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ePaper created 2016-05-19, 12:42:25 | version 1.38.0
| case report 20 implants 2 2016 dental implant and finally make way for osseo integration of the implant. The purpose of this case presentation is to de scribe the author’s experience of using A-PRF (Ad vanced platelet-rich fibrin) as sole grafting material and to show that it is possible to get good bone for mation around the dental implant inside the sinus withouttheuseofbiomaterials.Twooperationswere performed under local anaesthesia, venous blood wascollectedandA-PRFmade.Osteotomywasdone by means of osteotomes (Summers technique). There were no perforations to the Schneiderian membrane, A-PRF membranes were placed inside the sinus and the dental implant placed achieving adequate primary stability in both cases. Impres sions were taken after twelve weeks. From cone beam computed tomography it is clear that bone formation has taken place inside the sinus under neath the Schneiderian membrane. Both of the two implants were fully osseointegrated and restored successfully. State of research In the year 2003 Lundgren et al. published a con cise paper1 showing the spontaneous bone forma tion in the sinus after removal of a cyst.1 The space that was once filled with the cyst became filled with bone without any further operations. Lundgren and his colleagues proposed that if space is maintained, bone can form without the use of biomaterials. Lundgren then did a study that was published in 2004,where19dentalimplantswereplacedwiththe Summerstechniqueandnobiomaterialwasused.2 In this procedure, the implants are used as “tent pegs” thatholdtheSchneiderianmembranefromcollaps ing to the floor of the sinus; the blood that fills the gap then turns to bone in time. The results were that a lot of extra bone had formed around the implants without the use of biomaterials. Other authors followed and published similar studies that confirmed Lundgren’s results.3–9 To get a good filling of blood can be a challenge in this procedure because one cannot predict how much blood there will be between the sinus floor and the Schneiderian membrane after the opera tion. A-PRF can be seen as a good and advanced blood clot that is easy to obtain. In addition, one can control how much the filling will be. In 2009 Mazor and colleagues published a paper where A-PRF was used to fill this space.10 25 sinus lifts were performed in 20 patients and 41 dental im plants placed. The authors used the same method as Lundgren did earlier, except for filling the space between the sinus floor and the Schneide rian membrane with A-PRF membranes. The re sults showed an increase in bone height between 7 and 13 mm (mean ± SD: 10.1 ± 0.9 mm). Mazor and colleagues also took examples for histology six months after the operation that showed a well formed bone full of osteoblasts and osteoclastsintheirlacunae.In2013Tajimaandcol leagues published a similar paper where the mean bone height increase was 7.5 mm.11 It can be seen fromFigs.1–10belowthatthebonedoesnotgoall the way over the apex of the implants. Therefore, it Fig. 3 Fig. 6 Fig. 7 Fig. 4 Fig. 5 Fig. 3: Case 1, pre-operative. Fig. 4: Case 1, immediately after operation. Fig. 5: Case 1, 14 weeks after operation. Fig. 6 & 7: Case 1, six months post-op. 22016