Sinus Lift Using Trans-Alveolar Approach with Platelet Rich Fibrin Followed by Simultaneous Implant Placement in Posterior Atrophic Maxilla - A Clinical and Digital Volumetric Tomographical Analysis

Background The purpose of this case series was to evaluate the survival rate and gain in the apico-coronal height around implants placed in the posterior atrophic maxilla with the help of Platelet Rich Fibrin (PRF) and Bone Particulate (Biograft). Materials & Methods From September 2014 to March 2015, A total of 12 implants of size 11mm were placed in 9 patients within the age group of 20-55 years were taken up to rehabilitate atrophic maxilla where residual bone height in range of 4-7mm by means of Trans-alveolar sinus lift i. e osteotome-mediated sinus floor elevation (OMSFE) with PRF & bone graft. Initial and final bone height was measured from IOPA, Orthopantomogram (OPG), and Digital Volumetric Tomography Scan (DVT). Periapical radiographs were evaluated before surgery, post-surgery, and after 6 months and 1 year. We analyzed the residual crestal bone height under the sinus, the amount (mm) of height increase after surgery. Results 9 patients treated with the transalveolar sinus-lift technique were included. A total of 12 dental implants and sinus lifts were analyzed. The overall rates of implant success and failure were 100 % and 0 %, respectively. All patients treated with PRF & bone graft showed a better peri-implant bone formation. No Schneiderian membrane perforations, Postoperative complications, peri-implantitis were observed. The follow up time was for 12 months, The mean residual bone height of the alveolar ridge was 5.5 mm (range, 47 mm). The mean increase in the height of implant sites by transalveolar approach with Platelet Rich Fibrin (PRF) and Bone Particulate (Biograft) was 6.3 mm (range, 3.57mm). The mean healing time for the loaded implants was 4 months until abutment insertion (range, 35 months). Twelve implants showed additional gain in apico-coronal height following the 1-year. Conclusion Trans-alveolar technique can be advised when less than 8 mm of residual bone height is present. PRF and biograft provides addition synergistic effect to gain in apicocoronal height of bone. In case of more severe resorption direct method has to be performed. Therefore, transalveolar sinus-lift technique can be considered to be a safe, minimally invasive technique for sinus augmentation in atrophic maxilla followed by simultaneous implant placement.