Estrin Nathan E, Basma Hussein, Espinoza Alan Rene, Pinto Marco Antonio Castro, Pikos Michael A, Miron Richard J
Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA.
Department of Periodontics, University of Alabama, Birmingham, Alabama, USA.
Clin Implant Dent Relat Res. 2025 Feb;27(1):e13427. doi: 10.1111/cid.13427. Epub 2024 Dec 13.
Platelet-rich fibrin (PRF) is being increasingly utilized in surgical procedures due to various improvements in clinical outcomes. More recently, a heating process to denature albumin in the platelet poor plasma (PPP) layer has been shown to extend the resorption time of PRF from a typical 2-week period to 4-6 months. Because of its > 4 month resorption properties, extended PRF (e-PRF) membranes have been used in dentistry as an alternative to collagen membranes in alveolar ridge preservations, ridge augmentations, soft tissue grafting, and as a barrier membrane in lateral sinus grafting procedures.
A total of 22 patients from 3 different clinical facilities participated in this multicenter case series study. All clinicians completed a standard lateral window sinus technique with sticky bone utilizing allograft, xenograft, or autologous dentin with an e-PRF membrane utilized for sole coverage of the lateral window. The survival rate at second stage implant surgery (~6 months) and radiographic analysis determined on consecutive radiographs: (1) the mean residual bone height (RBH) under the maxillary sinus at implant placement and (2) the change in endosinus bone level, were calculated to assess the endosinus bone changes at 6 months.
Between June 2022 and December 2023, 22 patients were included in this study. Patients included 12 women and 10 men with a mean age of 58.8 years, ranging from 32 to 78 years. In 22 lateral window sinuses completed, a total of 31 implants were placed. All patients healed uneventfully without any post-operative complications. Post-op CBCTs were taken at 6 months to demonstrate successful sinus floor augmentation and to calculate endosinus gain. No soft tissue invagination was encountered in any of the study participants nor displacement of the graft material into the buccal mucosa. In one case highlighted in this study, the e-PRF membrane was utilized to repair a sinus perforation. The average 6-month post-operative sinus height was 12.3 mm with a mean change in endosinus bone gain of 8.0 mm.
Utilizing extended-PRF membranes in place of collagen membranes for coverage of the lateral window during sinus floor elevation was shown to be a successful treatment modality in this case series. These findings provide new opportunities utilizing denatured albumin membranes in implant dentistry and paves the way for additional applications. The material is 100% autologous, low cost. This is the first case series study highlighting its novel use for coverage of the lateral window during sinus grafting. Larger longitudinal studies are now needed with comparison to standard resorbable membranes as well as long-term follow-up of implants placed into sites grafted with e-PRF membranes.
由于临床疗效的各种改善，富血小板纤维蛋白（PRF）在外科手术中越来越多地被使用。最近，一种使血小板贫乏血浆（PPP）层中的白蛋白变性的加热过程已被证明可将PRF的吸收时间从典型的2周延长至4 - 6个月。由于其超过4个月的吸收特性，延长型PRF（e - PRF）膜已在牙科中用作牙槽嵴保存、嵴增宽、软组织移植中的胶原膜替代品，以及在外侧鼻窦移植手术中作为屏障膜。
来自3个不同临床机构的22名患者参与了这项多中心病例系列研究。所有临床医生均采用标准的外侧开窗鼻窦技术，使用同种异体移植物、异种移植物或自体牙本质进行粘骨操作，并使用e - PRF膜单独覆盖外侧开窗。在第二阶段种植手术（约6个月）时的存活率以及通过连续X线片进行的影像学分析：（1）种植体植入时上颌窦下方的平均剩余骨高度（RBH）和（2）窦内骨水平的变化，用于计算6个月时的窦内骨变化情况。
在2022年6月至2023年12月期间，本研究纳入了22名患者。患者包括12名女性和10名男性，平均年龄为58.8岁，年龄范围为32至78岁。在完成的22个外侧开窗鼻窦中，共植入了31颗种植体。所有患者均顺利愈合，无任何术后并发症。术后6个月进行CBCT检查以证明鼻窦底增高成功并计算窦内骨增量。在任何研究参与者中均未遇到软组织内陷，也没有移植材料移位至颊黏膜。在本研究突出的一个病例中，e - PRF膜被用于修复鼻窦穿孔。术后6个月的平均鼻窦高度为12.3毫米，窦内骨增量的平均变化为8.0毫米。
在本病例系列中，在鼻窦底提升过程中使用延长型PRF膜代替胶原膜覆盖外侧开窗被证明是一种成功的治疗方式。这些发现为在种植牙科中使用变性白蛋白膜提供了新的机会，并为更多应用铺平了道路。该材料是100%自体的，成本低。这是第一项突出其在鼻窦移植过程中用于覆盖外侧开窗的新用途的病例系列研究。现在需要进行更大规模的纵向研究，与标准可吸收膜进行比较，并对植入用e - PRF膜移植部位的种植体进行长期随访。
