{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:58:59Z","timestamp":1790258339282,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Crestal sinus augmentation is a minimally invasive approach used to increase vertical bone height in the posterior maxilla. Compared with the traditional lateral window technique, the crestal approach reduces surgical morbidity, postoperative discomfort, and overall treatment time, while still providing the ability to regenerate sufficient bone for implant placement. Despite these advantages, a major challenge of this technique is the difficulty in detecting and managing Schneiderian membrane perforations due to limited visual access. Schneiderian membrane perforation remains the most frequent complication associated with sinus augmentation and, if left unmanaged, may compromise graft stability, increase the risk of sinus pathology, and negatively affect implant survival. Therefore, the development of reliable methods to identify and manage membrane perforations is critical for achieving predictable outcomes. This case series aims to describe a novel approach for managing sinus membrane perforations encountered during crestal sinus augmentation using amnion\u2212chorion membrane. The technique involves the application of amnion\u2212chorion membranes to seal perforations, allowing simultaneous bone grafting and implant placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients presenting with posterior maxillary edentulism and insufficient vertical bone height were treated using the crestal sinus augmentation technique assisted by osseodensification drills. Clinical and radiographic outcomes were systematically evaluated. Preoperative assessment included measurement of the residual alveolar bone height and determination of the sinus floor angle. Each sinus was carefully examined radiographically to rule out any pre\u2010existing pathology, such as mucosal thickening, cystic changes, or evidence of sinusitis. Intraoperative sinus membrane perforations were identified during osteotomy preparation. Management involved the placement of dehydrated amnion\u2212chorion membrane configured in a \u201cwaffle cone\u201d shape, which allowed simultaneous implant placement and bone grafting in all cases. The amount of vertical lift achieved was also measured postoperatively to quantify the effectiveness of the crestal sinus augmentation and to ensure adequate bone gain for implant placement. At the 2\u2010year follow\u2010up, both clinical and radiographic evaluations were repeated to assess implant stability, peri\u2010implant bone levels, sinus architecture, and maintenance of the augmented height, thereby confirming the long\u2010term success of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All cases demonstrated successful sealing of the Schneiderian membrane using the amnion\u2212chorion membrane, with successful simultaneous implant placement. Immediate postoperative radiographs and cone\u2010beam computed tomography confirmed stable graft containment with average of 5.2\u00a0mm vertical sinus lift. After a healing period of 6 months, all implants achieved successful osseointegration. At the 2\u2010year follow\u2010up, periapical radiographs revealed stable peri\u2010implant bone levels with no radiographic or clinical signs of sinus complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The use of amnion\u2212chorion membranes in a \u201cwaffle cone\u201d configuration provides a simple and effective method for repairing Schneiderian membrane perforations encountered during crestal sinus augmentation. This technique enables simultaneous implant placement and grafting, expanding the scope of minimally invasive sinus augmentation procedures in compromised sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Predictable repair and graft containment<\/jats:bold>\n                            : The technique described in this case series offers a predictable method for managing Schneiderian membrane perforations that occur during crestal sinus augmentation. By placing an amnion\u2212chorion membrane in a \u201cwaffle cone\u201d configuration, clinicians can achieve stable graft containment and secure defect coverage. This approach provides an effective biologic barrier that supports simultaneous bone grafting and implant placement, thereby maintaining surgical efficiency while minimizing the risk of graft migration or sinus complications.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Favorable long\u2010term outcomes<\/jats:bold>\n                            : Clinical and radiographic evaluations at the 2\u2010year follow\u2010up demonstrated consistent membrane repair, predictable bone regeneration, and stable peri\u2010implant bone levels, with all implants achieving successful osseointegration. These results align with recent evidence indicating that small, well\u2010managed sinus membrane perforations do not negatively affect implant survival or regenerative outcomes. The findings further support the long\u2010term predictability of biologically based repair strategies in crestal sinus augmentation.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            <jats:bold>Clinical relevance and practicality<\/jats:bold>\n                            : This technique reduces the need for staged procedures, lowers surgical morbidity, and enhances overall treatment efficiency. From a clinical perspective, it is particularly relevant for periodontists and implant surgeons, as it transforms a common intraoperative complication into a manageable event that does not compromise long\u2010term success. By incorporating biologically active membranes such as amnion\u2212chorion into the management protocol, clinicians can expand the safety and applicability of the crestal sinus lift technique, even in anatomically challenging cases.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>When placing dental implants in the upper back jaw, there is often not enough bone height to hold the implants securely. A common way to solve this is by gently lifting the sinus floor and adding bone graft material through a small opening in the bone (called a \u201ccrestal sinus lift\u201d). One of the main risks with this procedure is tearing the sinus lining, which can make treatment more difficult and increase the chance of complications. In this report, we describe a new method for repairing these tears using a thin, biologic material called an amnion\u2212chorion membrane, folded into a \u201cwaffle cone\u201d shape. This simple technique seals the tear and keeps the bone graft in place, while also allowing the implant to be placed at the same time. All patients in this study healed well. At the 2\u2010year follow\u2010up, the implants were stable, the bone levels were preserved, and no sinus problems were seen. This technique gives dentists a predictable and minimally invasive way to manage sinus tears and successfully place implants in areas with limited bone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cap.70019","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:42:41Z","timestamp":1760107361000},"page":"530-537","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Novel use of amnion\u2212chorion membrane in managing sinus membrane perforations during crestal sinus augmentation: The waffle cone technique"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1913-0411","authenticated-orcid":false,"given":"Thaer","family":"Alqadoumi","sequence":"first","affiliation":[{"name":"Department of Periodontics Loma Linda University  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2948-7234","authenticated-orcid":false,"given":"Noor","family":"Daras","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics Loma Linda University  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","first-page":"152","article-title":"A new concept in maxillary implant surgery: the osteotome technique","volume":"15","author":"Summers RB","year":"1994","journal-title":"Compend Contin Educ Dent"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.13294"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u2010051X.2008.01273.x"},{"issue":"5","key":"e_1_2_11_5_1","first-page":"659","article-title":"The effect of Schneiderian membrane perforations on dental implants placed in the augmented maxillary sinus: a retrospective study","volume":"18","author":"Proussaefs P","year":"2003","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.11607\/jomi.4817"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.13368"},{"issue":"4","key":"e_1_2_11_8_1","first-page":"559","article-title":"The effect of sinus membrane perforation and repair with fibrin glue on the outcome of maxillary sinus floor augmentation: a radiographic assessment","volume":"19","author":"Shlomi B","year":"2004","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100501.2007.01438.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976\u2010237X.137900"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2020.11.005"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1563\/AAID\u2010JOI\u2010D\u201012\u201000083"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13017"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1563\/aaid\u2010joi\u2010D\u201024\u201000167"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.b.33141"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/cid.130"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70019","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.70019","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.70019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:01:10Z","timestamp":1790254870000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.70019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/cap.70019"],"URL":"https:\/\/doi.org\/10.1002\/cap.70019","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"assertion":[{"value":"2025-06-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}