Growth Factor‐Mediated Sinus Augmentation Grafting With Recombinant Human Platelet‐Derived Growth Factor‐BB (rhPDGF‐BB): Two Case Reports

Abstract

Introduction: In the following two case reports, growth factor‐mediated sinus augmentation surgery is used to treat significant posterior maxillary alveolar bone deficiency. At initial examination, preexisting subsinus alveolar bone height was ≤3 mm. A composite graft of anorganic bovine bone mineral (ABBM) + mineralized bone allograft was combined with recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) for augmentation grafting via a traditional maxillary lateral wall osteotomy approach to the sinus. In both cases, early implant placement and loading following sinus grafting, as well as long‐term clinical follow‐up, document potential benefits of growth factor‐mediated bone regenerative sinus augmentation procedures. The significantly abbreviated durations seen in these two cases between sinus augmentation grafting and implant placement and prosthetic restoration, to the best of our knowledge, have not been previously reported in the literature.Case Presentations: Two adult males presented with severe posterior maxillary alveolar bone atrophy, with a maximum subsinus bone height of 3 mm in patient #1 and <1 mm in patient #2. For each patient, a 50:50 particulate composite graft of ABBM and mineralized allograft was hydrated with 1 mL of 0.3 mg/mL rhPDGF‐BB. Four and one‐half (4.5) and 3.5 months following grafting in patient #1 and #2, respectively, implants were placed and core biopsy specimens obtained. Histologic examination of osteotomy cores demonstrated significant amounts of vital bone for each patient. Definitive implant‐supported restorations in full occlusion were placed 8.5 and 7.5 months following sinus grafting for patient #1 and #2, respectively. Three (3) and 2.4 years following implant placement, all implants were well integrated, with no evidence of radiolucency at the implant‐to‐bone interface.Conclusion: The addition of tissue‐engineered proteins, i.e., rhPDGF‐BB, to sinus augmentation protocols may allow earlier implant placement secondary to accelerated bone formation following grafting in the severely pneumatized sinus and may provide for increased long‐term positive clinical outcomes.