osteotome-mediated sinus floor elevation using...

Osteotome-Mediated Sinus Floor ElevationUsing Only Platelet-Rich Fibrin: An Early

Report on 110 PatientsMichael Toffler, DDS,* Nicholas Toscano, DDS, MS,* and Dan Holtzclaw, DDS, MS†

The bone-added osteotome si-nus floor elevation (BAOSFE)technique1 and its reported

modifications2–5 represent substan-tially less invasive and less costlyalternatives for predictable implant in-stallation in the moderately deficientposterior maxilla. Introduced by Sum-mers1 in 1994, the BAOSFE proce-dure uses tapered concave-tippedosteotomes and graft materials to fa-cilitate sinus floor elevation (SFE)with concurrent implant placement.Osteotomes are used to apically dis-place the graft materials, fracturingthe sinus floor and elevating theschneiderian membrane. After this“bone-cushioned” SFE and additionof more of the graft mixture, an im-plant, referred to as “the final os-teotome,” is inserted resulting in atented grafting area with elevation ofthe sinus floor for several millime-ters.1 Many reports have appliedmodifications to Summers’ originalBAOSFE protocol to expedite theprocedure, minimize malletingforce, and simplify sinus floor in-fracture.2– 4 Other authors have sug-gested modifications to the BAOSFEprocedure in terms of instrumenta-tion,6 –10 grafting materials,11–14 andimplant surface and design.4,15,16

Clinical studies on osteotome-mediated SFE (OMSFE) with simulta-neous implant placement show a successrate between 88.6% and 100%.1–3,12,15–23

The primary determinant in implantsurvival with OMSFE procedures isthe residual subantral bone height(RSBH).3,20 Summers1 claimed that apreoperative RSBH of at least 5 to 6mm was needed for predictable im-plant success with the BAOSFE pro-cedure, and this has been confirmedby other reports.2,3,7,12,20 A review ofthe literature indicates that the implanttype, the choice of graft material, theabsence of graft material, and themethod of sinus floor infracture (di-rect or bone cushioned) exerted min-

imal influence on survival outcome;however, factors such as edentulism,osteoporosis, and an overdentureprosthesis have been shown to influ-ence postloading survival of im-plants placed in areas of limitedRSBH.3

Grafting material is traditionallyused in combination with OMSFE tocreate more bone volume to aid insupport of the implant. However, thereis no conclusive data in the literaturereporting on the possible advantageand maturation of a bone graft at theapical portion of the implant.24,25 Infact, recent reports have demonstratedsimilar degrees of localized SFE orendo/sinus bone gain (3–4.5 mm) and

*Private Practice limited to Periodontics, New York, NY.†Private Practice limited to Periodontics, Austin, TX.

Reprint requests and correspondence to: MichaelToffler, DDS, 116 Central Park South, Suite 3, NewYork, NY 10019, Phone: �1-212-581-4646, Fax:�1-212-757-0224, E-mail: [email protected]

ISSN 1056-6163/10/01905-447Implant DentistryVolume 19 • Number 5Copyright © 2010 by Lippincott Williams & Wilkins

DOI: 10.1097/ID.0b013e3181f57288

Purpose: This article describesa technique and reports on the earlyhealing for localized sinus augmen-tation using a crestal approach incombination with an autologousleukocyte- and platelet-rich fibrin(PRF) concentrate.

Materials: From November 2008to January 2010, 138 implants wereplaced in 110 patients usingosteotome-mediated sinus floor eleva-tion (OMSFE) with PRF.

Results: The mean residual sub-antral bone height of the alveolarridge was 6.6 mm (range, 4–8 mm).The mean increase in the height ofimplant sites by OMSFE/PRF was 3.4mm (range, 2.5–5 mm). A variety of 8-to 11.5-mm long (mean length, 10.1mm) and 3.5- to 6-mm wide (meanwidth, 4.4 mm) screw-type implants

were used. Of the 138 implants thathad been placed, 97 have been re-stored and in function for an aver-age loading time of 5.2 months(range, 1–11 months). The meanhealing time for the loaded implantswas 4 months until abutment inser-tion (range, 3–5 months). Three im-plants failed before loading for anearly survival rate of both loadedand unloaded implants of 97.8%.

Conclusions: Early review of theOMSFE/PRF technique presented forlocalized sinus floor elevation and im-plant placement demonstrates a highdegree of safety and success at siteswith 5- to 8-mm residual subantralbone height. (Implant Dent 2010;19:447–456)Key Words: growth factors, residualsubantral bone height, infracture

IMPLANT DENTISTRY / VOLUME 19, NUMBER 5 2010 447

equivalent implant survival rates(94%–100%), using no grafting mate-rials,12,13,23,26 –28 suggesting that themere tenting of the schneiderian mem-brane by the implant apex could initi-ate subantral bone formation.

The authors’ currently preferredOMSFE technique uses platelet-richfibrin (PRF) as the grafting material toaccelerate wound healing14,29,30 and toprovide membrane protection duringelevation and implant insertion. PRFis a second generation platelet concen-trate31,32 prepared from centrifugedblood. Simple centrifugation of wholeblood with no additives produces anautologous fibrin matrix rich in plate-let and leukocyte growth factors. It ishypothesized that these soluble mole-cules are trapped in the fibrin meshesof PRF and can be slowly releasedproducing a relatively long-term effectfor �7 to 14 days.31 PRF is also aninexpensive and easily handled mate-rial with healing properties on the si-nus membrane14 and bone.29,30,33,34 Itprovides protection for the sinus mem-brane during the use of the osteotome,and in case of perforation, the fibrinmatrix could help the wound clo-sure.14,35 Diss et al14 documented ra-diographic changes in the apical bonelevels on 20 patients with 35 micro-threaded implants placed usingOMSFE with PRF. Measurements ofthe changes in the endo/sinus bonelevel were attained radiographicallyand showed a mean gain of 3.2 mmwith the procedure. Despite a limitedRSBH (4.5–8 mm), a healing periodof 2 to 3 months was found to besufficient to resist a torque of 25 Ncmapplied during abutment tightening.One implant failed during the initialhealing, but at 1 year, all implantswere clinically stable, and the defini-tive prostheses were in function, re-sulting in a survival rate of 97.1%.

The predictability of OMSFEwith or without graft materials hasbeen clearly confirmed in previousarticles.2– 4,12–23,25–28 This article dem-onstrates similar early success andpresents a rationale for incorporatingconcentrated autologous growth fac-tors (PRF) into the procedure.

MATERIALS AND METHODS

Between November 2008 and Jan-uary 2010, in 110 patients, 138 siteswere treated; of these, 70 (92 sites)were women and 40 (46 sites) weremen. Patient age ranged from 34 to 90years (mean age, 58.4 years). Bothpartially and completely edentulous(3) patients were included. The esti-mated RSBH, as measured on a pre-operative digital radiograph, was 4 to8 mm. Intraoperative radiographicmeasurements were performed duringsurgery to more accurately assess theRSBH, so that the depth of sinuspenetration could be estimated afterimplant placement. All implantspenetrated at least 2 mm beyond theoriginal level of the sinus floor.

PRF Preparation

During surgery, 18 to 54 mL (2–6tubes) of whole blood was drawn into9-mL glass-coated plastic tubes with-out anticoagulant and immediatelycentrifuged (PRF Process, Nice,France) at 2700 rpm for 12 minutes.Within a few minutes, the absence ofanticoagulant induced the activationof platelets contained in the sample,thus triggering a coagulation cascade.The result was a fibrin clot located inthe middle of a mass of acellularplasma, with a maximum number ofplatelets and more than half of theleukocytes caught in the mesh of fi-brin. The clot was removed from thetube with a forceps (Fig. 1), and theattached red blood cells were shavedoff and discarded. The clots were thenplaced on a grid in the PRF box (PRFProcess) and compressed by a cover

(masher) to create a fibrin membrane(Fig. 2). Alternatively, the clots werealso placed in cylinders contained inthe box and compressed by pistons tocreate a fibrin plug (Fig. 3). PRF plugsare preferred over the membranesbecause they are simpler to insert,compress, and apically displace in theprepared osteotomy.

Implant Selection

The distribution of the 138 screw-type implants was as follows:

• sixty-four Neoss ProActive im-plants, 3.5 to 5.5 mm in diameterand 9 to 11 mm in length (Neoss,Woodland Hills, CA),

• forty Straumann SLA and SLAc-tive implants, 3.3 to 4.8 mm indiameter and 8 to 10 mm in length(Straumann, Andover, MA),

• twenty-three Biomet 3i OsseotiteNT-tapered screws, 4 to 6 mm indiameter and 8.5 to 11.5 mm inlength (Biomet 3i, Palm BeachGardens, FL),

• three Keystone XP-1 implants,4.8 mm in diameter and 10 mm inlength (Keystone Dental, Burling-ton, MA),

• three Astra Osseospeed implants, 4mm in diameter and 11 mm in length(Astra Tech, Lexington, MA),

• five Nobel BioCare TaperedGroovy implants, 5 to 6 mm in di-ameter and 10 mm in length (NobelBioCare, Yorba Linda, CA).

OMSFE/PRF Surgical Technique

All patients were premedicatedwith 2.0 g of amoxicillin or 500 mg ofazithromycin 1 hour before surgery.

Fig. 1. Pliers are inserted into the tube to gently grab the fibrin clot with attached red bloodcells.Fig. 2. Masher (cover) in PRF Box is used to compress the clots and create 4 PRF membranes.Serum exudate collects in the bottom of the box beneath the grid and is used to irrigate thesurgical site.Fig. 3. Piston compression of the fibrin clot results in the formation of an attached PRF plug.

448 OMSFE USING ONLY PRF • TOFFLER ET AL

Just before anesthesia, the patientrinsed with 0.12% chlorhexidine glu-conate for 1 minute, and the surgicalsite was cleaned thoroughly with thesame solution or Betadine on a cottonswab.

Full-thickness flaps were elevatedafter a midcrestal incision. Flap reflec-tion was usually minimized but had toprovide for adequate access and visu-alization to the entire ridge crest.

The authors used personally de-signed rapid-expansion-limited-bone(RELB) osteotomes (H&H Co., On-tario, CA) for localized SFE and si-multaneous implant placement inareas of limited bone height (4.0–8.0mm). The RELB osteotomes aremarked at 4, 5, 6, 8, and 10 mm, are2.0 to 5.5 mm in diameter, and haveeither a 0.5-mm tapered tip or areparallel-sided (Fig. 4). The osteotomesof choice must be available in straightor offset design because access to firstand second molar sites is very oftenlimited with straight osteotomes andcan result in less than ideal axial in-clination of the implant and trauma tothe lower lip. Osteotomes with a 30-degree offset are preferred as theyprovide adequate access without sac-rificing tactile sensitivity or instru-ment stability. A surgical mallet(H&H Co.) was used to advance theosteotomes.

The osteotome technique favoredby the authors most closely resemblesa modification of Summers’ BAOSFEtechnique,1 termed localized sinus lift,first reported by Cavicchia et al2 andfurther refined by Toffler.3 The tech-nique was performed in 4 steps: (1)

crestal bone site preparation with cal-ibrated drills, (2) direct sinus floorfracture with an osteotome, (3) sinusmembrane elevation with PRF as thegrafting material, and (4) implantplacement.

By using a surgical template to aidin implant positioning, an osteotomywas initiated at the future implant sitewith a 2.0-mm round bur. A 2.0-mmtwist drill was then advanced to adepth that was 0.5 to 1 mm from thesinus floor (working depth) as measuredfrom the preoperative radiograph. A 2.0-to 2.2-mm wide calibrated guide pinwas then inserted into the osteotomy,and this ideal subsinus position wasconfirmed radiographically beforeproceeding (Fig. 5). Another measure-ment of the RSBH was then taken bymeasuring the distance from the guidepin apex to the sinus floor and addingit to the known depth of the insertedpin. This measurement was recordedfor each patient as the RSBH beforeOMSFE. If a perforation was createdand detected (Fig. 6) during initialdrilling (3 patients), a calibrated probewas inserted to get an accurate readingof the RSBH. Once the working depthhad been established, the site was thencompletely prepared with the conven-tional sequence of drills needed for theplacement of an implant of the se-lected diameter. As the diameter of theosteotomy was widened, the surgeonascertained the residual bone quality.This determined the degree to whichthe osteotomy was to be underpre-pared relative to the final implantdiameter (range, 0.5–1.2 mm) to im-prove primary implant stability. In the

interest of patient comfort, the authorswidened the osteotomy using drillsonly, remaining 0.5 to 1 mm below thefloor of the sinus. The final diameterof the osteotomy was 0.5 to 1.2 mmsmaller than the implant diameter.Consistently maintaining the workingdepth and drilling to within �1 mm ofthe sinus floor minimizes the mallet-ing force required to displace residualbone beneath the sinus floor, therebyreducing the possibility of membraneperforation because of uncontrolledapical penetration of the osteotome.The patient’s head was stabilizedwhile malleting the osteotomes byplacing firm pressure on the forehead.A calibrated straight or offset RELBosteotome consistent with the apicaldiameter of the last drill used for im-plant site preparation was used toachieve the initial sinus floor infrac-ture. If the osteotome was not easilyadvanced, a slightly narrower (�1.0mm) osteotome was used or additionalapical preparation with drills was per-formed to pierce a dense spot in thebone. The moment of induced green-stick fracture of the sinus floor waseasily recognized as the layer of cor-tical bone forming the floor was dis-placed apically carrying the membraneup with it (Fig. 7). Immediately afterinfracture, the implant site was testedfor perforation of the sinus membraneby direct inspection and the Valsalvamaneuver, which was performed byasking the patient to blow through thenose (after pinching the nostrils),while holding a mirror directly under-neath the osteotomy site. Two perfo-rations were detected after infractureusing the maneuver. Once membraneintegrity had been verified, 2 to 4membranes or plugs made of PRFwere added to the osteotomy (Fig. 8)and compressed apically (Fig. 9) intothe developing subantral space by in-serting the osteotome to a depth equalto the measured RSBH. The PRF actsas a “membrane insurance” to possiblyseal any undetected perforation andprovides tenting of the antral mem-brane in advance of implant place-ment. Sites where a perforation wasdetected (5 sites), PRF was inserted inthe osteotomy, and an implant wasplaced no �2.0 to 3.0 mm into the

Fig. 4. RELB osteotomes (H&H Co.) have markings at 4, 5, 6, 8, and 10 mm and are 2.0 to 5.5mm in diameter and have a straight or 0.5-mm tapered tip.Fig. 5. Periapical radiograph of a 2.2-mm Neoss depth gauge confirms the ideal “workingdepth” of 7.0 mm before the drilled expansion of the osteotomy.Fig. 6. Small 2-mm perforation detected on the mesial aspect of the osteotomy as site 14.After insertion of 2 PRF plugs, a 9-mm implant will be safely placed, measuring 2 to 3 mmlonger than the RSBH.


sinus cavity. If the RSBH was �5 mmor the patient was using a removableprosthesis to replace the missing teeth,the implants were submerged to pre-vent inadvertent early loading. Animmediate postoperative periapical ra-diograph was taken to confirm sinusfloor intrusion and ideal implant posi-tioning (Fig. 10). The extent of SFEwas determined by subtracting the in-traoperatively measured RSBH fromthe implant length.

After surgery, all patients re-ceived (1) oral antibiotics for an addi-tional 3 to 6 days, (2) nonsteroidalanalgesics for 3 to 5 days, (3) detailedinstructions about oral hygiene (mouthrinses with 0.12% chlorhexidine for 2weeks), and (4) sinus-specific instruc-tions for the next 7 days including (a)no smoking or sipping through astraw, (b) sneezing with an openmouth, (c) no blowing of the nose, and(d) use of intranasal antihistaminemedication for 72 hours. Fixed pros-theses were immediately replaced andrelieved in the pontic area to avoidtraumatizing the surgical site. Remov-able prostheses were relined and re-placed 2 to 3 weeks postoperatively.Sutures were removed 8 to 15 daysafter surgery. Implants were allowedto heal for a minimum of 3 monthsbefore second-stage surgery if re-quired. Implant stability was testedwith an Osstell (Osstell AB, Gothen-berg, SW) device, and a new periapi-cal radiograph was taken to evaluatethe new position of the sinus floorrelative to the implant apex (Fig. 11).Healing abutments were placed ifsecond-stage surgery was required,and the implants were restored 2 to 3weeks later. Implant survival criteria

were as follows: (1) absence of clini-cally detectable implant mobility; (2)absence of pain or any subjective sen-sation; (3) absence of recurrent peri-implant infection; and (4) absence ofcontinuous radiolucency around theimplant.

RESULTS

Between November 2008 and Jan-uary 2010, 138 OMSFE/PRF proce-dures were performed in 110 patients.These procedures were accomplishedat 8 second molar sites, 62 first molarsites, 54 second bicuspid sites, and 14first bicuspid sites. The mean RSBHof the alveolar crest was 6.6 mm(range, 4–8 mm). The mean increasein the height of implant sites byOMSFE was 3.4 mm (range, 2.5–5mm). A variety of implant lengthswere used, including 8.0 to 8.5 mm(n � 7), 9 mm (n � 22), 10 mm (n �59), and 11.0 to 11.5 mm (n � 48). Atthe time of statistical analysis, of the138 implants that had been placed, 97had been restored and in function foran average loading time of 5.2 months(range, 1–11 months). The mean heal-ing time for the loaded implants was 4months until abutment insertion(range, 3–5 months). Five sinus mem-brane perforations were detected for adetectable perforation rate of 3.6%.Three occurred during the initial dril-ling and measured 2 mm in diameter,and two were discovered immediatelyafter sinus floor infracture. Three im-plants were lost, all before loading.Two implants failed 4 weeks postop-eratively because of infection. One ofthe implants was placed at the time ofextraction, and the other was placed 8

weeks after extraction. At both sites, 3to 4 mm of localized SFE and crestalbone augmentation were performed.At the immediate site, a perforationwas detected at the time of sinus floorinfracture. At the delayed site, theRSBH measured 4 mm. Both implantswere replaced 4 months later withoutcomplication using OMSFE and PRF.The third implant failure occurred in atotally edentulous maxilla at uncover-ing because of rotational instability.This implant was placed in 4 mm ofRSBH, and the patient wore her max-illary full denture throughout the heal-ing process of 5 months. It seems thatthe presence of minimal RSBH, un-controlled denture related forces, andsinus perforation increased the risk forfailure because of reduced primarystability, occlusal trauma, and localizedinflammatory or an altered healingresponse at a perforated sites. After sur-gery, 3 patients experienced nasal con-gestion and headache that abatedwithin a few days with the use of nasaldecongestants and prolonged antibiotics.One of these patients did experience aperforation during the procedure. Atup to 11 months of loading, all re-stored implants were clinically stable.When the restored and unrestored im-plants are combined, the early survivalrate is 97.8%.

DISCUSSION

A variety of SFE procedures havebeen proven to be successful in aug-menting the subantral bone volume inthe atrophic posterior maxilla.36 – 45

However, many of these techniquesare costly and invasive and requireextensive treatment time. This was therationale for Summers’ developmentof OMSFE procedures.1,46,47 Early re-ports on OMSFE incorporated partic-ulate graft materials to aid in sinusfloor infracture and tenting of the si-nus membrane around the implantapex.1,4 When using osteotomes to api-cally displace these potentially sharp-edged graft materials and bone chips,perforation of the sinus membranemay occur, but the real disadvantage isthat if the internal SFE is performedthis way, there is no opportunity todetect perforations unless they arevery large.22 Displacement of graft

Fig. 7. Extraction site 4 after direct infracture with 3-mm diameter RELB osteotome. Note: thinsinus floor connected to elevated membrane.Fig. 8. PRF plugs have been packed into osteotomies at sites 13 and 14 after direct infractureof the sinus floor.Fig. 9. PRF plugs are apically displaced to the level of the sinus floor to tent the membranebefore implant insertion.Fig. 10. The 4.1 � 10-mm and 3.3 � 10-mm Straumann Bone Level implants placed at sites4 and 5 with 2.5 to 4 mm of SFE using PRF.


material through the sinus membraneis a great concern, as it can lead totransient or chronic sinusitis in 10% to20% of sinus elevation cases, promptingthe need for additional treatment.48–51

Postoperative sinus infection, even iftreated early with antibiotics and sa-line rinsing, can potentially destroythe graft material and jeopardize im-plant success. In addition, if repeatedhard malleting of a column of graftmaterial does not result in sinus infrac-ture, the graft plug must be removed,additional apical preparation performed,and the grafting procedure repeated.Cavicchia et al.2 and Toffler3,45 foundthat the bone-cushioned approach wasimpractical unless the subantral bonewas extremely soft and a definite sinusfloor was not present, a feature that, intheir experience, was not frequentlyfound. These clinical concerns and thereported success of OMSFE withoutparticulate grafts12–14,23,26 –28 haveprompted many clinicians to excludegraft materials when performingOMSFE. For the less-experienced clini-cian, direct infracture without bonecushioning may increase the risk ofmembrane perforation, but as one be-comes more familiar with the tactile andauditory changes associated with si-nus floor encroachment, modifica-tion of the applied malleting forceresults in a more controlled, lesstraumatic infracture.3

Most authors report an aver-age bone height gain of 3 to 4 mmusing traditional osteotome proce-dures,3,15,19,22 and this report confirmstheir findings (Figs. 12 and 13).Greater degrees of elevation are attain-

able, but it will certainly increase theincidence and size of membrane per-foration.10,24 Fortunately, membraneperforations seem to have no long-term effect on implant survival, but itis more likely that a patient wouldexperience postoperative complica-tions at perforated sites. It is the au-thors’ opinion and standard operatingprotocol that at perforated sites, noparticulate materials should ever beplaced, solely 2 plugs of PRF, whichare inserted and apically displaced tothe working depth. The selected im-plant length should not be �2 to 3 mmthan that of the original RSBH. If thisdoes not allow for the placement of animplant at least 8 to 9 mm in length,the site is abandoned, and implantplacement is delayed for 3 months.This perforation protocol would seemjustified in light of the fact that in themajority of cases, small rifts of theschneiderian membrane will not dis-turb the healing process,12 and protru-sion of an implant 2 to 3 mm into thesinus without grafting material doesnot adversely affect apical bone for-mation or implant success.13,52–54

A previous report has noted a de-creased survival rate (23%) on im-plants placed in �5 mm of RSBH.3 Inthis study, 2 of 6 sites that had 4 mmof RSBH failed; 1 at 4 weeks and theother at uncovering because of rota-tional instability. On the basis of morerecent clinical experience, the authorswill place and submerge implants atsites with 4 mm of RSBH usingOMSFE/PRF only if they achieve ex-cellent primary stability with an im-plant stability quotient of 65 or more

and they are to be part of a multipleimplant-splinted restoration.55 It is feltthat these surgical and restorative re-strictions and the incorporation ofPRF and its slow release of growthfactors would provide equivocal suc-cess to those sites with �5-mmRSBH. The early results of this studyare in accordance with many publishedreports documenting both the predict-ability and the reliability of OMSFEprocedures.12–14,22,23

CONCLUSIONS

PRF may be used in lieu of par-ticulate grafting to predictably elevatethe sinus floor using a crestal ap-proach. The authors use PRF when-ever possible in OMSFE proceduresbased on its reported efficacy in mem-brane repair14,35 and its ability to re-duce sinus graft healing time.29 ThePRF membrane, or plug, also providesprotection for the sinus membraneduring the use of an osteotome, and incase of perforation, the fibrin matrixcan aid in wound closure.14

OMSFE procedures will continueto gain popularity in an economic en-vironment that favors less-invasiveand more affordable implant-supported rehabilitation of the poste-rior maxilla. The incorporation ofshorter implants,56,57 as well as easilyobtained and inexpensive patient-derived growth factors such as PRF,58

can readily compliment OMSFE so asto shorten treatment time, expand theindications, and broaden the appeal ofa minimally invasive approach totreating the moderately atrophic pos-terior maxilla.

Disclosure

The author Dr. Toffler designedthe rapid-expansion-limited-bone(RELB) osteotomes, which are manu-factured by H&H Co., Ontario, CA.He receives 10% on their sale from themanufacturer.

ACKNOWLEDGMENTS

The authors thank surgical assis-tants Tracey Lindsay, Gricel Crespo,

Fig. 11. After 4 months of healing, the new apical position of the sinus floor is evident.Fig. 12. Keystone XP-1 4.8 � 10-mm implant placed at site 14 with 4 mm of localized SFE.Note: localized inflammatory response in membrane to elevation with PRF.Fig. 13. After 3.5 months, the sinus floor is now located at the implant apex.


and Opal Lumbsden for their encour-agement and support.

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Abstract Translations

GERMAN / DEUTSCHAUTOR(EN): Michael Toffler, DDS, Nicholas Toscano,DDS, MS, Dan Holtzclaw, DDS, MSAnhebung des Sinusbodens mittels Osteotomie (OMSFE)unter ausschließlicher Verwendung von thrombozyten-reichem Fibrin: Ein fruher Bericht unter Einbeziehung von110 Patienten

ZUSAMMENFASSUNG: Zielsetzung: Die vorliegende Ar-beit beschreibt eine Methodik sowie die fruhen Heilerfolgebei einer lokalen Sinusanreicherung unter Verwendung einesKammgerichteten Ansatzes in Kombination mit einemautologen Leukozyten- und Thrombozytenreichen Fi-brinkonzentrat (PRF). Materialien und Methoden: VonNovember 2008 bis Januar 2010 wurden 110 Patienten ins-gesamt 138 Implantate durch Anhebung des Sinusbodensmittels Osteotomie (OMSFE) und unter zusatzlicher Ver-wendung von PRF eingepflanzt. Ergebnisse: Die durch-

schnittliche verbleibende Knochengewebshohe im Bereichunter der Kieferhohle (RSBH) des alveolaren Kamms lag bei6.6 mm (Werte zwischen 4 bis 8 mm). Das durchschnittlicheWachstum der Hohe der Implantierungsbereiche mitOMSFE/PRF lag bei 3.4 mm (Werte zwischen 2.5 bis 5 mm).Es wurde eine Auswahl von 8 bis 11.5 mm langen (durch-schnittliche Lange 10.1 mm) und 3.5 bis 6 mm breiten(durchschnittliche Breite 4.4 mm) Schraubimplantaten ver-wendet. Von den insgesamt 138 eingepflanzten Implantatenwurden 97 wiederhergestellt und blieben uber eine durch-schnittliche Belastungszeit von 5.2 Monaten (Werte zwischen 1bis 11 Monaten) vital und in Funktion. Die durchschnittlicheHeilungsdauer fur die belasteten Implantate lag bei 4 Monatenbis zur Einsetzung der Stutzapparatur (Werte zwischen 3 bis 5Monaten). 3 Implantate versagten bereits vor Belastung fur einefruhe Uberlebensrate von sowohl belasteten als auch un-belasteten Implantaten in Hohe von 97.8%. Schlussfolgerung:Eine fruhe Prufung der OMSFE/PRF Methodik fur eine lokal-isierte Anhebung des Sinusbodens sowie Implantatsetzung


zeigte ein hohes Maß an Sicherheit und Erfolg in den Bereichenmit einer verbleibenden Knochengewebshohe im Bereich unterder Kieferhohle von 5 bis 8 mm.

SCHLUSSELWORTER: Wachstumsfaktoren, verbleibendeKnochengewebshohe im Bereich unter der Kieferhohle, Infraktur

SPANISH / ESPAÑOLAUTOR(ES): Michael Toffler, DDS, Nicholas Toscano,DDS, MS, Dan Holtzclaw, DDS, MSElevacion del piso del seno a traves de osteotomos(OMSFE) usando solamente fibrina rica en plaquetas:Primer informe sobre 110 pacientes

ABSTRACTO: Proposito: Este trabajo describe una tecnica einforma sobre la curacion inicial del aumento localizado delseno usando un metodo crestal en combinacion con concen-trado de fibrina rica en plaquetas (PRF por sus siglas eningles) y leucocitos autologos. Materiales y metodos: Desdenoviembre de 2008 a enero de 2010, se colocaron 138 im-plantes en 110 pacientes usando una OMSFE con PRF.Resultados: El altura media residual del hueso subantral(RSBH) de la cresta alveolar fue 6.6 mm (variacion de 4 a 8mm). El aumento medio de la altura en los lugares de losimplantes con OMSFE/PRF fue 3.4 mm (variacion de 2.5 a 5mm). Se usaron una variedad de implantes tipo tornillo de 8 a11.5 mm de largo (longitud media de 10.1 mm) y de 3.5 a 6mm de ancho (ancho medio de 4.4 mm). De los 138 implantesque se habían colocado, 97 fueron restaurados y en funciondurante un período de carga promedio de 5.2 meses (varia-cion de 1 a 11 meses). El período medio de curacion para losimplantes cargados fue de 4 meses hasta la colocacion delpilar (variacion de 3 a 5 meses). Tres implantes fallaron antesde la carga para lograr una tasa de supervivencia inicial de losimplantes cargados y sin cargar del 97.8%. Conclusion: Unaevaluacion inicial de la tecnica OMSFE/PRF presentada parala elevacion localizada del piso del seno y colocacion delimplante demuestra un alto grado de seguridad y exito enlugares con RSBH de 5 a 8 mm.

PALABRAS CLAVES: Factores de crecimiento, altura resid-ual del hueso subantral, infractura

PORTUGUESE / PORTUGUÊSAUTOR(ES): Michael Toffler, Cirurgiao-Dentista, NicholasToscano, Cirurgiao-Dentista, Mestre em Ciencia, Dan Holtz-claw, Cirurgiao-Dentista, Mestre em CienciaElevacao da Superfície da Cavidade Mediada por Os-teotomo (OMSFE) Usando-se Apenas Fibrina Rica em Pla-quetas: Relatorio Precoce Sobre 110 Pacientes

RESUMO: Objetivo: Este artigo descreve uma tecnica erelata a cura precoce para aumento localizado da cavidadeusando-se uma abordagem de crista em combinacao com um

concentrado de leucocitos autologos e fibrina rica em plaqu-etas (PRF). Materiais e Metodos: De novembro de 2008 ajaneiro de 2010, 138 implantes foram colocados em 110pacientes usando-se OMSFE com PRF. Resultados: A alturaresidual media do osso subantral (RSBH) do rebordo alveolarera 6.6 mm (variacao 4 a 8 mm). O aumento medio na alturados locais de implante por OMSFE/PRF era 3.4 mm (varia-cao 2.5 a 5 mm). Uma variedade de implantes tipo parafusode 8 a 11.5 mm de comprimento (extensao media 10.1 mm)e 3.5 a 6 mm de largura (largura media 4.4 mm) foi usada.Dos 138 implantes que haviam sido colocados, 97 foram res-taurados e estiveram em funcionamento por um tempo de car-regamento medio de 5.2 meses (variacao 1 a 11 meses). O tempode cura medio para os implantes carregados foi 4 meses ate ainsercao do suporte (variacao 3 a 5 meses). Tres implantesfalharam antes do carregamento para uma taxa de sobrevivenciaprecoce tanto dos implantes carregados quanto dos descarrega-dos de 97.8%. Conclusao: A revisao precoce da tecnicaOMSFE/PRF apresentada para elevacao localizada da superfícieda cavidade e colocacao de implante demonstra um alto grau deseguranca e sucesso em locais com RSBH de 5 a 8 mm.

PALAVRAS-CHAVE: fatores de crescimento, altura residualdo osso subantral, fratura incompleta

RUSSIAN /��: Michael Toffler, �� -��, Nicholas Toscano, �� , �� , Dan Holtz-claw, �� , �� (Osteotome-Mediated Sinus Floor Elevation, OMSFE) � �� : �� !" ��#�� 110��

�$%&'$. (��. � �� , �� (PRF).'�� ! ��!. �� 2008 . �� 2010 . 110 �� 138 ��-��, �� OMSFE �� PRF. ��!. �� (RSBH)�� 6,6 �� (�� -�� 4 �� 8 ��). �� , �� OMSFE/PRF, �� 3,4 �� (�� 2,5�� 5 ��). !�� -�� 8 �� 11,5 �� (�� 10,1��) � �� 3,5 �� 6 �� (�� 4,4

454 ABSTRACT TRANSLATIONS • TOFFLER ET AL

��). "� 97 �� 138 �� ,� �� 5,2 �� (� �� 1 �� 11 ��). �� -�� 4 �� (�� 3 �� 5 ��). #�� . #�� , �� 97,8%. �!��.$�� OMSFE/PRF,�� , �� , ��RSBH �� 5 �� 8 ��.

)*&+$��$ ,*��: �� , �� , ��

TURKISH / TURKCEYAZARLAR: Michael Toffler, DDS, Nicholas Toscano,DDS, MS, Dan Holtzclaw, DDS, MSSadece Trombositten Zengin Fibrin Kullanılarak OsteotomAracılıgıyla Sinus Yukseltme (OASY): 110 Hastadan ErkenRapor

OZET: Amac: Bu calısma, bir kret yaklasımıyla birlikteotolog lokosit ve trombositten zengin fibrin (TZF) kon-santresi kullanılarak yapılan lokalize sinus ogmantasyonuteknigini tanımlamakta ve erken evrede iyilesmeyi anlatmak-tadır. Gerec ve Yontem: Kasım 2008�den ocak 2010�a kadar110 olguda TZF ile birlikte OASY kullanılarak 138 implantyerlestirildi. Bulgular: Alveoler sırtın ortalama reziduel sub-antral kemik yuksekligi 6.6 mm (4 ile 8 mm arasında) idi.OASY/TZF ile implant yerlerinde ortalama yukseklik artısı3.4 mm (2.5 ile 5 mm arasında) olarak bulundu. 8 ile 11.5 mmuzunlugunda (ortalama uzunlugu 10.1 mm olan) ve 3.5 ile 6mm genisliginde (ortalama genisligi 4.4 mm olan) vida tu-runden cesitli implantlar kullanıldı. Yerlestirilen 138 implant-tan 97’sine restorasyon uygulandı ve ortalama olarak 5.2aylık yukleme suresinde fonksiyon sagladı (1 ile 11 ay aras-ında). Yuklenen implantların abutman yerlestirmeye kadarortalama iyilesme suresi 4 ay idi (3 ile 5 ay arasında). Yukl-eme yapılmadan once 3 implant basarısızlıga ugradı ve boy-lece, yuklenmis ve yuklenmemis implantların erken sagkalımoranı %97.8 olarak bulundu. Sonuclar: Lokalize sinus yuk-seltme ve implant yerlestirme icin sunulan bu OASY/TZF teknigi-nin erken evrede degerlendirmesi, bu teknigin 5 ile 8 mm arasındareziduel subantral kemik yuksekligi ile birlikte yuksek duzeydeguvenlik ve basarı sagladıgına isaret etmektedir.

ANAHTAR KELIMELER: buyume faktorleri, reziduel sub-antral kemik yuksekligi, infraktur.

JAPANESE /


CHINESE /

KOREAN /

456 ABSTRACT TRANSLATIONS • TOFFLER ET AL

osteotome-mediated sinus floor elevation using...

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