Crestal Sinus Lift-Sinus Crestal Approach Kit and Simultaneous Implant Placement Using Platelet Rich Fibrin as an Exclusive Graft Material

Abstract

Background: Sinus augmentation surgery has become a well accepted preprosthetic procedure for creating sufficient bone volume for the placement of endosseous implants in the atrophic posterior maxilla. All of the indirect sinus augmentation procedures to bring about sinus lift present the possibility of Schneiderian membrane perforation, the most common intraoperative complication with these techniques, with perforation rates of 21.4% on an average reported in the literature. This complication can occur either during osteotomy, which is performed with burs, or during the elevation of the membrane. Several other post operative complications reported are due to the malleting forces - benign paroxysmal vertigo, headache, excessive bleeding and other sinus complaints. During sinus-lift, the biomaterials are used as space maintainers and bone scaffold to promote bone formation in the sub sinus area. As evidenced by literature, when graft is not used, some authors have shown that true bone gain is in fact always limited and that implant apical ends might be enmeshed in the sinus connective tissue and, thus, not osseointegrated. Methods: To evaluate the Efficacy of Sinus Crestal Approach (SCA) kit for Indirect sinus lift surgeries and further evaluate the bone regenerative property and over all utility of Platelet rich-fibrin when used as the exclusive graft material for sinus lift cases. Fifteen healthy patients seeking replacement of missing teeth in atrophic posterior maxilla or pneumatisation of sinus with all other situations ideal for placing implants were chosen. SCA kit was used for the surgical intervention. Endosseous implants of appropriate length and diameter with autologous graft material (PRF) was placed in the premolar-molar region.All patients were followed for clinical and radiological evaluation using IOPAR and digital OPG after 1 week, 3, 6 and 12 months period. Results and Conclusion: SCA kit is an innovative tool to perform indirect sinus augmentation surgery in the atrophic posterior maxilla for prosthetic rehabilitation with limited complications. At the end of the study, the mean endosinus bone gain measured on the proximal sides of the implant was 1.2mm. Choukroun’s PRF used as sole filling material during the sinus lift and simultaneous implantation creates space and acts as a scaffold for predictable bone formation.