Simultaneous Maxillary Sinus Fistula Repair With Sinus Lift And Implant

This case demonstrates an innovative single-stage approach to resolve a chronic maxillary sinus fistula (MSF) following tooth extraction with severe bone deficiency (≤3 mm residual bone height), integrating ‌Simultaneous infection control and guided bone regeneration to shorten the time period for implant rehabilitation. A 22-year-old female presented with persistent purulent discharge at site of tooth 26, 4 months post-extraction. Clinical and CBCT findings confirmed mucosal dehiscence, sinus inflammation, and critical bone loss. A lateral window approach (piezoelectric osteotomy; Piezosurgery®, Mectron) facilitated debridement of granulation tissue and sinus membrane elevation. The subantral space was grafted with deproteinized bovine bone mineral (Bio-Oss®, Geistlich) stabilized by concentrated growth factor (CGF) membranes (Medifuge®, Silfradent). The fistula was sealed with layered CGF membranes, and the lateral window was covered with a collagen membrane (Bio-Gide®, Geistlich).‌ Immediate CBCT showed 10 mm sinus membrane elevation with stable graft containment. At 6 months, bone continuity enabled implant placement (TSIII®, Osstem Implant Co., Ltd.). Three-year follow-up confirmed stable function (radiographic bone loss <0.5 mm) and resolved sinus pathology. The success of this single-stage protocol presented innovations summarized below: ① ‌CGF dual application- As a fibrin scaffold for graft stabilization and a barrier for fistula closure. ② ‌Simultaneous infection control and regeneration. ③ Thorough infection eradication prior to augmentation promoting ‌long-term sinus health. This approach reduces treatment time, cost, and patient morbidity, offering a viable alternative in complex cases with combined sinus communication and bone deficiency.