A Modification to Schneiderian Membrane Perforation Repair Technique: The Hammock Approach

Cuadrado-González L, Jiménez-Garrudo A, Brizuela-Velasco A, Pérez-Pevida E, Chávarri-Prado D, Diéguez-Pereira M, Pacho-Martínez JM (2018) J Oral Implantol. Aug;44(4):301-304.

Scope – Limitations of conventional repair techniques

Classic methods to repair large sinus membrane perforations use resorbable membranes in different ways as a new wall, enabling accurate placement of the bone grafting material and avoiding the displacement of the graft particles into the sinus cavity. However, these methods can have some limits:

  • Suturing of the collagen membrane with the sinus membrane is sometimes demanding or not possible
  • Application of the barrier membrane without immobilization bears the risk of its dislocation
  • Creating a pouch that surrounds the bone grafting material may block blood supply to the graft


The goal of the new approach was to devise a repair technique that avoids the dislocation of the membrane and thus to increase treatment predictability.

Approach – Improved immobilization of the membrane

Jason® membrane was fixed like a hammock in the regenerative cavity. To this end, Jason® membrane was attached to a suture and pulled through the lateral buccal window and was fixed through two horizontal palatal perforations. To place it as a new ceiling in the regenerative cavity, the membrane is also fixed to two corresponding perforations on the buccal sinus wall. After immobilization the cavity is filled with the bone grafting material, and the lateral window is sealed with the previously removed bone plate and/or a collagen membrane and finally closed by suturing the flap.

Fig. 1 Simplified drawing of the Hammock Approach: Unlike conventional repair techniques, the used collagen membrane is immobilized buccally and palatally.

Advantages – Stable fixation and better blood supply

Compared to classic Schneiderian membrane repair techniques, the hammock approach enables complete immobilization of the collagen membrane. Furthermore, the membrane is directed only against the sinus membrane and the perforation, hence allowing for better blood supply to the bone grafting material by the surrounding bone walls.

Beneficial properties of Jason® membrane for the method

Tear resistance, non-stickiness and low thickness of Jason® membrane enable to efficiently pull the membrane through the lateral window and allow for tight fixation to the buccal and palatal sinus wall with sutures.