Lifting the bottom of the maxillary sinus with use of growth factor-rich plasma

Podizanje dna maksilarnog sinusa kirurška je metoda koja se primjenjuje kod opsežne resorpcije alveolarnoga grebena stražnjeg dijela gornje čeljusti. Resorpcija kosti posljedica je pneumatizacije maksilarnog sinusa najčešće nakon gubitka molara, rjeđe premolara u gornjoj čeljusti. Kod podizanja dna maksilanog sinusa postoje određene indikacije, kao i kontraindikacije, kao što su patološki promijenjena sluznica sinusa, bilo u obliku sinusitisa, cista ili tumorske mase. Podizanjem dna maksilarnog sinusa postiže se povećanje alveolarnog grebena u gornjoj čeljusti, čime se omogućuje ugradnja dentalnih implantata. Uz različite tehnike podizanja dna maksilarnog sinusa, danas se osim ksenogenih materijala koriste i autologni faktori rasta: plazma obogaćena trombocitima (PRP), fibrin obogaćen trombocitima (PRF) i plazma bogata faktorima rasta (PRGF). Operateri, ovisno o pojedinačnom slučaju, mogu koristiti autologne faktore rasta i bez ksenogenih materijala. PRP, PRF i PRGF trombocitni su koncentrati koji se dobivaju iz autologne venske krvi različitim protokolima centrifugiranja i kasnijom obradom. Ti pripravci razlikuju se u brzinama i trajanju centrifugiranja, dodatku ili odsutnosti aditiva, izdvajanju određenih slojeva te radom u jednoj ili više faza. Zbog drukčijih načina pripreme između PRP-a, PRF-a i PRGF-a postoje mnoge razlike, od onih u udjelu krvnih komponenti u sastavu koncentrata, mehaničkim svojstvima, imunomodulacijskim i osteoinduktivnim svojstvima, količini dobivenog koncentrata, jednostavnosti pripreme, prisutnosti ili odsutnosti fibrinske mrežice (što je povezano s brzinom otpuštanja faktora rasta) pa sve do praktičnosti aplikacije i ekonomičnosti. U ovom radu analizirano je podizanje dna maksilarnog sinusa samo s PRGF-om te u kombinaciji sa ksenogenim materijalima.Lifting the bottom of the maxillary sinus is a surgical method used in extensive resorption of the alveolar ridge of the posterior part of the upper jaw. Bone resorption is due to the pneumatization of the maxillary sinus most often after the loss of molars, less often the premolars in the upper jaw. Upon lifting the bottom of the maxillary sinus, there are certain indications, as well as contraindications, such as pathologically altered sinus mucosa, being in the form of sinusitis, cysts or tumor mass. By raising the bottom of the maxillary sinus, an increase in the alveolar ridge in the upper jaw is achieved, enabling the installation of dental implants. Along with various techniques for lifting the bottom of the maxillary sinus, besides xenogeneic materials, autologous growth factors are also used today: platelet-rich plasma (PRP), platelet-rich fibrin (PRF) and growth factor-rich plasma (PRGF). Operators, depending on the individual case, can use autologous growth factors even without xenogeneic materials. PRP, PRF, and PRGF are platelet concentrates obtained from autologous venous blood by different centrifugation protocols and their subsequent processing. These preparations differ in the speed and duration of centrifugation, the addition or absence of additives, the separation of certain layers and the work in one or more phases. Numerous differences exist, from those in the proportion of blood components in the composition of the concentrate, mechanical properties, immunomodulatory and osteoinductive properties, the amount of concentrate obtained, simplicity of preparation, presence or absence of fibrin network (related to the rate of growth factor release) up to the practicality of application and economy, due to the different methods of preparation between PRP, PRF and PRGF. The present work analyses the lifting of the bottom of the maxillary sinus only with PRGF and in combination with xenogeneic materials