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评价富血小板纤维蛋白(L-PRF)联合脱蛋白牛骨矿物质在上颌窦提升后早期植入的效果:一项随机临床试验。

Evaluation of L-PRF combined with deproteinized bovine bone mineral for early implant placement after maxillary sinus augmentation: A randomized clinical trial.

机构信息

Department of Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil.

School of Medicine of Ribeirao Preto, Sao Paulo University - USP, São Paulo, Brazil.

出版信息

Clin Implant Dent Relat Res. 2019 Apr;21(2):253-262. doi: 10.1111/cid.12713. Epub 2019 Jan 28.

Abstract

PURPOSE

To investigate the effectiveness of adding leukocyte and platelet-rich fibrin (L-PRF) to deproteinized bovine bone mineral (DBBM) for early implant placement after maxillary sinus augmentation.

MATERIALS AND METHODS

Twelve patients requiring two-stage bilateral maxillary sinus augmentation were enrolled to the study. The elevated sinus cavities were randomly grafted with DBBM + L-PRF (test) or DBBM alone (control) in a split-mouth design. Implants were placed in the augmented sites after 4 months in the test group and 8 months in the control group. Bone biopsies were collected during implant placement for histomorphometric evaluation. Resonance frequency analysis was performed immediately after implant placement and at implant loading in both groups. Cone-beam computed tomography was obtained preoperatively and postoperatively for evaluation of graft volume changes.

RESULTS

Both procedures were effective for maxillary sinus augmentation. Cone-beam computed tomography analysis did not reveal differences in graft volume between test and control group at any of the evaluated time points (P > .05). Histological evaluation demonstrated increased percentage of newly formed bone for the test group (44.58% ± 13.9%) compared to the control group (30.02% ± 8.42%; P = .0087). The amount of residual graft in the control group was significantly higher (13.75% ± 9.99%) than in the test group (3.59 ± 4.22; P = .0111). Implant stability quotient (ISQ) immediately after implant placement was significantly higher in the control group (75.13 ± 5.69) compared to the test group (60.9 ± 9.35; P = .0003). The ISQ values at loading did not differ between the groups (P = .8587). Implant survival rate was 100% for both groups.

CONCLUSION

The addition of L-PRF to the DBBM into the maxillary sinus allowed early implant placement (4 months) with increased new bone formation than DBBM alone after 8 months of healing.

摘要

目的

研究在去蛋白牛骨矿物质(DBBM)中添加白细胞和富血小板纤维蛋白(L-PRF)对上颌窦提升后早期植入物放置的效果。

材料和方法

本研究纳入了 12 名需要进行双侧上颌窦提升两期手术的患者。采用随机分组的方法,将提升后的窦腔分别用 DBBM+L-PRF(试验组)或 DBBM 单独(对照组)进行骨移植。在试验组,植入物在提升后 4 个月,在对照组 8 个月后放置。在植入物放置过程中采集骨活检标本进行组织形态计量学评估。在两组中,均在植入物放置后即刻和负荷时进行共振频率分析。术前和术后均行锥形束计算机断层扫描评估移植体积变化。

结果

两种手术方法对上颌窦提升均有效。在任何评估时间点,CBCT 分析均未显示试验组和对照组之间的移植体积有差异(P>.05)。组织学评估显示,与对照组(30.02%±8.42%)相比,试验组(44.58%±13.9%)的新骨形成百分比增加(P=0.0087)。对照组中残留移植物的量明显高于试验组(13.75%±9.99%,3.59%±4.22%;P=0.0111)。植入物放置后即刻的种植体稳定性指数(ISQ)在对照组(75.13±5.69)显著高于试验组(60.9±9.35;P=0.0003)。两组在负荷时的 ISQ 值无差异(P=0.8587)。两组的种植体存活率均为 100%。

结论

与单独使用 DBBM 相比,将 L-PRF 添加到 DBBM 中可以在上颌窦中更早地植入(4 个月),并在 8 个月的愈合期后增加新骨形成。

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