A novel crestal protocol for the application of denatured Albumin in minimally invasive Implantology and Sinus Piezosurgery - Preliminary Results of a Pilot Study

Abstract

Sinus-Floor-Elevation surgical procedure has been considered the dominant treatment protocol towards posterior maxillary atrophy and implant rehabilitation. Nevertheless, the high incidence of postoperative sinusitis and intra- and post-operative complications, such as Schneider’s membrane perforation in 10-55% of patients, constitute it an invasive approach of high morbidity (mainly adopted for open-lateral-window version). The innovative crestal approach termed PAC-Protocol (Piezo-Alb-CGF) comprises: a) Minimally invasive transcrestal-flapped or flapless-approach, b) Piezosurgery preparation by Sinus Intralift™ Technique (Satelec–France), c) Schneiderian membrane cavitation by hydrodynamic membrane detachment-elevation, d) CGF-matrix into the sinus, e) Denatured Albumin, mixed together with Autologous Concentrated Growth Factors (CGF), an Autologous-Osseoinductive-Slow-Absorption-Graft (of 6 to 8 weeks) placed (within the interspace between membrane & sinus bone floor) as a scaffold, f) Bone grafting (optional), (g) Implantation, (h) Wound closure, evaluation for next 4-6 months postop. The clinical sample comprises five (5) patients (2 women – 3 men) with an average age of 55.6 years and an average residual-bone-height of 3.9 mm. A total of eight (8) implants were placed, showing sufficient to high primary stability without any complications. CBCT and panoramic x-rays also showed new bone formation and complete osseointegration. The Albumin-CGF regenerative properties promote new bone formation, eliminate sinus surgery's high-risk and postoperative patient morbidity, and reduce the healing period (4-6 months) compared to the current surgical procedures. PAC-Protocol provides uniform-safe-hydraulic membrane lift and bi-cortical implant fixation due to piezo-surgery under-preparation of only 2.8mm in diameter, even in cases with a residual bone height below 6mm to avoid an open lateral-window approach.