Department of Diagnosis and Surgery, School of Dentistry at Araraquara, São Paulo State University - UNESP, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil.
Private practice, School of Medicine of Ribeirão Preto, Sao Paulo University - USP, Ribeirao Preto, Sao Paulo, 14040-904, Brazil.
Clin Oral Investig. 2023 Sep;27(9):5485-5498. doi: 10.1007/s00784-023-05167-z. Epub 2023 Aug 15.
The resorption of alveolar ridge bone and maxillary sinus pneumatization are challenges to implant-supported prosthetic rehabilitation. Bone regeneration using bone substitutes and growth factors are alternatives for maxillary sinus augmentation (MSA). Therefore, we sought to evaluate the effects of the association between leukocyte and platelet-rich fibrin (L-PRF) and deproteinized bovine bone mineral (DBBM) in MSA procedures.
Thirty-six maxillary sinuses from 24 individuals were included in this randomized clinical trial. The maxillary sinuses were randomly grafted with LPRF and DBBM (test group) or grafted only with DBBM (positive control). Dental implants were installed in the test group following two periods of evaluation: after 4 (DBBM+LPRF4) and 8 (DBBM+LPFR8) months of sinus graft healing, while the control group received implants only after 8 months. Cone beam computed tomography (CBCT) was taken 1 week after surgery (T1) and before implant placement (T2). Bone samples were collected during implant placement for histomorphometric and immunohistochemical (IHC) analysis. The primary implant stability was assessed by resonance frequency analysis.
CBCT analysis demonstrated a significant decrease in bone volume from T1 to T2 in all groups without differences among them. Histologically, the test group showed significantly increase in bone neoformation in both periods of evaluation (LPRF+DBBM4: 44.70±14.01%; LPRF+DBBM8: 46.56±12.25%) compared to the control group (32.34±9.49%). The control group showed the highest percentage of residual graft. IHC analysis showed increased staining intensity of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and runt related transcription factor 2 (RUNX-2) in LPRF+DBBM4 group, and osteopontin (OPN) in the L-PRF+DBBM8. Primary implant stability was successfully achieved (above 60 in implant stability quotient) in all the evaluated groups.
Combination of L-PRF and DBBM increased and accelerated new bone formation allowing early implant placement probably due to the higher protein expression of RUNX2, VEGF, OCN, and OPN. These data suggest that the use of L-PRF might be an interesting alternative to use in combination with DBBM for augment the maxillary sinuses allowing the installation of appropriate length implants in shorter period of time.
This study showed improvement in bone neoformation and accelerated healing when associating L-PRF and DBBM for maxillary sinus augmentation procedures.
This study was registered before participant recruitment in Brazilian Registry of Clinical Trials (ReBEC - RBR-95m73t).
牙槽嵴骨吸收和上颌窦气化是影响种植体支持修复的挑战。使用骨替代物和生长因子进行骨再生是上颌窦提升（MSA）的替代方法。因此，我们旨在评估白细胞和富血小板纤维蛋白（L-PRF）与脱蛋白牛骨矿物质（DBBM）联合应用于 MSA 手术中的效果。
本随机临床试验纳入了 24 名个体的 36 个上颌窦。上颌窦随机接受 L-PRF 和 DBBM（实验组）或仅接受 DBBM（阳性对照组）移植。实验组在窦腔移植愈合后 4 个月（DBBM+LPRF4）和 8 个月（DBBM+LPFR8）进行两次评估后植入牙种植体，而对照组仅在 8 个月后植入牙种植体。手术 1 周后（T1）和植入前（T2）进行锥形束 CT（CBCT）检查。在植入物放置过程中采集骨样本进行组织形态计量学和免疫组织化学（IHC）分析。通过共振频率分析评估初始种植体稳定性。
所有组在 T1 至 T2 期间均显示出骨量的显著减少，但组间无差异。组织学上，实验组在两个评估期（LPRF+DBBM4：44.70±14.01%；LPRF+DBBM8：46.56±12.25%）显示出明显的新骨形成增加，与对照组（32.34±9.49%）相比。对照组显示出最高比例的剩余移植物。IHC 分析显示，L-PRF+DBBM4 组中骨钙素（OCN）、血管内皮生长因子（VEGF）和 runt 相关转录因子 2（RUNX-2）的染色强度增加，而 L-PRF+DBBM8 组中骨桥蛋白（OPN）的染色强度增加。所有评估组均成功实现了初始种植体稳定性（种植体稳定性系数大于 60）。
L-PRF 与 DBBM 的联合应用增加并加速了新骨形成，从而可能更早地植入种植体，这可能归因于 RUNX2、VEGF、OCN 和 OPN 的更高蛋白表达。这些数据表明，使用 L-PRF 可能是一种有趣的替代方法，与 DBBM 联合应用于上颌窦提升术，可在更短的时间内植入合适长度的种植体。
本研究表明，在 MSA 手术中联合使用 L-PRF 和 DBBM 可改善新骨形成并加速愈合。
本研究在巴西临床试验注册中心（ReBEC-RBR-95m73t）进行参与者招募前进行了注册。
