Implantology — Sinus Lift
What is the correct next step?
Case
During a lateral window sinus lift, the Schneiderian membrane tears. On inspection, the perforation is approximately 3mm.
Abort the graft entirely and close without placing any material
Correct —Cover the perforation with a resorbable collagen membrane and continue the graft
Pack graft material directly through the tear to seal it
Convert immediately to a crestal (osteotome) approach instead
Explanation
Small perforations under 5mm are managed by covering the tear with a resorbable collagen membrane and continuing the procedure — this is standard, well-documented management. Only large perforations require aborting the graft and staging the case 2-3 months later.
Clinical Pearl
Perforation rates in the literature run 10-35% even for experienced surgeons. The skill isn't avoiding every perforation — it's correctly sizing it and knowing which of the two paths to take.
Reference: Standard sinus augmentation protocol