[Massive sinus-lift procedures with beta-tricalcium phosphate: long-term results].
BACKGROUND
The use of bone substitutes in massive sinus-lift pre-implant procedures remains controversial. The aim of our study was to evaluate the long-term reliability of pure-phase beta-tricalcium phosphate (betaTCP, Cerasorb, Curasan, Kleinostheim, Germany) used in this particular indication.


METHODS
Twenty patients (33sinus) presenting with severe sinus floor atrophy (class 4 to 6 according to Cawood) and having undergone a sinus lift procedure by mean of betaTCP were followed in a prospective study between January 2002 and May 2008. The surgical approach was classical (under local anesthesia in eight patients) and the sinuses were filled with betaTCP (6 cm3 on average per sinus) and autologous growth factors (platelet rich plasma PRP and platelet rich fibrin PRF, according to the technique described by Dohan and Weibrich). One hundred and twenty-three dental implants were inserted in the grafted sinuses between the fourth and the eighth postoperative month (Nobel Biocare MK III and MK IV-mean length: 12.44 mm) using a 2-step buried technique and loaded between the fourth and the sixth month. Follow-up included regular clinical examination and panoramic X-rays to screen for possible sinus and implant complications. The control X-rays also allowed measuring the biomaterial resorption rate.


RESULTS
The mean postoperative follow-up was 4.5 years for the sinus lift procedures and 4 years for the implants. We noted one case of local infection at the 15th postoperative day (3%). The implant success rate was 97.6% (lack of osteo-integration for two implants in the same patient, one failure after loading). The prosthetic success rate was 100%. The mean resorption rate of the material was 20.3% and the mean gain of height was 16.9 mm.


CONCLUSIONS
The use of betaTCP associated to growth factors (PRP ou PRF) without bone graft, in massive sinus-lift procedures induces few complications. The implant success rate is comparable to the one obtained by using autologous bone grafts. The resorption rate of the material is comparable to that of autologous bone.
Meyer
C
C
Service de chirurgie maxillofaciale et de stomatologie, hôpitaux universitaires de Besançon-hôpital Jean-Minjoz, boulevard Fleming, 25030 Besançon cedex, France. christophe.meyer@chu-besancon.fr
Chatelain
B
B
Benarroch
M
M
Garnier
J-F
JF
Ricbourg
B
B
Camponovo
T
T
D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001284:Atrophy; D001672:Biocompatible Materials / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000627:therapeutic use*; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D005260:Female; D005337:Fibrin / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008443:Maxillary Sinus / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D011862:Radiography, Panoramic; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
D001672:Biocompatible Materials; D018786:Bone Substitutes; D002130:Calcium Phosphates; D015921:Dental Implants; C485817:beta-tricalcium phosphate; D005337:Fibrin