| Objective: Because of the long time of tooth loss,maxillary sinus pneumatization or periodontitis,the height of alveolar bone in the maxillary posterior area is often insufficient,so it is impossible to carry out conventional implant surgery.The purpose of this study is to compare the incremental effect of A-PRF,A-PRF combined with autogenous bone fragments and without bone grafting materials,and to provide a clinical basis for the application of A-PRF in the elevation of maxillary sinus floor.Methods: From September 2017 to December 2019,46 patients with bone deficiency in the maxillary posterior teeth were reviewed,including 19 males and 27 females,with an average age of 53.98 years(27-78 years).According to the bone graft materials used,they were divided into three groups: group A A-PRF alone,20 implants,group B with A-PRF mixed with autogenous bone chips,15 implants,group C without bone graft materials,and 15 implants.The average observation time was11.14 months.CBCT or rotational panoramic radiographies were taken before operation to measure the height and width of the remaining bone,observe the bone density in the edentulous area,check and treat the rest of oral diseases,clean the whole gingiva before operation.Patients in group A and group B received blood 2~4before operation,each 5ml,and centrifugally made A-PRF.Choose different flap methods according to the amount of keratinized gingiva in the edentulous area,use the sinus floor elevator to raise the floor to the predetermined height after preparing the implant socket,and fill in the bone graft materials according to the operation plan and then to insert the implant.The permanent restoration was completed 3-6months after implant placement and the follow-up period was reached.The data of operation process and follow-up were collected.In order to analyze the osteogenic effect of A-PRF as a bone graft material and its influencing factors,six evaluation indexes were compared,including implant torque,postoperative pain,implant retention rate,new bone height change at mesial and distal side,ISQ and patient satisfaction.Results: 1.All the implants were repaired,the implant retention rate was 100%,and the function was good.2.There were 6 cases of sinus mucosa perforation and no intraoperative complications other cases(wound dehiscence,implant loosening and falling off,maxillary,maxillary sinus infection,implant falling into the maxillary sinus,etc.)3.The mean value of implant torque in group A was 38.25±13.7N×cm,that in group B was 38.21±8.46N×cm,and that in group C was 40.67±12.80N×cm.4.The height of new bone was 2.74 mm and 2.79 mm in group A,3.90 mm and3.99 mm in group B,1.65 mm and 1.55 mm in group C.the height of new bone in group A,B and C had statistical significance.Conclusion:In this study,it was found that the effect of A-PRF membrane combined with autogenous bone chips on bone regeneration in maxillary sinus was the best.Group A had sufficient bone mass and slight postoperative response,which indicated that only using A-PRF as the material of maxillary sinus lifting bone transplantation could obtain sufficient bone mass and reduce postoperative response.In clinical practice,doctors should choose A-PRF or A-PRF mixed with autogenous bone chips according to different conditions of patients to achieve satisfactory clinical results. |
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