Early Placement of Dental Implants in Maxillary Sinus Grafted With Leukocyte and Platelet-Rich Fibrin and Deproteinized Bovine Bone Mineral

Abstract

This case report aimed to describe the effects of leukocyte and platelet-rich fibrin (L-PRF) associated with demineralized bovine bone mineral (DBBM) and absorbable collagen membrane (CM) on bone regeneration in maxillary sinus augmentation. A 59-year-old male patient was referred to the Department of Periodontology for implant rehabilitation of his edentulous upper jaw. The treatment plan involved maxillary sinus augmentation followed by implant installations. A split-mouth design was employed in which the right maxillary sinus was filled using L-PRF, DBBM, and CM; the left side was filled with DBBM and CM. After 4 and 8 months postoperatively, 2 dental implants were installed in each of the right and left maxillary sinuses. Cone-beam computerized tomography (CBCT) was taken before and after sinus augmentation for evaluation of tridimensional bone volume alterations. Bone biopsies were harvested from the implant sites for histomorphometric evaluation. Resonance frequency analysis was employed immediately after implant placement and before prosthetic rehabilitation for evaluation of implant stability. Implants were loaded 10 months after sinus augmentation. CBCT analysis showed a higher resorption rate in the right side of the maxillary sinus (L-PRF + DBBM) compared to the left side (22.25% and 8.95%, respectively). Implant stability quotients were above 68 in all time-points for both groups. Histomorphometric analysis showed a high amount of newly formed bone when L-PRF was used compared with DBBM alone (2 118 102 and 975 535 mm3, respectively). Taken together, both techniques were effective for maxillary sinus augmentation, however the addition of L-PRF to the graft allowed early implant placement and accelerated bone healing in the conditions studied.

Evaluation of L‐PRF combined with deproteinized bovine bone mineral for early implant placement after maxillary sinus augmentation: A randomized clinical trial

“…Importantly, the maturation of this type of material may take up to 8 months before implants can be safely placed in maxillary sinus, which might be considered a disadvantage of this material. To mitigate this shortcoming, the addition of growth factors, particularly L‐PRF, to the graft material has been suggested as an alternative approach to increase bone formation, enhance implant stability, favor osseointegration, and accelerate tissue maturation and healing …”

“…The surgical procedures were performed as described earlier . Briefly, patients received local anesthesia (Articaine 4% and epinephrine 1:100 000; DFL, Rio de Janeiro, RJ, Brazil) followed by a mid‐crestal and vertical releasing incisions along the residual alveolar bone to expose the lateral sinus wall.…”

“…The surgical procedures were performed as described earlier. 12,13,44 Briefly, patients received local anesthesia (Articaine 4% and epineph- After surgery, the patients received postoperative instructions for appropriate oral hygiene control and treatment with an oral antibiotic (amoxicillin, 500 mg three times a day for a week), an oral antiinflammatory (nimesulide, 100 mg twice a day for 5 days), and an analgesic (paracetamol, 750 mg every 6 hours for 2 days). They were advised to rinse their mouth with chlorhexidine (0.2%) daily for 14 days.…”

“…To mitigate this shortcoming, the addition of growth factors, particularly L-PRF, to the graft material has been suggested as an alternative approach to increase bone formation, enhance implant stability, favor osseointegration, and accelerate tissue maturation and healing. 1,18,21,22,[28][29][30]34,35,44,45,[47][48][49][50][51][52] CBCT is considered a reliable technique for the 3D visualization of graft volume changes after sinus augmentation. In this study, we performed three different CBCTs at different time points: immediately after the bone graft, and after 4 and 8 months of healing.…”

Platelet-Rich Fibrin as a Bone Graft Material in Oral and Maxillofacial Bone Regeneration: Classification and Summary for Better Application

“…The disease types included periapical inflammatory lesion with bony defect [58, 59], IBD [60, 61] maxillary sinus augmentation [62–64], and extraction of the molar teeth [65]. Moreover, Pichotano et al [63] filled the right sinus with PRF, deproteinized bovine bone mineral (DBBM), and CM, but they filled the left side with DBBM and CM in a patient for maxillary sinus augmentation, and they found higher proportion of bone formation when using PRF on histomorphometric analysis (2,118,102 mm 3 and 975,535 mm 3 , respectively). However, a small sample size and lack of a control group undermined the conclusion of these studies.…”