augmentation and implant placement outcome:
In this case, the sinus membrane was unmanageable and was removed from the floor of the sinus up to a level where the amount of bone regeneration would cover the implant being placed.


Day of graft and implant placement.

Approximately 1 year after restoration.

Post op ct scan. Bone covers the implant.

With SteinerBio bone grafts, the bone in the sinus will remodel until load is sensed by the bone. Any extra bone in the sinus will be eventually resorbed. This is opposed to traditional grafts that never remodel or resorb.

In this case, the graft and implant were placed with no sinus membrane covering the bone graft. The graft material will set in approximately 30 minutes and as bone grows into the graft, the sinus membrane grows from the peripheral bone over the graft.

After successful cancer therapy, the patient wanted to proceed with replacement of tooth #15. However, as was the case with the upper right, the membrane was also lost when attempting to elevate the membrane and the membrane was again removed and the site grafted with Sinus Graft and the implant was placed.

Day of graft and implant placement.
Two weeks post op.

The graft material has lost radiodensity as extracellular fluid displaces a component of the graft material, making the graft porous for migrating osteoblasts.
Healing abutment appointment 3 months after grafting and implant placement. After loading, the density of the bone in the grafted area will increase in density. Note the level of the newly regenerated sinus membrane.

The surgery utilized was the minimally invasive Steiner Sinus Lift developed nearly 20 years ago. The technique and success rate of this procedure have been published:
Preop radiographs of minimal bone. Again, in this case the sinus membrane was lost and removed prior to grafting.
Day of grafting and implant placement.
Healing abutment appointment.
15 months post restoration.

This case was performed in 2011 with regular follow up appointment with no change in alveolar bone support.
Using SteinerBio bone grafts enables the clinician the ability to change course when the planned treatment doesn’t go as planned. For example, during a sinus augmentation, when any membrane damage occurs, the membrane is removed and the site is grated with Sinus Graft and implants are placed at the time of the lift. The advancements of our technology has allowed us to achieve many clinical treatments that traditional bone graft therapy cannot. After a few hundred of these cases with no failures, it has become standard protocol.

No matter what amount of bone is present in the residual crest, delayed implant placement is never needed. While it does require surgical skill to place implants in 1 to 2 mm of residual crestal bone, the limitation is the surgical skill of the operator and not the technical abilities of the graft material.

Delayed implant placement in the sinus is an antiquated technique that is abusing to the patient and should no longer be utilized. The only need for delayed implant placement is a result of using antiquated graft materials that should no longer be placed in the sinus. When using traditional graft materials, delayed implant placement is required because all other graft materials fail to produce integration to the implant surface when the graft and implant are placed at the same time. Delayed implant placement is never needed when using SteinerBio graft materials because it has been proven that integration to the implant surface occurs when the implant and graft is placed at the same time.
If the practitioner is unable to transition to modern science-based graft materials, it is reasonable that SteinerBio graft materials be available when a sinus tear occurs. If the practitioner is still utilizing a large lateral wall technique and a tear occurs, we advise removing the sinus membrane, placing our Ridge Graft and placing the implants at the same appointment. If the practitioner is using minimally invasive sinus augmentation and the sinus membrane tears, we advise removal of the sinus membrane and any graft material followed by grafting with Sinus Graft and implant placement. If any other graft material has been placed in the sinus and the membrane tears, all of the graft material must be removed from the sinus before placing any SteinerBio graft materials. Any residual graft material irrespective if the graft material is an alloplast or cadaver will block bone formation when using our graft materials.

Our academics and our lecturers have no knowledge or experience with science-based bone graft materials and will always be limited to the use of cadaver tissues. All of our knowledge and training about bone grafting is based on cadaver bone grafts which does not translate to science-based bone grafting, so we cannot look to our academics or lecturers to introduce new clinical advances. It is left up to the private practitioner to take advantage to the superior performance of science based bone grafts, which can significantly improve success rates, allow for the treatment of more challenging cases, shorten treatment times and reduce post operative morbidity.


American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)