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Closing a recurrent oroantral fistula (OAF) that occurs at an infected sinus augmentation site is a challenge for clinicians. The recurrent OAF has a detrimental impact on bone regeneration and subsequent implant placement. This case report includes three cases in which sinus graft infection and OAF occurred after maxillary sinus augmentation (MSA). In these cases, treatments to control sinus infection were performed using an otolaryngologist; then, intraoral interventions comprising mucosal flap procedures, bone grafts, and barrier membrane applications were performed 2–5 times by oral surgeons. Nevertheless, OAF recurred persistently. The failure to stop OAF recurrence may be due to the inability to effectively block air pressure at the OAF site. Following a comprehensive debridement of the infected tissue at the previous sinus augmentation site, a pouch was created through sinus mucosal elevation. The perforated sinus mucosa at the OAF site was covered with a non-resorbable membrane in one case and with resorbable collagen membranes in the other two cases, followed by bone grafting within the pouch. Lastly, this procedure was completed by blocking the entrance of the pouch with a cortical bone shell graft and a resorbable collagen membrane. The cortical bone shell graft, obstructing the air pressure from the nasal cavity, facilitated bone formation, and, ultimately, allowed for implant placement. Within the limitations of the present case report, the application of a guided bone regeneration technique involving a cortical bone shell graft and a barrier membrane enabled the closure of the recurrent OAF and subsequent implant placement. [ABSTRACT FROM AUTHOR]

Closing a recurrent oroantral fistula (OAF) that occurs at an infected sinus augmentation site is a challenge for clinicians. The recurrent OAF has a detrimental impact on bone regeneration and subsequent implant placement. This case report includes three cases in which sinus graft infection and OAF occurred after maxillary sinus augmentation (MSA). In these cases, treatments to control sinus infection were performed using an otolaryngologist; then, intraoral interventions comprising mucosal flap procedures, bone grafts, and barrier membrane applications were performed 2–5 times by oral surgeons. Nevertheless, OAF recurred persistently. The failure to stop OAF recurrence may be due to the inability to effectively block air pressure at the OAF site. Following a comprehensive debridement of the infected tissue at the previous sinus augmentation site, a pouch was created through sinus mucosal elevation. The perforated sinus mucosa at the OAF site was covered with a non-resorbable membrane in one case and with resorbable collagen membranes in the other two cases, followed by bone grafting within the pouch. Lastly, this procedure was completed by blocking the entrance of the pouch with a cortical bone shell graft and a resorbable collagen membrane. The cortical bone shell graft, obstructing the air pressure from the nasal cavity, facilitated bone formation, and, ultimately, allowed for implant placement. Within the limitations of the present case report, the application of a guided bone regeneration technique involving a cortical bone shell graft and a barrier membrane enabled the closure of the recurrent OAF and subsequent implant placement.

Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing.

Background: The purpose of the study was to analyze the efficacy of platelet-rich fibrin (PRF) as a single augmentation material for complicated cases of maxillary sinus floor elevation, resulting from membrane perforation or previous infections. Methods: Implant insertion in the posterior region of the maxilla was simultaneously performed with maxillary sinus floor augmentation. Schneiderian membrane elevation can be accompanied by extremely serious sinus membrane perforation, due to accidental tearing or intended incision for mucocele removal. PRFs were placed in the sinus cavity both for membrane sealing and sinus floor grafting. Radiological, histological and micro-CT analyses were performed. Implant survival was assessed every 6 months for 1 to 4 years, with a mean follow up of 1.8 years, after prosthetic loading. Radiological examinations were performed on CBCT at 9 and 12 and 36 months postoperatively and revealed improved degrees of radiopacity. Results: 19 implants were simultaneously placed in the course of nine maxillary sinus floor augmentation surgeries, with successful outcomes in terms of bone grafting and implant integration. New bone formation was evidenced 12 months postoperatively on radiological examination, micro-CT analysis, and histological analysis of a harvested bone segment from the augmented maxillary sinus. The mean gain in bone height of the sinus floor augmentation was 6.43 mm, with a maximum of 9 mm. The mean amount of vital bone obtained from histologic assessment was 52.30%, while bone volume/tissue volume ratio in micro-CT 3D had a mean of 50.32%. Conclusions: PRF may be considered as an alternative treatment for a single surgery of sinus augmentation with simultaneous implant placement, even in complicated cases with significant sinus membrane tearing. [ABSTRACT FROM AUTHOR]