Sinus Augmentation With Platelet-Rich Fibrin in Combination With Bovine Bone Graft Versus Bovine Bone Graft in Combination With Collagen Membrane
The purpose of this study was to compare the efficacy between the use of bovine bone graft material and platelet-rich fibrin (PRF) mixture (test group) and bovine bone graft material and collagen membrane combination (control group) in 2-stage maxillary sinus augmentation. According to specific inclusion/exclusion criteria, patients treated between 2008 and 2012 were selected. Panoramic radiographs were used for radiologic assessments. To evaluate the relationship between sinus-graft height and each implant, the bone level (BL) was divided by implant length (IL). To evaluate the change in the height of grafted sinus, the grafted sinus floor above the lowest part of the original sinus height (GSH) was divided by the original sinus height (OSH). Samples taken during implant surgery were used for histologic and histomorphometric analyses. Twenty-five patients, 32 augmentation surgeries, and 66 one-stage implants were included in the study. No implant loss or complication was observed in either group. There were no statistical differences according to new bone formation (P = .61) and biomaterial remnant (P = .87). During the evaluation period, the test group showed statistically less change in the BL/IL ratio (P = .022). The difference of GSH/OSH ratio was found to be insignificant between groups (P = .093). It was observed that the grafted sinus covering the implant apex and sinus floor was above the original sinus height in both groups. It may be concluded from this study that both combinations can be successfully used for sinus augmentation. Further studies evaluating different graft materials and PRF combinations in the early phases of healing would be beneficial.
Figure 1. Treatment stages of a patient treated with platelet-rich fibrin (PRF) and bovine bone graft material. (a) Schneiderian membrane was covered by PRF membrane. (b) Sinus cavity was filled with bovine bone graft and PRF in 1:2 ratios. (c) The osteotomy window was covered with PRF membrane. (d) Panoramic image 6 months after the prosthetic loading (T3). Figure 2. Treatment stages of a patient treated with bovine bone graft material and resorbable collagen membrane. (a) Schneiderian membrane was covered by resorbable collagen membrane. (b) Sinus cavity was filled with bovine bone graft. (c) The osteotomy window was covered with resorbable collagen membrane. (d) Panoramic image 6 months after the prosthetic loading (T3).
Figure 3. Diagram for the measurement of bone level and height. IL indicates implant length; BL, bone level; OSH, original sinus height; and GSH, grafted sinus height. Figure 4. The number of implants per site according to ADA Dental Terminology, 2011–2012.
Figure 5. (a) In the test group, newly formed bone trabeculae (BT), connective tissue (CT), and remnants of biomaterial (RB) are observable. Remnants of biomaterial were surrounded by bone trabeculae and connective tissue (hematoxylin and eosin, original magnification ×63). (b) In the control group, newly formed BT, CT, and RB are observable. Remnants of biomaterial were surrounded by bone trabeculae and connective tissue (hematoxylin and eosin, original magnification ×63). Figure 6. (a) In the test group, histologic detail showing cuboidal osteoblasts which are active bone-forming cells (black arrows) and osteocytes within bone lacunae (white arrow) (hematoxylin and eosin, original magnification ×400). (b) In the control group, histologic detail showing cuboidal osteoblasts that are active bone-forming cells (black arrows) and osteocytes within bone lacunae (white arrow) (hematoxylin and eosin, original magnification ×400). Figure 7. (a) In the test group, a multinucleated osteoclast (arrow) is observable at the newly formed bone trabeculae surface (hematoxylin and eosin, original magnification ×400). (b) In the control group, a multinucleated osteoclast (arrow) is observable at the newly formed bone trabeculae surface (hematoxylin and eosin, original magnification ×400).
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