Use of Plasma Rich in Growth Factor for Schneiderian Membrane Management During Maxillary Sinus Augmentation Procedure
The aim of this pilot study was to present a novel technique for the management of the Schneiderian membrane during maxillary sinus lift surgery using plasma rich in growth factors (PRGF). Eight maxillary sinuses were augmented in 8 patients. Two small perforations of the Schneiderian membrane occurred during the lifting procedure, which were solved using the PRGF clot before grafting the site with PRGF and anorganic bovine bone. With the exception of 1 patient who experienced pain following an acute sinus infection after 3 days of uneventful healing, the patients' postoperative quality of life was generally good. The most common complication (50% of cases) was hematoma, which disappeared after 1 week. Despite the limitations of this study concerning the sample size and the study design, the use of PRGF may be helpful in reducing complications following sinus lift surgery. More well-designed studies, with larger sample size, are needed to validate this protocol.
Figure 1. Computerized tomography scans showing low residual bone height in the atrophic posterior maxilla. Figure 2. Trapezoidal flap design. Figure 3. Mucoperiosteal flap reflection. Figure 4. An ellittic window was created in the sinus wall through the piezoelectric device.
Figure 5. Plasma rich in growth factors (PRGF) clot was placed over the window, adherent to the Schneiderian membrane. Figure 6. Sinus membrane was lifted through the use of an appropriate instrument. The presence of the PRGF clot protected the membrane itself during such a maneuver. Figure 7. After complete lifting, the PRGF clot remains strictly adherent to the lifted sinus membrane. Figure 8. Evaluation of the depth and height of the newly created cavity. Figure 9. The cavity is filled with deproteinized bovine bone matrix (big granules) mixed with PRGF liquid. Figure 10. The fibrin membrane is placed close to the window, protecting the bone graft and with the aim of enhancing soft-tissue healing. Figure 11. Postsurgical radiographic control. Width evaluation. Figure 12. Postsurgical radiographic control. Height evaluation.
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