Increasing Bone Regeneration in Maxillary Sinus Augmentation Using Platelet-rich Fibrin: An Interventional Pre-Post Study.

Abstract

Aim: This study aimed to evaluate the impact of a combination of immediate implant placement with maxillary sinus augmentation (MSA) solely using platelet-rich fibrin (PRF) on guided bone regeneration.

Materials and methods: An interventional before-after (pre-post) study design was used with 30 dental patients (≥18 years of age; 14 males and 16 females) with initial bone heights ranging between 4 and 6 mm. Following the general check-up and the creation of a study model, the planned implant location demonstrated an external right maxilla diameter of more than 5 mm, thereby validating the cone-beam computed tomography (CBCT) radiograph. The next step is the sinus lift operation, followed by the placement of dental implants. Production of PRF: 30 mL of venous blood was extracted and separated into three layers. The PRF was inserted into the space formed by the sinus floor and sinus membrane, and the flap was secured. The procedure involved creating an opening in the bone, separating the sinus membrane from the sinus floor, and making holes for implant insertion. The primary stability of the implant was assessed using an ISQ measurement device. Cone-beam computed tomography scans were taken and compared preoperatively, 6 months postoperatively, and follow-up assessments after 3 days, 7 days, and 6 months. And showed initial stability, pain, infection, blood bruises, peri-implant inflammation, osseointegration, bone loss around the implant, changes in bone thickness and sinus mucosa, and problems during the procedure. The Chi-squared test tested initial stability, whereas the paired sample t-test analyzed bone width and height changes.

Results: The study assessed the initial stability of a dental implant using bone density, with bones classified as D2 showing the strongest stability (76.7%). Three days after surgery, 26.7% of patients experienced mild pain, which decreased to 6.7% after 7 days. Six months later, the implant site showed no pain, no inflammation, and no bone loss. The ISQ was greater than 70, indicating strong integration with the surrounding bone. The thickness of the sinus membrane mucosa and alveolar bone changed significantly, with a significant difference (p < 0.05) in breadth and height. Sinus membrane perforation, hemorrhage, and flap tear were observed at a rate of 16.7%.

Conclusion: Exclusively using PRF was highly effective in augmenting the bone level during maxillary sinus lift surgery (MSA), especially for immediate implant-supported rehabilitation purposes.

Clinical significance: This study highlights the significance of using PRF to promote healing and enhance the thickness of bone in MSA without a bone graft in immediate implant placement. How to cite this article: Nguyen XT, Le LN, Do TT, et al. Increasing Bone Regeneration in Maxillary Sinus Augmentation Using Platelet-rich Fibrin: An Interventional Pre-Post Study. J Contemp Dent Pract 2024;25(9):814-819.