Lateral Window Research Articles

Sling Suture Technique Used to Stabilize the Collagen Membrane on the Lateral Bone Window During Maxillary Sinus Floor Augmentation With a Lateral Approach: A Retrospective Case Series.

Maxillary sinus floor augmentation is a safe and predictable technique used to increase bone volume under sinus cavity for implant placement in atrophic posterior maxilla before implant placement. Despite conflicting results concerning the new bone formation rates with or without a barrier membrane, the benefits of using a collagen membrane to cover the lateral bone window has been demonstrated, in order to prevent bone substitute particles dislodgement that may occur from the sinus cavity through the sinus antrostomy towards the oral mucosa, and to significantly reduce the postoperative swelling and pain reactions. The purpose of this case series is to present a sling suture technique used to stabilize the collagen membrane against the lateral bone window so as to improve the bone substitute stability inside the sinus cavity. Maxillary sinus floor augmentation with lateral approach using sling suture technique to maintain the collagen membrane against the lateral bone window was performed in 17 patients (8 women/ 9 men, mean age: 58.2 years). Postoperative cone-beam computed tomography (CBCT) images up to 6-month follow-up were performed to control the bone graft stability at the level of the lateral antrostomy. The clinical postoperative pain and swelling were assessed through a Visual Analogue Scale (VAS) questionnaire from level 1 (low), level 5 (acceptable), to level 10 (high) at one week postoperative. No bone substitute displacement was observed for all clinical cases on the CBCT images at 6-month postoperative. The pain and swelling level observed at one-week post operative were significantly low (respectively 1.6±1.0/2.1± 0.9). Within the limits of this case series, the use of sling suture technique to maintain the barrier membrane at the level of the lateral bone window in case of maxillary sinus floor augmentation with lateral approach surgery revealed to be a predictable protocol to prevent bone substitute displacement outside the sinus cavity.

Quantitative analysis of change in bone volume 5 years after sinus floor elevation using plate-shaped bone substitutes: a prospective observational study

PurposeTricalcium phosphate (TCP) has osteoconductive ability and reportedly offers similar clinical results as autogenous bone grafts in dental implant treatment. However, few reports quantify temporal changes in augmented bone volume after sinus augmentation. We aimed to establish a three-dimensional (3D) quantification method to assess bone volume after sinus augmentation and to evaluate biocompatibility of the TCP plate.MethodsMaxillary sinus floor augmentation was performed employing the lateral window technique, and plate-shaped β-TCP (TCP plate) was used instead of granular bone grafting materials. After lifting the sinus membrane, the TCP plate was inserted and supported by dental implants or micro-screws. The changes in bone volumes in the maxillary sinus before and after surgery were recorded using cone-beam computed tomography, saved as Digital Imaging and Communications in Medicine-formatted files, and transformed to Standard Triangle Language (STL)-formatted files. Pre- and post-operative STL data of bone volume were superimposed, and the augmented bone volume was calculated. Moreover, changes in bone volumes, TCP plate resorption rates, and bone heights surrounding the implants were three dimensionally quantified.ResultsFifteen implants in nine subjects were included in this study. TCP plates secured long-term space making, with results similar to those of granular bone substitutes. Newly formed bone was identified around the implant without bone graft material. TCP plate was absorbed and gradually disappeared.ConclusionsA novel 3D quantification method was established to evaluate changes in bone volume. Clinical application of TCP plate in sinus augmentation could be a better procedure in terms of prognosis and safety.

Medial surface plating of posterior column through the anterior intrapelvic approach in acetabulum fractures with involvement of both columns.

Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up. Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged. Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.

APCs in sinus floor augmentation.

After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.

Classifying Maxillary Sinuses of Polish Patients for Sinus Lift: A Pilot Study.

To date, there is no systematic anatomical classification available that could help clinicians in choosing between the lateral and palatal approach in sinus lift procedures. The aim was to provide a simple-to-use and memorable classification of the maxillary sinus concerning the thickness of lateral and palatal walls to facilitate the most adequate choice for the window location during direct sinus floor elevation. Cone beam computed tomography scans were consecutively obtained for 200 maxillary sinuses of patients needing dental implant placement with potential maxillary sinus augmentation. The thickness and height of the alveolar bone of the lateral and palatal walls of the maxillary sinuses were assessed. Four variants were distinguished. Class 0: an adequate sub-sinus residual bone height; without the need for sinus floor augmentation. Classes 1-3 had a reduced sub-sinus residual bone height. Class 1: a thinner lateral than palatal sinus wall. Class 2 (the most frequent; 49%): the comparable thickness of both walls in which either lateral, palatal, or crestal window osteotomies can be applied. Class 3 (the least frequent; 3%): a thinner palatal sinus wall in comparison to the lateral wall. The presented anatomical classification simplifies the decision-making process of choosing the most adequate window location and osteotomy technique.

Comparative evaluation of hard and soft tissue parameters by using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla.

The objective is to compare and evaluate the hard and soft tissue parameters by using short and standard long implants with sinus lifting in the posterior maxilla. Eleven patients with complaints of missing upper back teeth were enrolled in the study for implant-supported rehabilitation and were categorized into two groups: Group long (GL): longer implant (>8 mm) placement, preceded by Sinus Augmentation. Group short (GS): short implant (≤8 mm) placement, without sinus augmentation. The primary outcome measured was cumulative survival rate (CSR) in the compromised partial edentulous posterior maxilla. Secondary outcomes measured were implant stability (IS), marginal bone level alterations (MBL), pocket probing depth (PPD), crown-to-implant ratio, and any complications. The difference in CSR between the groups was not statistically significant (P = 0.317). High stability was achieved immediately after the placement of the implants, in both groups (GS: 64 ± 4.07, GL: 65.58 ± 9.75); this difference in the mean ISQ (IS quotients) values was not found to be statistically significant at implant placement (P = 0.7). The mean MBL reported in the study at the end of 12 months of prosthesis function was - 0.762 ± 0.48 mm and - 0.7 ± 0.34 mm for GS and GL, respectively. The mean PPD measurements in GS and GL groups were 1.917 ± 0.68 mm and 1.833 ± 0.38 mm, respectively, and it was not statistically significant (P = 0.8). Within the limitations of the present study, the obtained results indicate that short implants provided a similar clinical and radiographic performance compared to long implants placed in combination with a sinus augmentation procedure (lateral window) up to 12 months after prosthetic loading.

Correlation Analysis of the Anatomical Structures Related to Maxillary Sinus Augmentation

Aims: Preoperative evaluation of maxillary sinus anatomy is crucial to minimize procedural complications. The aim of this study was to assess the anatomical structures associated with sinus augmentation and investigate the correlation between these structures. Materials and Methods: This retrospective study included cone-beam computed tomography scans of patients referred for the reconstruction of the posterior maxilla with dental implants. The intraosseous anastomosis (PIA) and septa were evaluated on the images. Lateral wall thickness (LWT), the diameter of the PIA (DIA), the vertical distance of the PIA to the sinus floor (DSF), and sinus floor angle (SFA) were also measured. Results: A total of 250 sinuses were examined. PIA was detected in 46.8% of the sinuses. The mean SFA value was 77.11° ±11.11° (range 48.25°–112.33°). The LWT ranged from 0.63 to 10.23 mm with a mean value of 1.35 ± 0.79 mm. Of 250 sinuses, 82 (32.8%) showed septa. A strong negative correlation was found between SFA and PIA detection (r = 0.98, P = 0.008), SFA and DSF (r = 0.99, P = 0.000), and SFA and septa (r = 0.98, P = 0.000). LWT showed a positive correlation with DIA (r = 0.72, P = 0.082), although not statistically significant. Conclusions: The relationships highlight the combined effect of the structures on membrane perforation. As this makes the lateral window approach more problematic, the surgeon may seek minimally invasive approaches. Moreover, the strong correlation of SFA-PIA-DSF may significantly affect graft vascularization and needs to be evaluated with clinical studies.

Minimally invasive techniques for sinus floor elevation using dental implants among Indians.

It is of interest to compare conventional lateral window technique, trans-alveolar technique with minimally invasive technique like modified trephine technique and antral membrane balloon elevation technique for sinus floor elevation in placement of dental implants. The current study included 140 participants (191 dental implants) who had maxillary posterior edentulous regions and had low sinuses and insufficient alveolar ridges but had chosen an implant-retained prosthesis. The minimally invasive techniques of sinus augmentation can be suitable alternative to conventional traumatic techniques due to low incidence of pain, gingival swelling. Moreover, the success rate of implants and increase in total bone height was almost same in minimally invasive techniques of sinus augmentation as compared to conventional traumatic techniques.

VNOTES hysterectomy using the lateral window technique in case of a ventrofixed uterus following previous cesarean sections: A video article

vNOTES uses the vagina as the surgical channel for endoscopy and achieves improved cosmesis compared to conventional laparoscopy as there are no abdominal incisions. Ventrofixation of the uterus to the abdominal wall following previous cesarean sections further adds to the surgeon's concern of bladder injury. In such cases, a modification of the technique is proposed: introducing the vNOTES port first, before the opening of the vesico-uterine peritoneal folds, thus carried out under endoscopic view. Medial anterior vesico-uterine adhesions are identified and circumscribed by creating a lateral window in the broad ligament on both sides. This allows the cutting of adhesions under endoscopic view to minimize the risk of bladder injuries. The aim of this technical note is to present this modification of the surgical technique for vNOTES hysterectomy in case of ventrofixed uterus.

Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures.

To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.

Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.

A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.

Extended platelet-rich fibrin.

Platelet-rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2-3 week period. Very recently, however, a novel heating process was shown to extend the working properties of PRP/PRF from a standard 2-3 week period toward a duration of 4-6 months. Numerous clinicians have now utilized this extended-PRF (e-PRF) membrane as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration. This review article summarizes the scientific work to date on this novel technology, including its current and future applications in periodontology, implant dentistry, orthopedics and facial aesthetics. A systematic review was conducted investigating key terms including "Bio-Heat," "albumin gel," "albumin-PRF," "Alb-PRF," "extended-PRF," "e-PRF," "activated plasma albumin gel," and "APAG" by searching databases such as MEDLINE, EMBASE and PubMed. Findings from preclinical studies demonstrate that following a simple 10-min heating process, the transformation of the liquid plasma albumin layer into a gel-like injectable albumin gel extends the resorption properties to at least 4 months according to ISO standard 10 993 (subcutaneous animal model). Several clinical studies have now demonstrated the use of e-PRF membranes as a replacement for collagen membranes in GTR/GBR procedures, closing lateral windows in sinus grafting procedures, for extraction site management, and as a stable biological membrane during recession coverage procedures. Furthermore, Alb-PRF may also be injected as a regenerative biological filler that lasts extended periods with advantages in joint injections, osteoarthritis and in the field of facial aesthetics. This article highlights the marked improvement in the stability and degradation properties of the novel Alb-PRF/e-PRF technology with its widespread future potential use as a potential replacement for collagen membranes with indications including extraction site management, GBR procedures, lateral sinus window closure, recession coverage among others, and further highlights its use as a biological regenerative filler for joint injections and facial aesthetics. It is hoped that this review will pioneer future opportunities and research development in the field, leading to further progression toward more natural and less costly biomaterials for use in medicine and dentistry.

Bicortical stability of implants placed in severely atrophic posterior maxilla: A case report

Maxillary sinus lift is a common procedure to achieve adequate alveolar bone height in patients with sinus hyper-pneumatization. Simultaneous implant placement with sinus floor augmentations is possible when appropriate primary stability could be achieved. In severe atrophic posterior maxillary ridge, vertical bone height is sometimes less than 4mm, which may hinder simultaneous implant placements and necessitate two stage procedure. In current study, a novel technique is described to perform a single stage implant placement with bicortical stability in severe atrophic maxilla that can shorten the treatment time of an edentulous patient. During the procedure, to achieve an adequate access a conventional lateral window osteotomy is performed. After elevating the Schneiderian membrane using conventional instruments, an autologous ramus block is harvested from the mandible and then the block will be fixed in correct location in the sinus using screws with appropriate length to build sufficient stability as superior cortex for simultaneous implant insertion.

Simultaneous sinus elevation and immediate implant placement without biomaterial: A technical note

Sinus floor elevation is widely considered as one of the most reliable and predictable procedures for augmenting posterior maxillary bone volume before implant placement. The lateral window technique is often described as the gold standard, especially when dealing with limited residual bone height. Traditionally, severe vertical defects in the posterior maxilla required a two-stage approach: first elevating the sinus membrane with biomaterial, followed by a second surgery for implant placement. This article introduces an innovative approach to the lateral sinus lift procedure, enabling simultaneous implant placement in sites with less than 5 mm of remaining bone height. This original one-stage surgical approach is interesting because it does not involve grafting of any biomaterial into the sinus. Its main objectives are to enhance safety and predictability while reducing the risk of post-operative infections. However, it's essential to emphasize that achieving an ideal implant position with adequate primary stability is crucial for its viability.

Revisiting the flexion-valgus type unicondylar posterolateral tibial plateau depression fracture pattern: classification and treatment

ObjectiveThis study aimed to reclassify posterolateral tibial plateau fractures caused by a flexion-valgus force and describe this fracture pattern to provide a relatively programmed surgical treatment based on morphological characteristics that may improve reduction and stabilization.MethodsWe retrospectively reviewed the fracture pattern and injury mechanism of patients with posterolateral tibial plateau fractures who underwent surgery at the First Affiliated Hospital of Nanjing Medical University between January 2014 and April 2020. The cohort was divided into three types. Type I was a depression fracture of the posterolateral platform with an intact posterolateral cortex. Type II was a depression fracture of the posterolateral platform with a disrupted posterolateral cortex. Type III was a depression fracture of the posterolateral platform in combination with anterior cruciate ligament (ACL) rupture or tibial insertion avulsion fracture of the ACL. The lateral window of the modified Frosch approach with an L-type locking plate was used for patients with type I and type III fractures. For patients with type II fractures, both lateral and posterolateral windows of the modified Frosch approach were used for surgery, and a T-plate on the posterior side with an L-plate on the lateral side were used for fixation. The Rasmussen radiology scoring was used to evaluate the quality of surgical reduction and the Rasmussen functional scoring evaluation standard was used to evaluate knee joint function.ResultsA total of 69 tibial plateau fractures (36 male, 33 female) involving the posterolateral platform were discovered and included in this study. All patients suffered flexion-valgus force at the moment of the accident. There were 32 cases of Type I fracture, 28 cases of Type II fracture, and 9 cases of Type III fracture. The patients were followed up for 12–30 (mean 20.8 ± 9.4) months. The postoperative Rasmussen radiological scores for the three types of fractures were 15–17 (mean 16.31 ± 0.78), 14–17 (mean 15.93 ± 0.94), and 14–17 (mean 16.22 ± 0.97), respectively. The postoperative Rasmussen functional scores for the three types of fractions were 27–30 (mean 27.97 ± 0.90), 27–29 (mean 27.36 ± 0.56), and 27–29 (mean 27.56 ± 0.73), respectively.ConclusionFlexion-valgus posterolateral tibial plateau fractures were divided into three types based on the integrity of the posterolateral wall and ACL injuries. We hope the classification can play a certain reference role in recognizing and treating flexion-valgus-type posterolateral tibial plateau fractures.

Modified Stoppa Approach for Acetabular Fixation

Introduction: When acetabular fractures are intra-articular, correct anatomic reduction is important to achieve an excellent functional outcome. A few of the surgical techniques like ilioinguinal and modified Stoppa techniques are the only available intra-pelvic procedures. Despite the fact that ilioinguinal method is more commonly used, modified Stoppa technique is becoming more popular due to the possibility of visualizing and reducing quadrilateral plate fragments in addition to fixation of posterior column through anterior approach. The goal of our study is to assess the efficacy of various reduction tools/ techniques for reduction and fixation of fractures by use of modified Stoppa technique. Materials and Methods: We have operated on 16 patients with acetabular fractures through modified Stoppa approach within the age group of 19 years to 70 years (mean 42 years) with male female ratio of 13:3. In patients requiring combined method, the anterior approach was performed first. In most of the patient’s, modified Stoppa was combined with a lateral window. we have used various reduction strategies consisting of trans trochanteric Schanze pin, intra-focal elevators, ball spike, bone hook, iliac crest Schanze pin, Farebeat forceps, under contoured plate and many others. Results: Matta’s radiographic reduction criteria showed anatomic reduction in 10 cases. Clinical evaluation using Merle d’ Aubigne scoring showed excellent outcomes in 9 cases and good results in 6 cases. Follow up was done for a most duration of six months. Conclusion: Modified Stoppa technique provides better visualisation of quadrilateral floor and sciatic buttress while compared to the ilioinguinal method. Using suitable reduction strategies gives good reduction of anterior column, at the same time offers possibility to restore the posterior column from the anterior aspect using anterior to posterior column screws, obviating the need for a separate posterior approach.

Comparison Between Corticocancellous Allograft and Bovine Xenograft for Sinus Augmentation: A Radiographic, Histologic, and Histomorphometric Clinical Study.

Sinus floor augmentation is one of the most common approaches to obtain sufficient bone availability for placing implants in cases with severe bone atrophy in the posterior maxilla. Several bone substitutes are indicated for sinus augmentation, but they may achieve different clinical outcomes. This study aims to compare bovine bone mineral (BBM) with freeze-dried bone allograft (FDBA) in a two-stage lateral window sinus grafting approach. Twenty patients received a lateral window sinus elevation with either FDBA or BBM. Postoperative graft height was measured with CBCT. Implants were placed 6 months later, at which time biopsy samples were taken for histologic analysis and new CBCT scans were performed to measure graft height. The mean height reduction at 6 months was 20.27% ± 4.94% for FDBA samples and 5.36% ± 2.41% for BBM samples. The histologic analysis revealed a mean ratio of newly formed bone of 43.70% ± 5.29% for the FDBA group and 38.11% ± 4.03% for the BBM group. The FDBA group also showed a higher amount of residual biomaterial (17.25% ± 10.10%) and connective tissue (14.63% ± 4.38%) compared to the BBM group (15.53% ± 5.42% and 13.11% ± 4.42%, respectively). The differences between groups were statistically significant for the height reduction and newly formed bone (P ≤ .05) but not for the amounts of residual biomaterial and nonmineralized connective tissue (P ≥ .05). Six months after performing a lateral window sinus elevation, the percentage of newly formed bone was significantly higher when using FDBA than when using BBM, although the graft height reduction was also significantly higher for the FDBA group.

Bilateral Sacroiliac Joint Dislocation, Discussion and Surgical Strategies: A Case Report.

A 16-year-old male patient presented with isolated bilateral sacroiliac (SI) joint dislocation. In this report, we discuss the presentation and focus on strategies for operative reduction and fixation for this rare injury. In conclusion, we present a case of a bilateral ligamentous SI joint dislocation in an adolescent. The patient was reduced in the supine position with a sacral bump and bilateral traction with direct and indirect reduction aids inserted through a lateral window. Bilateral SI screws stabilized the pelvis, facilitating uncomplicated healing.

Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process.

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation (<alveolar bone resorption, >bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

Retrieval of displaced dental implant in maxillary sinus by modified Caldwell Luc technique

Displacement of dental implants into the maxillary sinus is an uncommon complication during implant placement. Here we present a case report of retrieval of dental implant displaced in the maxillary sinus with modification of Caldwell-Luc technique. A 35-year-old man presented to our institution for replacement of the maxillary right first molar using dental implant. At the point of final tightening of the implant, it suddenly got displaced into the maxillary sinus. The displaced dental implant was retrieved by performing a modification of the Caldwell-Luc technique which utilises gravitational force, saline as a vehicle and a tight-fitting suction tip in the surgically created lateral window. He was also instructed in coughing and sneezing techniques. Medical and dental professionals can utilise this technique effectively when advanced equipment such as endoscopes are not available to retrieve dental implants displaced in the maxillary sinus and it also preserves significant amount of alveolar bone in comparison to the traditional Caldwell Luc technique