Andreasi Bassi M, Andrisani C, Lico S, Ormanier Z, Barlattani A, Ottria L
Private practice in Rome, Italy.
Private practice in Matera, Italy.
Oral Implantol (Rome). 2016 Nov 16;9(4):157-163. doi: 10.11138/orl/2016.9.4.157. eCollection 2016 Oct-Dec.
In this article the Authors describe a procedure aimed to restore under endoscopic control, the continuity, of the Schneiderian membrane (SM) incidentally teared during a sinus lift with transcrestal approach.
In a 44-year-old male, due to aforementioned complication, the SM was gently detached via transcrestal approach, with a customized small ball burnisher, in order to facilitate the placement of a collagen sponge, to close the communication with the sinus, followed by the subsequent insertion of a graft material. All the procedure was endoscopically controlled and, considering the successful grafted area elevation, was simultaneously followed by implant placement. After 6 months the second stage was performed always under endoscopic control.
The endoscopic view of the grafted area showed a dome-shaped elevation sited on the top of the implant, the SM was apparently normal with no signs of inflammation, the antrum was empty and normally functioning. Periapical X-rays were performed: immediately after the surgery; at both 14 days and 6 months post-operative; at 6 months post prosthetic finalization. The volume of the grafted area progressively decreased over the time while its radiopacity, on the contrary, gradually increased, as expected after graft integration and remodelling. The implant was submitted to no functional load for 4 months by means of a temporary screwable acrylic crown inserted on a peek abutment and then finalized with a cementable metal-ceramic crown on a preformed titanium abutment.
The Authors recommend the use of endoscope to repair the SM incidentally teared during transcrestal sinus lift.
在本文中，作者描述了一种在内镜控制下恢复经嵴顶入路鼻窦提升术中意外撕裂的施耐德膜（SM）连续性的手术方法。
在一名44岁男性患者中，由于上述并发症，通过经嵴顶入路，使用定制的小球形抛光器轻柔地分离SM，以便于放置胶原海绵，封闭与鼻窦的连通，随后植入移植材料。整个手术过程在内镜控制下进行，鉴于移植区域成功抬高，同时进行种植体植入。6个月后在同样的内镜控制下进行第二阶段手术。
移植区域的内镜观察显示，在种植体顶部有一个圆顶形隆起，SM外观正常，无炎症迹象，窦腔空虚且功能正常。术后立即、术后14天和6个月以及修复完成后6个月均进行根尖X线检查。随着时间的推移，移植区域的体积逐渐减小，而其不透射线性则如移植整合和重塑后预期的那样逐渐增加。通过在窥视基台上插入临时可旋拧丙烯酸冠，使种植体在4个月内不承受功能负荷，然后在预制钛基台上用可粘结金属陶瓷冠完成修复。
作者建议使用内镜修复经嵴顶鼻窦提升术中意外撕裂的SM。
