Reconstruction of the severely resorbed maxilla with autogenous bone, platelet-rich plasma, and implants: 1-year results of a controlled prospective 5-year study.
BACKGROUND
Prosthetic treatment of the edentulous maxilla may require bone augmentation to enable placement and integration of dental implants. This constitutes a complex healing situation, and resorption of the grafted bone and failure of the implants often occur. The application of autogenous platelet-rich plasma (PRP) has been suggested to improve incorporation and preservation of bone grafts.


OBJECTIVE
The aim of this controlled clinical study was to evaluate whether PRP in conjunction with grafting of particulated autogenous bone to the maxilla could improve the integration and clinical function of dental implants. An additional aim was to compare block bone grafts without PRP with PRP-treated particulated bone.


METHODS
Nineteen consecutive patients were included in the study and treated with iliac bone grafts and dental implants in the maxilla according to a split-mouth design. In the anterior maxilla, particulated bone mixed with PRP (test) was compared with onlay block grafts without additional PRP (control). In the posterior maxilla, particulated bone grafts with (test) or without (control) PRP were placed as sinus inlay grafts. After 6 months of healing, 152 implants (8 implants/patient) (TiOblast, Astra Tech AB, Mölndal, Sweden) were placed. Test (PRP; 76 implants) and non-PRP (76 implants) sides were evaluated and compared by implant survival rate, marginal bone level, and implant stability using resonance frequency analysis (RFA) during 1 year in function.


RESULTS
Two control implants in control sites in two patients were lost at abutment connection. After 1 year in function, no further implants were lost, giving an overall survival rate of 98.7%. The marginal bone level measurements showed no significant differences, although there was a tendency toward less resorption on PRP sides. RFA measurements showed statistically significantly higher implant stability quotient values for PRP sites at abutment connection in the anterior but not in the posterior regions.


CONCLUSIONS
The present clinical study showed that a high implant survival rate and stable marginal bone conditions can be achieved after 1 year of loading in the maxilla following autogenous bone grafting whether or not PRP is used. RFA measurements revealed differences at abutment connection, which could be explained by the type of graft rather than as an effect of PRP. Although no obvious positive effects of PRP on bone graft healing could be demonstrated, the handling of the particulated bone grafts was improved.
Thor
Andreas
A
Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University Hospital, Sweden. andreas.thor@lul.se
Wannfors
Karin
K
Sennerby
Lars
L
Rasmusson
Lars
L
D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001792:Blood Platelets / Q000502:physiology; D001862:Bone Resorption / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods / Q000473:pathology; D000044:Dental Abutments; D015921:Dental Implants; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007575:Jaw, Edentulous / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008439:Maxillary Diseases / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D010949:Plasma; D017713:Platelet Transfusion; D011446:Prospective Studies; D014945:Wound Healing / Q000502:physiology
D015921:Dental Implants