Background:Schneiderian membrane perforation is the most frequent complication during lateral-window sinus
augmentation. While standard repair (collagen patch ± suturing/glue) is widely used, the collagen pouch (Loma Linda) technique may better isolate graft material and promote early healing. Comparative data on healing and graft containment remain limited.
Materials and Methods: Prospective comparative study at Taibah University Dental College and Hospital, Madinah,
Saudi Arabia. Adults with intraoperative perforation during lateral-window augmentation were assigned by a preset
size/location algorithm to collagen pouch or standard repair. Primary outcome: membrane healing at 8–12 weeks
(clinical/CBCT). Secondary outcomes: graft containment, bone gain at 6–9 months, sinonasal complications ≤3
months, and implant survival 6–12 months. CBCT reads were blinded; effect sizes reported with 95% CIs.
Results: Sixty-two patients were included (31 per arm). Collagen pouch improved early outcomes: healing 96.8% vs
80.6% (risk ratio 1.20; risk difference 16.1%); faster recovery (median 8 vs 10 weeks); and superior graft containment
(100% vs 87.1%). Bone gain was similar (8.5 ± 1.6 vs 8.1 ± 1.8 mm) and short-term implant survival remained high in
both groups (96.0% vs 95.8%), with fewer sinonasal events in the pouch cohort.
Conclusions: Findings support a size-/site-based algorithm favoring collagen pouch for larger or complex tears, while
standard patching remains adequate for small, favorable defects.
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