Management of a Large Schneiderian Membrane Perforation and Repair of the Missing Maxillary Lateral Wall Using a Collagen Barrier Alone in a Patient With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.

INTRODUCTION: Sinus floor augmentation (SFA) to aid in implant placement has been shown to be very predictable. A history of membrane perforation or intraoperative Schneiderian membrane perforation (SMP) is one of the most frequent complications of SFA. In this case report, the management of a large preexisting SMP with the aid of a collagen barrier in a patient with human immunodeficiency virus/acquired immunodeficiency syndrome is described.

CASE PRESENTATION: A 51-year-old male presented for retreatment of an endodontically treated maxillary molar (tooth #14). The endodontic consultation recommended extraction, which was performed by the patient's primary dentist. Two months later, a clinical and radiographic examination revealed significant vertical and bucco-lingual bone loss in that area. Cone-beam computed tomography (CBCT) indicated insufficient bone volume for implant placement and the absence of cortical bone with a homogeneous fibrous mass in the edentulous region. A lack of Schneiderian membrane continuity, most likely the result of the extraction, was suspected. A treatment plan of guided bone regeneration followed by implant placement was presented. The SMP was repaired using a collagen barrier alone, and postoperative healing was uneventful. One year later, a repeat CBCT scan revealed complete reformation of the buccal cortical plate and sinus floor with ≈6 mm of vertical bone gain. An implant was placed without complications 16 months after SMP repair.

CONCLUSIONS: This case report describes how a large preexisting SMP was repaired using a collagen barrier alone. Three-dimensional bone regeneration was achieved without the use of bone grafts primarily because of the stability of the blood clot.