Purpose: The purpose of this study was to evaluate the predictability of new bone formation in the maxillary sinus using an autologous fibrin-rich blocks with concentrated growth factors (CGFs) alone as an alternative to graft material. Materials and Methods: A total of sixty-one sinus grafts were consecutively performed using the lateral window approach. After making replaceable bony window, the sinus membrane was elevated to make a new compartment. After 113 implants (average 13 mm high) with 11 different systems were placed simultaneously, the collected fibrin-rich blocks with CGFs alone were inserted in the sinus. To seal the lateral window, the bony window was repositioned. Radiographic, clinical, and histologic evaluation was performed to verify sinus augmentation. Results: No significant postoperative complications developed. New bone consolidation in all augmented maxillary sinus was observed along the implants on plain radiographs and on cone-beam computed tomograms. The success rate of implant was 98.2% after an average of 10 months loading. Conclusion: Fibrin-rich blocks with CGFs act as an alternative to bone grafting and can be a predictable procedure for sinus augmentation.

Purpose: The purpose of this retrospective study was to evaluate the success rate of implants and the amount of sinus augmentation using the flapless hydrodynamic piezoelectric internal sinus elevation (HPISE) technique with autologous concentrated growth factors (CGF) alone. Materials and Methods: A total of 11 maxillary sinuses were augmented using the HPISE technique through the flapless transcrestal approach. Sixteen implants (average 11.38 mm in length and 4.83 mm in diameter), with 2 different surfaces, were placed simultaneously with CGF alone. Plain panoramic radiograms and cone-beam computed tomograms (CBCT) were taken in all patients to evaluate the sinus augmentation preoperatively and postoperatively. Results: The sinus membranes were successfully elevated, averaging 13.95 ± 6.61 mm in immediate postoperative CBCT without any iatrogenic perforation. After an average 23.8 weeks, the average bone gain above the sinus floor was 8.23 ± 2.88 mm in the axial aspect of CBCT. No complications were recorded in any patients during the follow-up period. Conclusion: The flapless transcrestal approach to the sinus augmentation using the HPISE technique with autologous CGF alone could be an alternative to the lateral approach, even at severely resorbed edentulous posterior maxilla with insufficient bone height.

The aim of this animal study was to evaluate, by histomorphometric analysis, new bone formation in rabbit maxillary sinuses with, and without, bone grafting. Bilateral sinus augmentation procedures were performed in 20 adult male rabbits. Bony windows were made by a saw insert connected with a piezoelectric surgical device in both groups. In the experimental group, the replaceable bony window was repositioned after careful elevation of the sinus mucosa without bone grafting. In the control group, anorganic bovine graft (Bio-Oss; Geistlich AG, Wolhusen, Switzerland) was grafted in the new compartment of the maxillary sinus after elevation of the sinus membrane, and resorbable collagen membrane was used to cover over the bone graft. A mini screw was placed on the bony window to support the elevated sinus membrane. Animals were sacrificed at 1, 2, 4, 6, or 8 weeks after surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin-eosin and tartrate-resistant acid phosphatase stain. Histologically, new bone was revealed along the elevated sinus membrane, but new bone was not revealed under the collagen membrane or Bio-Oss in the control group after 1 week. In the control group, new bone formation was revealed on the surface of Bio-Oss particles from 2 weeks and continued to 8 weeks. However, new bone formation began from the floor of the replaced bony window and the elevated sinus membrane in the experimental group after 1 week. New bone formation increased under the floor of the repositioned bony window and the elevated sinus membrane, and blood clots appeared in the new compartment of the maxillary sinus throughout the experimental period in the experimental group. Significant higher new bone formation was revealed in the experimental group than in the control group. New bone formation in the experimental group was faster and denser than that in the control group. Replaceable bony window, as an autologous barrier, accelerates new bone formation early in the healing phase compared with the collagen membrane over a bone graft in the maxillary sinus. The replaceable bony window and elevated sinus membrane revealed osteoinductive potential.

This article reports the surgical procedure of a transalveolar approach for sinus floor elevation using piezoelectric surgery without a mallet, called piezoelectric internal sinus elevation (PISE) technique. PISE is the modified technique of the osteotome-mediated sinus floor elevation. Osteotome-mediated sinus floor elevation uses a mallet to break the sinus floor and to push sinus membrane up. Using this technique might possibly bring positional vertigo to the patient. PISE technique does not use a mallet during the procedure to break the sinus floor and to elevate the sinus membrane; therefore, it can reduce the possibility of postoperative positional vertigo.