New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation

Ji-Min Kim; Ju-Hyoung Lee; In-Sook Park

doi:10.5125/jkaoms.2011.37.4.278

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(4) > 1032478

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Kim, Lee, and Park: New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(4):278-286.

Published online: 7 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.4.278

New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation

Ji-Min Kim, Ju-Hyoung Lee, In-Sook Park

Division of Oral and Maxillofacial Surgery, Department of Dentistry, Daegu Catholic University Medical Center, Daegu, Korea

In-Sook Park Division of Oral and Maxillofacial Surgery, Department of Dentistry, Daegu Catholic University Medical Center 3056-6 Daemyung-4 dong, Nam-gu, Daegu, 705-718, Korea TEL: +82-53-650-4291 FAX: +82-53-622-7067 E-mail: ispark@cu.ac.kr

Received 29 March 201123 July 2011 Accepted 25 July 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

This study examined the predictability of new bone formation in the pneumatized maxillary sinus using only fibrin-rich blocks with concentrated growth factors as an alternative to bone grafts.

Materials and Methods

Maxillary sinus augmentation was performed in thirty-three patients with a deficient alveolar bone height (mean 3.9 mm). All patients were treated consecutively with sinus membrane elevation via the lateral window approach and panoramic radiograms and cone-beam computed tomograms were taken to evaluate the remaining bone height and the new bone formation in the maxillary sinus, before and after surgery. Four biopsy specimens were taken at the time of implant consolidation (after an average of five months healing) and were stained by H & E and Trichrome staining.

Results

None of the patients had postoperative complications during implant consolidation. After an average of 5 months since sinus augmentation, newly formed bone was observed in all cases by a radiographic evaluation. In 4 biopsy samples, newly formed bone was observed along the floor of the replaced bony window. The osteoblast lining and well distinguished Osteocytes in the lacunas were observed in the newly formed bone. Of the 74 implants (4 different surfaced implants - resorbable blast media-surfaced (RBM), Hydroxyapatite (HA) coated, acid-etched, sintered porous-surfaced implant) placed, one RBM implant failed. The success rate was 98.6% after a mean of 15 months.

Discussion

These results suggest that maxillary sinus augmentation using fibrin rich block with concentrated growth factors is a successful and predictable technique.

Keywords: Maxillary Sinus Augmentation, Fibrin rich blocks, Concentrated growth factors

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Fig. 1.

Cone-beam computed tomogram showing 2-5 mm bone height at the left maxillary first and second molar, respectively.

Fig. 2.

A fibrin rich block with concentrated growth factors made by a specific centrifugation (Medifuge, Silfradent srl, Sofia, Italy). The second and third layers were used for sinus augmentation.

Fig. 3.

Replacable bony window was created by piezoelectric saw insert (S-Saw, Bukboo Dental Co., Daegu, Korea) connected with piezoelectric device (Surgybone, Silfradent srl, Sofia, Italy) in all cases.

Fig. 4.

Sinus membrane was elevated until the height of superior osteotomy line of lateral bony window. It was brought to blood supply from median wall of the sinus.

Fig. 5.

After sinus membrane elevation, 2 pieces of fibrin rich block was inserted between sinus floor and elevated sinus membrane.

Fig. 6.

The bony window was repositioned to seal lateral window as a barrier.

Fig. 7.

On immediate postoperative cone-beam computed tomogram showing sinus membrane was elevated above the apexes of implants.

Fig. 8.

Cone-beam computed tomograms revealed new bone consolidation along the implant body at the left maxillary the first molar and second molar, respectively, after 17 weeks healing.

Fig. 9.

Cone-beam computed tomograms showing stable bone volume and implant prosthesis at first and second molar site.

Fig. 10.

Final prosthesis after eight months healing.

Fig. 11.

A, B. H&E stain, osteoblast lining (arrows) and well distinguished osteocytes in lacunas were observed in the newly formed bone, C, D. Trichrome stain, active new bone formation and osteoblast lining (arrows) were seen.

Table 1.

Data on study participants

Patient No.	Sex	Age (yr)	Site	Residual bone height (mm)	Implant length (mm)	Healing period (mo)	Achived bone height (mm)	Loading period (mo)	Membrane perforation (N/Y)
1	M	52	L max first molar	3.0	13	4.1	8	7.2	N
			L max second molar	2.0	11.5	4.1	8.5	7.2	N
2	M	49	R max second premolar	4.0	13	6.5	8.5	11.9	N
			L max second premolar	5.5	13	6.5	7	11.9	N
3	M	56	L max first molar	1.5	13	5.1	11	7.9	N
			L max second molar	3.0	13	5.1	10	7.9	N
4	M	61	R max first molar	6.0	12	2.6	7	7.8	N
5	F	56	L max first molar	8.0	13	4.2	5	12.7	N
			L max second molar	7.0	13	4.2	3	12.7	N
6	F	57	R max second premolar	4.0	13	4.9	10	12.0	N
			R max first molar	2.0	13	4.9	9	12.0	N
			L max second premolar	3.0	13	4.9	9	12.0	N
			L max first molar	3.0	13	4.9	10	12.0	N
7	F	60	L max first molar	2.0	13	4.7	12	6.6	N
			L max second molar	3.0	13	4.7	11	6.6	N
8	F	47	L max first molar	3.0	13	4.2	12	9.0	N
			L max second molar	2.0	13	4.2	16	9.0	N
9	F	44	R max first molar	4.0	13	4.1	9.5	7.6	N
			R max second molar	10	13	4.1	10	7.6	N
10	M	63	R max first molar	3.5	13	6.5	7	10.5	N
			R max second molar	5.0	13	6.5	7.5	10.5	N
			L max first molar	6.0	13	6.5	7	10.5	N
			L max second molar	5.0	13	6.5	9	10.5	N
11	M	60	R max first molar	4.0	12	5.1	10	8.0	N
			R max second molar	4.0	12	5.1	12	8.0	N
12	M	51	R max first molar	6.0	13	4.7	8.5	7.7	N
			R max second molar	3.0	13	4.7	10	7.7	N
			L max first molar	5.0	13	4.7	9	7.7	N
			L max second molar	3.0	13	4.7	9	7.7	N
13	F	45	L max first molar	3.5	13	4.6	12	8.9	N
			L max second molar	2.0	13	4.6	12	8.9	N
14	F	33	L max first molar	5.0	13	1.8	11.5	8.9	N
			L max second molar	2.0	13	1.8	10	8.9	N
15	M	48	R max first molar	5.5	13	4.4	8	13.1	N
			R max second molar	5.0	13	4.4	5	13.1	N
16	M	54	R max first molar	3.0	12	5.6	8	8.5	N
			R max second molar	5.0	12	5.6	10	8.5	N
			L max first molar	4.5	12	5.6	8.5	8.5	N
			L max second molar	2.5	12	5.6	11.5	8.5	N
17	F	64	R max first molar	1.5	13	6.3	12	8.3	N
			R max second molar	3.0	13	6.3	11	8.3	N
18	F	31	R max first molar	1.5	13	4.0	12	8.1	N
19	M	67	L max first molar	4.0	13	7.2	11	10.2	N
			L max second molar	3.5	13	7.2	9	10.2	N
20	M	61	R max second premolar	10	13	5.6	2	11.8	Y
			R max first molar	8.0	13	5.6	7	11.8	Y
			R max second molar	6.0	13	5.6	8	11.8	Y
21	M	31	L max second premolar	3.0	13	4.6	9	9.1	N
22	M	34	R max first molar	8.0	13	4.0	3	12.0	N
			R max second molar	6.0	13	4.0	7	12.0	N
23	M	51	R max first molar	3.0	13	4.0	12	10.4	N
24	F	30	R max first molar	2.0	13	4.1	13	12.8	N
25	M	47	R max second premolar	6.0	13	6.2	5	7.9	N
26	M	31	R max first molar	7.0	13	4.0	7	5.3	Y
27	F	54	R max first molar	5.0	12	4.2	7	8.2	N
28	F	37	R max first molar	5.0	11.5	5.3	8	7.9	N
29	F	65	R max first molar	6.5	13	4.0	8	4.6	N
			R max second molar	4.5	13	4.0	8.5	4.6	N
			L max first molar	2.5	13	4.0	10	4.6	N
			L max second molar	1.0	13	4.0	12	4.6	N
30	F	57	L max first premolar	2.0	13	7.5	9	4.5	N
			L max first molar	4.0	13	7.5	9	4.5	N
			L max second molar	1.0	13	7.5	10	4.5	N
31	F	42	R max first molar	2.0	12	1.5	12.5	5.5	N
			R max second molar	1.0	12	1.5	13	5.5	N
32	F	52	R max first molar	1.5	9	5.6	10	2.5	N
			R max second molar	0.5	9	5.6	8	2.5	N
			L max first molar	3.0	9	5.6	10	2.5	N
			L max second molar	2.0	9	5.6	7	2.5	N
33	M	49	R max second premolar	4.5	13	6.1	10	4.4	Y
			R max first molar	2.0	13	6.1	10	4.4	Y
			R max second molar	4.0	13	6.1	10	4.4	Y
			L max first molar	3.5	13	6.1	10	4.4	Y
			L max second molar	1.0	13	6.1	12	4.4	Y

(M: male, F: female, L: left, R: right, Max: maxilla)

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