الفهرس 
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Abstract
This study aimed to evaluate both clinical and radiographic outcomes in sinus floor elevation following dental implant placement using flapless transcrestal sinus lift approach with Titanium platelet rich fibrin (T-PRF) as a sole sinus graft material compared to Platelet rich fibrin (PRF).
Sixteen participants who need implant placement for their lost posterior maxillary teeth with reduced bone height below the maxillary sinus floor were selected from the outpatient clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University.
Preoperative assessment
Full patient personal history was taken, patients were examined clinically to exclude any medical or local condition that may affect the implant success, CBCT was taken for every patient preoperatively. The residual bone height and bone width were measured to choose the suitable implant size.
Surgical procedure
All patients were treated under local anesthesia using maxillary vestibular and palatal infiltration. For the preparation of the platelet concentrate, 10 ml of patient’s blood were obtained from antecubital vein. Collected blood was immediately transferred to Titanium tube and centrifuged in centrifugation device at 2800 rpm for 12 min for the study group while the collected blood of the control group was immediately transferred to disposable glass tube that was centrifuged at 3000 rpm for 10 min. For proper implant positioning in mesiodistal available space, custom made clear acrylic surgical guide was used.
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Osteotomy site preparation began by drilling of 2.0mm twist pilot drill to the depth of 1.5 mm away and inferior to the sinus membrane followed by using 2.7mm intermediate drill to the same depth used with the pilot drill. After that, the first osteotome (3.2 mm) was inserted in the prepared osteotomy using wedging motion. Followed by 3.8mm osteotome until the same required level of sinus floor elevation was gained. A third osteotome was inserted using the same technique if it was desired. Countersink drill was used after, and integrity of the sinus membrane was checked. Clot removal from the tube and separation from the basal layer and further dividing of the obtained clot was done to enable easy packing of the fibrin clots inside the osteotomy site. Fibrin clots were added and packed successively using the last osteotome followed by implant placement.
Clinical and Radiographic Follow Up Parameters
Postoperative pain was examined using visual analogue scale (VAS) in the first, 3,7 days postoperatively. The mean pain score in the T-PRF group was (3.88 ± 2.36) (1.25 ± 1.49) (0.25 ±0.71) respectively, while in the PRF group the mean postoperative pain was (2.38 ± 1.41) for the 1st day, and (1.75 ± 1.28) for the 3rd and 0.00 for the 7th day. The pain level ranged from no pain to moderate pain in the 2 groups. No nasal bleeding was recorded in the study. Postoperative edema was measured at same intervals, 62.5% of patients had no edema and 37.5% with slight edema at the 1st day for T-PRF, in the 3rd day 75% of patients complained from slight edema and the remaining had mild edema. 25% of PRF group in the 1st day had no edema while 75% had slight edema, 50% in the 3rd day had slight edema and 50% came with mild edema. No edema was recorded on the 7th day for the two groups. There was no significant difference in pain score and edema level in the 2 groups. The mean primary stability in the T-PRF group was (58.63 ±5.68) while the mean in the secondary implant stability was (73.50±3.5) with significant difference between the 2 readings in the same group. The mean primary stability in the PRF group was (54.50 ±6.41) while the mean in the
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secondary implant stability was (72.63±2.67) with significant difference between the 2 readings in the same group. But there was no difference between the 2 groups, neither in the primary nor the secondary implant stability.
There was no significant difference in terms of implant protrusion length, residual bone height and sinus bone gain between the two groups. Significant difference was found in comparing the mean percentage of bone density increase, immediately after implant placement and 6 months postoperatively within the same group, while there was no significant difference recorded between the two groups.