Maxillary Sinus Floor Augmentation to Enable One-Stage ARDS Implant Placement by Using Bovine Bone Substitute and Platelet-Rich Fibrin

Maxillary Sinus Floor Augmentation to Enable One-Stage ARDS Implant Placement by Using Bovine Bone Substitute and Platelet-Rich Fibrin

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Clinical Study

Maxillary Sinus Floor Augmentation to Enable One-Stage Implant Placement by Using Bovine Bone Substitute and Platelet-Rich Fibrin

Horia Mihail Barbu,1 Claudia Florina Andreescu , 1 Monica Raluca Comaneanu , 1 Daniel Referendaru,1 and Eitan Mijiritsky 2

La acest caz au fost folosite implanturile dentare ARDS . 

1.Introduction

Maxillary sinus floor augmentation (also known as sinus lift, sinus graft, sinus augmentation, or sinus procedure) is a surgical procedure,whichincreasestheamountofboneinthe posterior maxilla by the elevation of the sinus (Schneiderian) membrane from the underlying sinus wall and by placing a bonegraftunderit.Theaimofsinusaugmentationistoobtain bone to support a dental implant. Implants can be applied at the same time as sinus surgery (simultaneous placement) or after a healing period (delayed placement). Since 1974 when the first surgery of sinus lift was per formed, the science of biomaterials has improved by enhanc ing the possibilities of graft augmentation and allowing clin icians to perform implant-borne dental restorations in com plex situations. As a result, it is possible to perform an opti malimplantplacementandtoachieveagoodlong-termprog nosis for an implant-borne prosthesis in the posterior grafted maxilla. Currently, maxillary sinus augmentation is a well documented surgery with long-term clinical success/survival of the implants similar to those placed in the pristine bone [1–3]. However, there is a debate about the best biomaterial or combination of biomaterials regarding sinus surgery. Studies reported that implants placed in the sinuses augmented with particulate grafts presented a higher survival rate than those augmented with block grafts [4]. Bovine bone mineral acts as a slowly resorbing space maintainer [5] and can diminish sinus pneumatisation after augmentation. Platelet-rich fibrin (PRF) [6] is a fibrin concentrate obtained from the patient’s blood, with integrated growing factors and cytokines, which provides a favourable environment for cell migration and rapid vascularization [7]. Studies showed that PRF promotes bone healing and could increase the success rate of bone grafting [8, 9]. 2 BioMed Research International T he association of particulate bovine bone graft with PRFcould allow faster healing and earlier rehabilitation. The purpose of this study was to evaluate one-stage piezosurgery using as graft material a combination of particulate bovine bone substitutes with PRF to attain sinus lift.

2. Materials and Methods

Tis study comprises the cases of 14 patients who required sinus augmentation. Te study was conducted in accordance with the standards of the Declaration of Helsinki (1983) and was approved by the Ethical Board of Titu Maiorescu University. Te patients were informed about the aim and design of the study and signed a written consent form before surgery. All patients were candidates for maxillary sinus foor augmentation and simultaneous implant placement during October 2013 and June 2014. Exclusion criteria were as follows: diabetes, hemocoagulation disorders, immunological defciency, previous radiation therapy of the head-neck area, or patients undergoing treatment with bisphosphonates. Inclusion criteria were as follows: posterior edentulous subjects with 4-5 mm of crestal bone height, pathology-free sinus, and being without active periodontal diseases. In all cases, the alveolar bone ridge was wide enough for simultaneous implant placement. Cone beam computed tomography (CBCT) was performed to measure the vertical and horizontal bone height existent between the alveolar crest and the sinus foor and to evaluate the health and anatomy of maxillary sinus [10–12]. Te used surgical procedure was lateral window technique (lateral or direct sinus lif) with simultaneous implant(s) insertion. Premedication with antibiotics (Amoxicillin or Clindamycin) was started one day prior to surgery for seven days. Surgery was performed under local anaesthesia (Articaine 1:100,000 Epinephrine) by applying piezosurgery (Piezosurgery touch Mectron) to minimize trauma and intraoperative complications [13]. Te modifed Caldwell-Luc approach was used to access the maxillary sinus through the lateral wall. A mucosal midcrestal incision was performed with anterior and posterior releasing vestibular incisions certain distance from the proposed osteotomy site. A full-thickness fap was refected to expose the lateral maxillary wall. An oval or round bony window was created with the piezoelectric instrument so that the Schneiderian membrane became visible (Figure 1). Te sinus membrane was elevated carefully with a sinus curette.....