Pichotano Elton Carlos, de Molon Rafael Scaf, Freitas de Paula Luiz Guilherme, de Souza Ricardo Violante, Marcantonio Elcio, Zandim-Barcelos Daniela Leal
1 Department of Diagnosis and Surgery, School of Dentistry at Araraquara, Sao Paulo State University - UNESP, Araraquara, SP, Brazil.
2 Department of Integrated Clinic, University Center of Anapolis - Unievangelica Dental School, GO, Brazil.
J Oral Implantol. 2018 Jun;44(3):199-206. doi: 10.1563/aaid-joi-D-17-00220. Epub 2018 Feb 19.
This case report aimed to describe the effects of leukocyte and platelet-rich fibrin (L-PRF) associated with demineralized bovine bone mineral (DBBM) and absorbable collagen membrane (CM) on bone regeneration in maxillary sinus augmentation. A 59-year-old male patient was referred to the Department of Periodontology for implant rehabilitation of his edentulous upper jaw. The treatment plan involved maxillary sinus augmentation followed by implant installations. A split-mouth design was employed in which the right maxillary sinus was filled using L-PRF, DBBM, and CM; the left side was filled with DBBM and CM. After 4 and 8 months postoperatively, 2 dental implants were installed in each of the right and left maxillary sinuses. Cone-beam computerized tomography (CBCT) was taken before and after sinus augmentation for evaluation of tridimensional bone volume alterations. Bone biopsies were harvested from the implant sites for histomorphometric evaluation. Resonance frequency analysis was employed immediately after implant placement and before prosthetic rehabilitation for evaluation of implant stability. Implants were loaded 10 months after sinus augmentation. CBCT analysis showed a higher resorption rate in the right side of the maxillary sinus (L-PRF + DBBM) compared to the left side (22.25% and 8.95%, respectively). Implant stability quotients were above 68 in all time-points for both groups. Histomorphometric analysis showed a high amount of newly formed bone when L-PRF was used compared with DBBM alone (2 118 102 and 975 535 mm, respectively). Taken together, both techniques were effective for maxillary sinus augmentation, however the addition of L-PRF to the graft allowed early implant placement and accelerated bone healing in the conditions studied.
本病例报告旨在描述富含白细胞和血小板的纤维蛋白（L-PRF）联合脱矿牛骨矿物质（DBBM）和可吸收胶原膜（CM）对上颌窦提升术中骨再生的影响。一名59岁男性患者因上颌无牙颌的种植修复被转诊至牙周病科。治疗方案包括上颌窦提升术，随后进行种植体植入。采用双侧对照设计，右侧上颌窦使用L-PRF、DBBM和CM填充；左侧填充DBBM和CM。术后4个月和8个月，在左右上颌窦各植入2颗牙种植体。在窦提升术前和术后进行锥形束计算机断层扫描（CBCT），以评估三维骨体积变化。从种植部位获取骨活检样本进行组织形态计量学评估。在种植体植入后立即和进行修复前采用共振频率分析评估种植体稳定性。在窦提升术后10个月对种植体进行加载。CBCT分析显示，上颌窦右侧（L-PRF + DBBM）的吸收速率高于左侧（分别为22.25%和8.95%）。两组在所有时间点的种植体稳定性商数均高于68。组织形态计量学分析显示，与单独使用DBBM相比，使用L-PRF时新形成的骨量较多（分别为2 118 102和975 535 mm）。综上所述，两种技术对上颌窦提升均有效，但在本研究条件下，在移植物中添加L-PRF可使种植体早期植入并加速骨愈合。
