Abstract:
An internal sinus procedure for patching a perforation in patient&#39;s sinus membrane comprising the steps of (i) creating an opening in the sinus floor of a patient to expose the portion of the sinus membrane including the perforation, (ii) inserting a quantity of a sinus membrane patching material through the opening to a location adjacent the sinus perforation and (iii) laterally expanding and forcing the patching material against the sinus membrane to seal the perforation.

Description:
RELATED PATENT APPLICATIONS 
       [0001]    The present application claims the benefit of U.S. Provisional Patent application Ser. No. 60/882,940 filed Dec. 31, 2006, which is herein incorporated by reference. The present application also relates to the subject matter of the concurrently filed U.S. patent application Ser. No. ______, entitled “Internal Sinus Manipulation (ISM) Procedure For Facilitating Sinus Floor Augmentation In Dental Procedures” (Docket 07JY-1), which is incorporated herein by this reference. 
     
    
     BACKGROUND OF INVENTION 
       [0002]    In the procedure described in the above-identified concurrently filed U.S. patent application, it is suggested that in forming an upward channel in the bone leading to the sinus floor of a patient, care should be taken to insure that the upward channel barely breaks through the existing bone without perforating the sinus membrane of the patient. The present invention is directed to a sinus membrane patching procedure that may be employed if a sinus membrane perforation should occur in the formation of the upward channel or is discovered as having been previously formed during an independent dental procedure or as a result of a physical accident suffered by the patient. 
       SUMMARY OF INVENTION 
       [0003]    Basically, the procedure of the present invention comprises the steps of (i) creating an opening in the sinus floor of a patient to expose the portion of the sinus membrane including the perforation, (ii) inserting a quantity of a sinus membrane patching material through the opening to a location adjacent the sinus perforation and (iii) laterally expanding and forcing the patching material against the sinus membrane to seal the perforation. 
         [0004]    The creation of the opening may be accomplished by the use of standard drills and drilling techniques and the like controlled to create an upward channel in the bone of the patient leading to the sinus floor. In this regard, the upper open end of the channel should extend to the base of the sinus floor and should be small enough to only expose the portion of the sinus membrane having the perforation. 
         [0005]    If the perforation of the sinus membrane occurs during the formation of the upward channel and if it is desired to lift and laterally extend the sinus membrane prior patching of the sinus membrane, such lifting and lateral separation of the portion of sinus membrane from the sinus floor may be accomplished using a sinus lifting tool that includes a disk-shaped tip and an angled neck. The disk-shaped tip is designed to release the sinus membrane from the bony wall of sinus floor. The angled neck is designed to aid in the proper positioning of the working tip. An inflection portion of the angled neck extending from the working tip allows the clinician to feel the tension of the sinus membrane and to determine the amount of initial lateral and vertical membrane reflection. The procedure for membrane release and elevation should be continued until a planned amount of sinus extension is achieved and a pocket of desired size is defined. 
         [0006]    The introduction of the sinus membrane patching material and the lateral expansion and forcing of the laterally extended material against the lower surface of the sinus membrane including the perforation may be accomplished using a patching material carrying instrument or insertion tool including a central support and laterally moveable outer supports spaced laterally outward of the central support. A preferred form of such an instrument is described and illustrated in detail in the concurrently filed U.S. patent application Ser. No. ______ entitled “Improved Sinus Membrane Patch Insertion Tool” (Docket 07JY-6), incorporated herein by this reference. 
     
    
     
       BRIEF DESCRIPTION OF ACCOMPANYING DRAWINGS 
         [0007]      FIG. 1  is a fragmentary sectional side view illustrating the step of creating an opening in the sinus floor to expose the portion of a sinus membrane including the perforation as by employing a standard drill to form an upward channel through bone leading to the sinus floor. 
           [0008]      FIG. 2  is a fragmentary sectional side view showing the bone channel of  FIG. 1  and illustrating the creation of a perforation in the sinus membrane by a fragment of bone during the drilling of the upward channel. 
           [0009]      FIG. 3  is a fragmentary sectional side view of the bone channel of  FIG. 1  receiving a sinus-lifting tool that includes a disk-shaped tip and an angled neck simultaneously lifting and laterally separating the exposed portion of the sinus membrane from the sinus floor to form a relatively small pocket between the sinus membrane and the sinus floor with lateral movement and a turning of the sinus lifting tool about a vertically extending axis of rotation. 
           [0010]      FIG. 4A  is a fragmentary sectional side view of the bone channel of  FIG. 3  receiving a sinus membrane patch insertion tool including a central support and laterally outward and moveable outer supports, the outer laterally moveable supports being laterally compressed against the central support to carry a quantity of sinus patching material upward in the bone channel to a location adjacent the lower surface of the lifted sinus membrane including the perforation formed in  FIG. 2 . 
           [0011]      FIG. 4B  is a fragmentary sectional side view of the bone channel and sinus patch insertion tool of  FIG. 4A  with the patching material engaging the sinus membrane over the perforation and the outer supports laterally separated from the central support, the patching material being extended laterally to form a patch sealing the perforation. 
           [0012]      FIG. 5  is a fragmentary sectional side view of the bone channel and sinus patch insertion tool of  FIG. 4B , the tool being lowered away from the sinus membrane leaving the patch in place. 
       
    
    
     DETAILED DESCRIPTION OF INVENTION 
       [0013]    As previously indicated, in order to seal a sinus perforation according to the method of the present invention, an opening  10  is created in the sinus floor of a patient exposing the portion of the sinus membrane  12  including the perforation  14 . This may be accomplished following a standard osteotomy drilling sequence using a surgical guide, a round marker and subsequent twist drills. Such a drilling procedure is depicted in  FIG. 1  where a standard twist drill  16  is shown forming a channel  18  in bone  20  in the maxillary posterior area of a patient. Conventional twist drills or surgical round diamond burs can be used to drill up to the sinus floor  22 , barely breaking through the existing bone and forming the desired opening  10  for exposing a preexisting sinus perforation or a perforation formed during a dental procedure such as shown in  FIG. 2  where the drilling results in the sinus perforation  14  by the forcing of a bone fragment  24  into and through the sinus membrane  12 . In either event, the sinus perforation  14  may be patched following the procedure of the present invention. 
         [0014]    As illustrated in  FIG. 3 , the actual patching of the sinus perforation  14  may be preceded by a lifting and separation of the perforated sinus membrane  12  from the sinus floor  22  to form a pocket  25  between a lower surface of the sinus membrane  12  and the sinus floor. Preferably, such lifting and lateral separation is accomplished by the use of a sinus lifting tool  26  that includes a disk-shaped tip  28  and an angled neck  30  extending longitudinally from a handle portion  32 . The disk-shaped tip  28  is designed to release the sinus membrane  12  from the bony wall of sinus floor  22 . The angled neck  30  is designed to aid in the proper positioning of the working tip  28 . An inflection portion  31  of the angle of the neck  30  extending from the working tip  28  allows the clinician to feel the tension of the sinus membrane  12  and to determine the amount of initial lateral and vertical membrane reflection. As illustrated in  FIG. 3  by the solid, dashed and broken outlines of the tool  26 , in the formation of the pocket  25  the tool  26  is simultaneously raised and turned back and forth on vertically extending axis  34  with the tip  28  simultaneously lifting and laterally separating the membrane  20  from the sinus floor  22  to form and enlarge the pocket  25 . A preferred form of the tool  26  is described and illustrated more fully in the concurrently filed U.S. patent application Ser. No. ______, entitled “Improved Sinus Membrane Lifting and Lateral Separation Instrument” (Docket 07JY-3), incorporated herein by this reference. 
         [0015]    The patching of the perforation  14  in the sinus membrane  12  is then accomplished as shown in  FIGS. 4A  and B and  FIG. 5 . As there depicted, an appropriate standard sinus membrane patching material  36  is introduced through the opening  10  into the pocket  25  using a patching material insertion tool  38  designed to carry the material upward in the channel  18  and into the pocket to a location adjacent and just below the portion of the sinus membrane  12  including the perforation  14 . 
         [0016]    Basically, the insertion tool  38  comprises a central support  40  and outer supports  42  and  44  laterally spaced from and laterally moveable relative to the central support  40 . The central support may comprise and is illustrated as comprising a ball  41  extending from a vertical support rod  43 . A preferred form of the insertion tool  38  is described and illustrated more fully in the concurrently filed U.S. patent application Ser. No. ______, entitled “Improved Sinus Membrane Perforation Patching Material Carrying Instrument” (Docket 07JY-6), incorporated herein by this reference. 
         [0017]    As shown in  FIG. 4A , during insertion of the sinus membrane patching material  36  through the opening  10  and into the pocket  25 , the outer supports  42  and  44  are moved laterally against the central support  40  and the patching material is carried by the upper surface of the central support  40  and the upper surfaces of the outer supports. Thus supported, the patching material  36  is moved by the insertion tool  38  upward through the opening  10  and into the pocket  25  to a location adjacent to and immediately below the perforation  14  in the sinus membrane  12 . As shown in  FIG. 4B , the insertion tool  38  is then moved upwardly within the channel  18  until the patching material  36  is engages the sinus membrane  12  and extends slightly into the perforation  14 . As this is accomplished, the outer supports  42  and  44  are released and moved laterally outward from the central support  40  to aid the central support  40  in laterally extending the patching material  36  to cover the lower surface of the sinus membrane adjacent the perforation and form a patch  46  as shown in  FIG. 5 . 
         [0018]    In these regards, the standard patching material  36  is usually a semi-solid material as initially mounted on the insertion tool  38  as shown in  FIG. 4A . When the patching material  36  engages the moist surface of the sinus membrane  12  it softens and becomes laterally extendable upon the release of the outer supports  42  and  44  and shapeable by the central support  40  to form a sticky adhesive patch  46  covering the perforation  14  and the adjacent lower surfaces of the sinus membrane  12  in response to movement of the central support  40 . 
         [0019]    While particular embodiments of the method and the preferred instruments employed in the method have been illustrated and described above, it is appreciated that changes and modifications may be made in the illustrated embodiments without departing from the spirit of the invention. Accordingly, the scope of present invention is to be limited only by the terms of the following claims.