| Objective:This study aimed to assess the clinical effect of the technique of transalveolar sinus floor elevation with simultaneous implant placement using platelet-rich fibrin membrane as sole grafting material when the residual bone height ≤5 mm.Methods:This study included patients whose residual bone heights ≤ 5 mm in the maxillary posterior area between April 2017 to December 2019 at the Oral Implantology Department of Jilin University Dental Hospital.In the transalveolar sinus floor elevation(TSFE)technique,implants were placed simultaneously,and the PRF membranes obtained by centrifugation of the patients’ blood were used as sole grafting material.The basic informations of patients were recorded,and we observed whether the intraoperative and postoperative complications occured,such as sinus membrane perforations,wound infections,maxillary sinusitis,etc.The implant stability quotient(ISQ value)was measured at the 2nd and 3rd month after the operation.For each patient,preoperative and postoperative(1、3、6、12 months after the surgery)CBCT imaging datas were collected to evaluate the following indicators: the residual bone height(RBH),the protruded implant length(PIL),peri-implant bone level(IBL),new bone height(NBH),new bone percentage(NBP),implant apicial bone height(IABH),marginal bone loss(MBL)and sinus grafting remodeling index(SGRI).At 1 year after operation,the implant cumulative survival rate and patients’ satisfaction were examined and recorded.SPSS 19.0 software was used for correlative statistical analysis.Results:According to the inclusion and exclusion criteria,21 implants were collected in this study.Except for 2 case failures,all the implants could function normally after dental restoration.The cumulative survival rate of implants was 90.5% at 12 months after the operation.Except for a few patients with mild facial swelling,pain and other postoperative routine reactions,there were no sinus mucosa membrane perforations,wound dehiscences,infections,and maxillary sinusitis in all cases.The ISQ value of implants was 63.51 ± 7.03 and 69.54 ± 6.45 at the 2nd and 3rd months after the operation,respectively,with statistical significance(P < 0.05).For 19 survival implants,the mean residual bone height was 3.86±1.09 mm(ranging from 1.5 to 5 mm)prior to operation.The mean protruded implant length into the maxillary sinus was 7.08 ± 1.18 mm after the operation.The peri-implant bone level was 9.65 ± 1.77 mm,9.66 ± 1.82 mm and 9.78 ± 1.97 mm at 3,6 and 12 months after the operation,respectively,there was no significant difference(P > 0.05).The new bone height at 3,6 and 12 months after operation was 5.79 ± 1.73 mm,5.80± 1.67 mm and 5.92 ± 1.80 mm,respectively,there was no significant difference(P >0.05).The new bone percentage at 3,6 and 12 months after the operation was 82.7%,83.6% and 85.3%,respectively,there was no significant difference(P > 0.05).The implant apicial bone height at 3,6 and 12 months after the operation was-1.53 ± 1.41 mm,-1.40 ± 1.49 mm,-1.42 ± 1.45 mm,respectively,there was no significant difference(P > 0.05).The level of marginal bone loss was low at 6 and 12 months after the operation,was 0.06 ± 0.44 mm and 0.21 ± 0.65 mm,respectively,there was no significant difference(P > 0.05).During 1 to 12 months after the operation,the SGRI indexe showed an increasing trend.The SGRI index was mainly 1(84.2% of the total implants)at 1 month postoperative.The SGRI index was mainly 2(89.4% of the total implants)at 3months postoperative.The SGRI index was mainly 2 and 3(47.4% respectively)at 6months postoperative.Bone remodeling in the sinus was basically completed at 12 months postoperative,and the SGRI index was mainly 3(73.7% of the total implants).The patients’ satisfaction was 100% at 1-year follow-up,81.8% of patients felt very satisfied.Conclusions:In this study,the PRF membrane was used alone for the the technique of transalveolar sinus floor elevation with simultaneous implant placement,when the residual bone height(RBH)was ≤ 5 mm(average 3.86 ± 1.09 mm).The results showed that 5.92 ± 1.80 mm of the new bone height could still be obtained when the protruded implant length was 7.08 ± 1.18 mm.The operation had a high level of sinus floor elevation and implant cumulative survival rate,the better effect was achieved in bone formation and marginal bone loss.The result has guiding significance for the clinical application of transalveolar sinus floor elevation.The transalveolar sinus floor elevation without bone grafting material was adopted in this study.Compared with the lateral sinus floor elevation,it is simpler and less traumatic,can avoid complicated operation process and reduce patients’ fear,therefore it is more acceptable by patients.PRF membrane can not only reduce the risk of maxillary sinus membrane perforation,but also promote bone regeneration and shorten the healing time.The results showed that the ideal intrasinus new bone height could be achieved at 3 months postoperative.After that,bone remodeling occurred in the sinus,and the new bone became mature.Therefore,when the RBH of maxillary posterior teeth is ≤ 5 mm,the technique of transalveolar sinus floor elevation with simultaneous implant placement using PRF membrane alone can be carried out safely and effectively,and the good clinical efficacy can be achieved. |
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