"A healthy mouth, makes a pleasant and functional
social message positive and reassuring."

dc. Maurizio Serafini

Clinical Cases

Oral Implantology

Advanced implantology with PRP growth factors

The term “advanced implantology” indicates surgical operations performed according to well-defined protocols...

The term “advanced implantology” indicates surgical operations performed according to well-defined protocols, in order to solve anatomical situations that – due to lack of bone, reabsorption caused by atrophy, inflammatory noxae, etc. - do not allow for implant placement and constitute a contraindication. In fact, the conditio sine qua non is the presence of bone in adequate quantity and quality for fixture placement and slots releasing force transmitted to the bone by mastication loads.

Thanks to a CT scan and derived programs, a 3D model was elaborated reproducing all the fundamental parameters, such as thickness, height and bone density. This allowed to visually understand bone loss and deal - with competence and modern regeneration techniques - with growth factors (for a deeper analysis read the article “Bone regeneration with PRP growth factors”), alloplastic materials, and autologous, homologous and heterologous bone grafting with targeted instruments and the most appropriate surgery.

Overall, advanced implantology has allowed to solve all those cases considered not suitable for implant treatment, such as atrophic crestal sinus lift and expansion, split-crest (to a certain degree), maxillary sinus lift and alveolar nerve shift. This gives hope and comfort to the patient carrying totally or partially mobile prostheses with all their disadvantages, or prostheses screwed on few implants needing recurrent and short-term check-ups to be removed and cleaned (read the article “One-to-one immediate load implant”).

Case reports

1st case

Image 1: one of the most representative dental scans (49-year-old female patient). Notice the serious alveolar palatine bone loss on 1.6-1.7, as pointed by the arrows.

Images 2- 2a: Detail showing the 3D reconstruction of the patient's maxilla, with oroantral connection.

Images 3-3a: 4 test tubes containing blood samples. After centrifugation, 4 ml of PRP is obtained by each one.

Image 4 - 4a: Surgical site post-mining, which highlighting the growth of fibrous gums around the roots that took the place of the alveolar bone, in fact, once removed, there is extensive loss of bone and the sinus membrane maxilla.

Image 5: Placement of two implants on 1.6-1.7, with previous endosinus injection of PRP liquid and placement of imbibed fibrin sponges. Notice the large remaining gap.

Image 6 - 6a: After implant placement, PRP packing followed, which was activated by calcium chloride necessary for platelet degranulation. Thus PRF (platelet-rich fibrin) + Bio-Oss was obtained.

Images 7-7a: Post- surgical orthopantomography and detail.

Images 8-8a: Suture removal after 15 days and soft tissue healing after 6 months.

Images 9-10-11-12: tomography showing radiographic integration and increased peri-implant bone density after 6 months from surgery.

3D reconstruction showing the newly formed bone in the peri-implant site.

2nd case

54-year-old male patient who had already had an implant placed 2 months before. In the first phase 6 implants were placed in order to fill the gap left by the mobile prosthesis (see one-to-one immediate load implant). Subsequently, in the second phase, other operations were performed on the right and left diatoric tooth, i.e. a right and crestal sinus lift, and another four implants were placed in order to re-establish normal occlusion (see 3D modelling, images 1 and 2). Notice bone atrophy on the right side and hypertrophy of the “rising sun” sinus membrane.

Images 3 and 4 show blood samples and PRP obtained after centrifugation.

Image 5 shows alveolar palatine reabsorption, notice the exposed molar palatine root.

Image 6: Molar avulsion, the alveolus is filled with gingival mucosa.

Image 7: Alveolus cleaning, the arrow points at the prolapsed mucosa of the right sinus, with consequent surgical site exposure on 1.5.

Image 8: implant placement after imbibing the surgical site and the implants with PRP. The huge residual palatal gap can be seen between the implant and the palatal gingival mucosa.

Image 9: After implant placement, PRP packing followed, which was activated by calcium chloride necessary for platelet degranulation. Thus PRF (platelet-rich fibrin) + Bio-Oss was obtained.

Image 10: Suture of a palatal flap shifted laterally.

Image 11: Post-surgical X- ray of the large crestal sinus lift, where only fibrin sponges imbibed with PRP were inserted. Notice the hypertransparence:

Images 12 and 13: Suture removal after 25 days. Notice the status of the soft tissues:

Images 14 and 15: Control X-ray after 6 months showing the restitutio ad integrum of bone and muscle tissues.