A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study.

PURPOSE: This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets. MATERIALS AND METHODS: A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05. RESULTS: No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30). CONCLUSION: Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

The Effects of Injectable Platelet-Rich Fibrin and Advanced-Platelet Rich Fibrin on Gingival Fibroblast Cell Vitality, Proliferation, Differentiation.

BACKGROUND: Injectable Platelet Rich Fibrin (I-PRF) and Advanced-Platelet Rich Fibrin (A-PRF) are autologous materials derived from patients' blood and employed in periodontal regenerative surgery. Although I-PRF and A-PRF have different characteristics, their biological effects on gingival tissue fibroblasts remain unclear. This research aims to compare the in vitro capacity in inducing gene expression and proliferation of human gingival fibroblasts between A-PRF and I-PRF. METHODS: Human donors undergoing dental implant surgery were sampled for normal human gingival fibroblasts (NHGFCs), followed by preparing A-PRF and I-PRF membranes. Enzyme-linked immunosorbent assay (ELISA) kit was used to assess the release of platelet-derived growth factor-AA (PDGF-AA), transforming growth factor-beta1 (TGF- ß1), and insulin growth factor-1 (IGF-1) at different periods. Cell viability and proliferation of A-PRF and I-PRF were compared using CCK-8 assay. The impacts of platelet concentration on human gingival fibroblast cells (HGFCs) were evaluated by quantifying the level or amount of phosphorylated extracellular signal-regulated protein kinase (p-ERK), and Matrix metalloproteinases (MMPs), MMP-1 and MMP-3. The effects of PRF on aged human gingival fibroblast cells were examined retrospectively. RESULTS: Overall, A-PRF demonstrated a higher release of TGF-B1 and PDGF-AA, while I-PRF reflected higher levels of IGF-1. A significantly higher level of cell proliferation was induced by higher cell proliferation by A-PRF and I-PRF. Additionally, in comparison to I-PRF, the expression of ERK phosphorylation and MMP-1 &MMP-3 in HGFCs was demonstrated by I-PRF and A-PRF. The increase in A-PRF was time-dependent (p < 0.05). CONCLUSION: Both I-PRF and A-PRF induced a stimulatory biological impact on the proliferation of human gingiva fibroblasts, with the latter demonstrating better capacity in facilitating the release of different growth factors. A-PRF also induced higher gene expression of p-ERK, MMP-1 &MMP-3, and the proliferation of fibroblasts.

Immediate implant placement with simultaneous bone augmentation versus delayed implant placement following alveolar ridge preservation: A clinical and radiographic study.

OBJECTIVE: The present study aimed to evaluate the clinical and radiographic outcomes of immediate implant placement (IIP) with guided bone regeneration (GBR) as compared to delayed implant placement (DIP) following alveolar ridge preservation (ARP) and to identify the potential risk factors influencing these outcomes. METHODOLOGY: A total of 56 patients (IIP = 28 vs. DIP = 28) with class I or II bony defects received 56 implants were included. GBR procedure using Bio-Oss® bone substitute mixed with advanced platelet-rich fibrin (A-PRF) and covered by Bio-Gide® membrane and additional A-PRF membrane was performed either simultaneously with the IIP or earlier at the time of ARP in DIP. Clinical and 3-D radiographic analyses of bone level, thickness, and density were performed at three-time intervals (T1, immediately; T2, 6-7 months; and T3, 1.5 to 2 years post-implantation), corresponding to the neck, coronal, middle, and apex of implants. RESULTS: The survival rate was 100% in both groups. IIP showed significant favorable outcomes regarding distal marginal bone level (anterior maxilla, T1-T3) and neck and coronal horizontal facial bone thickness (HFBT) (posterior maxilla, T1; and anterior maxilla, T1-T3, respectively) compared to DIP. However, DIP showed significant facial bone density at the neck and coronal parts in the anterior maxilla (T1) and the coronal part in the posterior maxilla (T3). The facial marginal bone level change was positively correlated with HFBT change (P = 0.007), which is negatively correlated with the secondary implant stability (P = 0.019). The implant region (anterior or posterior maxilla) was the only factor affecting on Implant stability quotient value (ISQ) and change in HFBT (P Ë‚ 0.05). CONCLUSION: Overall, the IIP combined with GBR in the post-extraction sites with pre-implant class I or II bony defects had some favorable outcomes compared to DIP after ARP. However, the clinical outcomes, ISQ value, and changes in bone level, thickness, and density from T1-T3 were comparable.