Management of large perforations of the sinus mucosa with PRGF-Endoret® platelet concentrate

The aim of the present study is to describe a new technique through which it is possible to complete the maxillary sinus lift procedure even in case of severe damage or complete removal of the sinus mucosa using the PRGF-Endoret® platelet concentrate. Eighteen patients (ratio F:M=4:5; average age: 58.2 years; DS: 8.85 years) with severe perforation (more than 10 millimetres of diameter) of the sinus mucosa during the maxillary sinus lift procedure were selected. Normally the procedure is interrupted due to impossible stabilization of the graft material inside the subantral cavity. On the contrary, our protocol foreseen the sealing of the perforation using the PRGF autologous gel membranes or the creation of a new sinus pseudomembrane through which the graft material was covered. The PRGF-Endoret were obtained according to the protocol developed by BTI (Biotechnology Institute - Vitoria, Spain). In 14 cases out of 18 implant fixtures were concurrently inserted while in 4 cases the fixture insertion was postponed after 6 months: 37 fixtures were inserted (27 at the same time and 10 after 6 months). 2 months after surgery the CBCT showed a correct pneumatization of the maxillary sinus in 16 patients out of 18 (89% of cases), while after 12 months the radiological normalization of the maxillary sinus was present in 17 patients out of 18, bringing the healing rate to 94% of cases. Regarding implant healing, 2 out of 37 implants inserted were lost in the first month after the surgical phase, whereas 12 months after prosthesis application the other 35 implants were perfectly osteointegrated with a healing rate equal to 94.6% of the fixtures. 36 months after the surgery all the fixtures were osteointegrated (35 of 37 implants with a percentage of 94.6% of success). We may conclude that the use of PRGF allowed to complete the sinus lift even in case of severe perforation of the sinus mucosa or its total removal thanks to its capability to stabilize the graft, its antibacterial and antifungal activity and its anabolic effect and favouring bone regeneration.