Novel “Suture-Pin Fixation” Technique For Large Schneiderian Membrane Perforation

Large Schneiderian membrane perforations (>10 mm) during maxillary sinus floor elevation pose significant challenges. This case demonstrates an innovative technique to address such complications. A 29-year-old female with congenital bilateral posterior edentulism exhibited severe maxillary atrophy (residual bone height: 1.5mm) and thin Schneiderian membranes (<1mm) on CBCT. During a lateral window sinus floor elevation for the left maxillary sinus, a perforation exceeding 10mm occurred. A novel “suture-pin fixation” technique was employed: two 1mm pilot holes were drilled on the palatal bone wall using a ball drill. One edge of the collagen membrane was anchored to the palatal bone wall by passing a 5-0 absorbable suture through the holes. The opposite edge was fixed to the buccal bone wall using membrane pins, creating a stable barrier over the perforation. Deproteinized bovine bone mineral was grafted between the collagen membrane and the sinus floor bone wall, covered with a secondary membrane. After 8 months, a 4.1×8mm implant was placed at site 25, followed by prosthetic rehabilitation. This technique provides a stable barrier over perforations, preventing graft material displacement and promoting direct graft-sinus floor contact for osteogenesis. A two-year follow-up demonstrated stable peri-implant bone levels and functional prostheses, highlighting its favorable treatment outcomes. The “suture-pin fixation” technique offers a reliable solution for large Schneiderian membrane perforations. This innovation promotes osteogenic outcomes, minimizes invasiveness, and enhances success rates in cases with large membrane perforations.