P - DENTSPLY Implants

Sinus Floor Augmentation Using Platelet Rich Plasma and Bovine Derived Xenograft
Ozkan Ebru*, Yilmaz Selcuk*, Cakar Gokser *, Kuru Bahar**, Sencift Kemal***, Kazazoglu Ender ****, Cologlu Sedat*****
* Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, TURKIYE
** Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, TURKIYE
***Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, TURKIYE
**** Department of Prosthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, TURKIYE
*****Department of Pathology, Faculty of Medicine, Yeditepe University, Istanbul, TURKIYE
INTRODUCTION
Maxillary sinus augmentation procedure is a well accepted and predictable method of increasing the volume of bone to facilitate the placement of implants in areas of the
posterior maxilla with insufficient bone quantity and/or quality (Wallace & Froum 2003, Del Fabbro et al. 2004). Various grafting materials are available for sinus
augmentation. Among these, bovine derived xenograft (BDX) has been shown to have osteoconductive properties and no inflammatory or adverse responses as grafting
materials used in sinus augmentation procedures (Mangano et al. 2007, Traini et al. 2007).
Platelet rich plasma (PRP) has become an increasing popular clinical tool as an alternative source of growth factors for regenerative procedures (Kassolis et al. 2005,
Plachokova et al. 2008, Steigmann et al. 2005,). The incorporation of PRP into sinus graft has been proposed as a method to shorten healing time, enhance wound healing,
and improve bone quality (Boyapati et al. 2006).
The purpose of this study is to compare the bone formation after bilateral sinus augmentation with PRP plus BDX versus BDX plus collagen membrane (CM) using
radiological and histological findings.
MATERIALS and METHODS
Figures 1-4. Clinical, radiological views and CT analysis before surgery
•Bilateral Sinus Augmentation (PRP+BDX) versus (BDX+CM); Two stage implant placement
• PRP (SmartPReP) Preparation:
• Autologous Thrombin Preparation:
20 ml Blood Drawn from the Antecubital Vein
10 ml Blood Drawn from the Antecubital Vein
Mixing the Blood with 2 ml Citrate Anticoagulant Solution
Mixing the Blood with 1 ml Anticoagulant Solution
Centrifuge for 14 minutes
45 minutes of Incubation Period / Centrifuge for 14 minutes
3 ml PRP obtained
1 ml Autologous Thrombin obtained
Figures 5-6. PRP + BDX application
• Postsurgical Care
Figures 7-8. BDX + CM application
Amoxicilline + Potassium Clavulonate (2x1, 1g) for 1 week + Chlorhexidine Digluconate (0,2 %) for 2 weeks post-surgically
• Radiological Analysis
• Baseline
• Immediately after surgery
• 8 months after surgery
Bone density (Hounsfield Unit [HU])
Computerized tomography (CT)
SimPlant11
Software
Alveolar bone height
Panoramic radiography
Figures 9-11. Clinical view and CT analysis immediately after surgery
• Histological Analysis
Bone specimen
Dehydratation
Formalin fixation
Embedding in paraffin
Figures 12-14. Clinical view and CT analysis 8 months after surgery
Hematoxylin + Eosin staining
• Flow Chart Of The Study
Bilateral sinus augmentations in
10 patients with ≤ 5 mm of residual alveolar bone height in the posterior maxilla
Baseline
One side
One side
Panoramic radiography
CT analysis
Sinus augmentation with PRP+BDX
Panoramic radiography
CT analysis
Sinus augmentation with BDX+CM
8th month
CT analysis
Bone biopsy specimen
Placement of AstraTech OsseospeedTM implants
CT analysis
Bone biopsy specimen
Placement of AstraTech OsseospeedTM implants
12th month
Exposure and loading of implants
Exposure and loading of implants
1-year follow up
1-year follow up
Figure 20. Histological view of
PRP + BDX side
Figure 21. Histological view of
BDX + CM side
CONCLUSIONS
RESULTS
Table 1. Mean (± SD) values of alveolar bone height at baseline and 8 months after surgery (n=10)
Mean (± SD)
Figures 18-19. Implant supported fixed prosthetic reconstruction
Figures 15-17. Placement of implants
Baseline (mm)
8th month (mm)
• The results of this study do not point out statistical clinical difference between both sites regarding alveolar bone heights and densitometric values.
Change (mm)
P
PRP + BDX
3,14 ± 0,75
12,52 ± 2,66
9,38 ± 2,56
0.005
BDX + CM
3,02 ± 1,06
12,60 ± 2,02
9,33 ± 2,34
0.005
p
0,999
• The difference noted was that, the side treated with PRP was presumed to have more newly formed mature bone whereas the contralateral side continued to show histological evidence of
residual graft materials.
• Both combinations seem to be suitable for sinus augmentaion procedures and accommodate osteointegrated implants.
REFERENCES
Table 2. Mean (± SD) values of alveolar bone densities at baseline and 8 months after surgery (n=10)
Mean (± SD)
PRP + BDX
BDX + CM
Baseline (HU)
8th month (HU)
Change (HU)
p
575,65 ± 157,58
692,74 ± 155,72
117,09 ± 144,96
0.037
530,57 ± 125,58
P
p < 0,05 ; P: intragroup comparison ; P: intergroup comparison
752,23 ± 194,22
221,66 ± 126,98
0,131
0.005
•
Wallace SS, Froum J.Effect of maxillary sinus augmentation on the survivalof endosseous dental implants. A systematic review. Ann Periodontol 2003; 8: 328-43.
•
Del Fabbro M, Testori T, Francetti L, Weinstein R. Systematic survival rates for implants placed in the grafted maxillary sinus. Int J Periodontics Restorative Dent 2004; 24: 565-77.
•
Mangano C, Scarano A, Perrotti V, Iezzi G, Piatelli A. Maxillary sinus augmentation with a porous synthetic hydroxyapatite and bovine-derived hydroxyapatite: a comparative clinical and histologic study. Int J Oral Maxillofac Implants 2007; 22: 980-86.
•
Traini T, Valentini P, Iezzi G, Piatelli A. A histologic and histomorphometric evaluation of anorganic bovine bone retrieved 9 years after a sinus augmentation procedure. J Periodontol 2007; 78: 955-61.
•
Kassolis JD, Reynolds MA. Evaluation of the adjunctive benefits of platelet-rich plasma in subantral sinus augmentation. J Craniofac Surg 2005; 16: 280-87.
•
Plachokova AS, Nikolidakis D, Mulder J, Jansen JA, Creugers NH. Effect of platelet-rich plasma on bone regeneration in dentistry: a systematic review. Clin Oral Implants Res 2008; 19: 539-45.
•
Steigmann M, Arun K. Garg. A comparative study of bilateral sinus lifts performed with platelet-rich plasma alone versus alloplastic graft material reconstituted with blood. Implant Dent 2005; 14: 261-66.
•
Boyapati L, Wang HL. The role of platelet rich plasma in sinus augmentation: A critical review. Implant Dent 2006; 15: 160-70.