Materials to use for external sinus lift procedure?
I did several sinus lifts and I used mineral allograft from Ace Surgical.  All I did is mixed that with saline or used patient blood from the surgery, and placed in the sinus window. After 8 months I have been finding very soft bone in the grafted area. I was not able to achieve good hard bone. I know PRGF or PRF give good results. Without using PRF or PRGF what would you recommend for me to use when I do external sinus lift procedure? I have a patient scheduled in 1 week and I need your opinion. I will start using PRGF or PRP after I get proper training on this, but for now I’m looking at other options. The bone height in the  area is 1mm. The patient is healthy and a non-smoker. Please recommend what type of material and technique I should use.
27 Comments on Materials to use for external sinus lift procedure?
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CRS
1/4/2013
Use a better bone like Mineross or Allosorb I had sub par results with the Ace product also. For using the growth factors you need to know how to draw blood.
greg steiner
1/4/2013
You have proven to yourself that allografts are not producing adequate results. All allografts in dentistry are transplants and cannot be modified in any way. If an allograft is modified it would then would require FDA clearance to be sold. So it does not matter what the name is all allografts are the same and many of the different allografts on the market are produced by the same bone banks. Autografts and beta tricalcium phosphate granules have been shown to produce equally effective results. PRP has not been shown to improve bone graft outcomes. I do not do open window sinus lifts but our customers who do use Regen Biocement Putty mixed with Osseoconduct BTCP granules. Greg Steiner Steiner Laboratories
dr. s.
1/5/2013
Good comment crs. Everybody has successful experiences.
I prefer bio-oss as a xenograft.
It is most published in the literature worldwide, resorbable and you can be sure that in it you cannot find any remaining proteins from cows.
A real good graft material for external sinus lifts. Sometimes i use antibiotics for the prevention of inflammations. proven
Richard Hughes, DDS, FAAI
1/5/2013
BioOss does not resorb. It is a filler. You will get at best approximately 25% bone, 23% BioOss and approximately 50% fibrous connective tissue formed. This is not satisfactory. You may also fave as an ent result sclerotic tissue. When you compare histology, look at the magnification that was used. 23 to 25 percent is an insufficiet BIC for long term success!
I suggest using a good allograft, like OsteoGen and mix with autogenous bone. This yields a fantastic result. You also need marrow blood etc. other allografts are probably ok, but I prefer OsteoGen. It yields nothing less than 80% bone and usually 90% bone.
Even Daniel Buser states that Xenografts should be considered close to nonresorbable.
Richard Hughes, DDS, FAAI
1/6/2013
I am correcting myself. I suggest using an alloplast, not an allograft with autogenous bone. OsteoGen is an excellent alloplast. Xenografts are nonresorbable, a strain on the RES and immune system proper.
I question the great claims made about Xenografts.
Doctor X
1/8/2013
If we place an implant on a region we need good torque for it, the sclerotic tissue will be irrigated with blood by the second operation procedure most of the time we need ancilosis.also we need good stability for the implant and a good bacteriostatic graft.
CRS
1/5/2013
I like the comments, my secret formula is Allosorb or Mineross (cortico-cancellous)mixed with a small amount if Bio-OSS as a radiographic marker and PRP. Now I use PRGF.(better product) I feel that Autologous instead of the PRGF would also be good. The PRGF helps hold the graft together and prevents migration. Lately it seems that I have done less lateral lifts and more vertical/horizontal augmentations of the ridges with the PRGF and internal lifts with expanders. I think the lateral lift is a great technique also depending on the patients anatomy. I feel that each individual practioner has a formula that works best for them, but I am always up for new techniques!
greg steiner
1/5/2013
Dr. s
I would listen to Dr. Hughes. If you are grafting human or animal tissue into your patient you are the transplant team. Because these products are not regulated it is your responsibility to know everything about the transplanted material and how it will perform in the individual you are transplanting the tissue into. But please keep posting. It is better to be contradicted and learn something than be quite and be wrong. Greg Steiner Steiner Laboratories
Oleg amayev
1/6/2013
has anybody used bone cement and how has that worked out?
Richard Hughes, DDS, FAAI
1/6/2013
Bone Cement is nothing more than PMMA (acrylic). I don't recommend this, since its nothing more than a filler and will not make bone.
Joseph CHOUKROUN
1/6/2013
soft bone after 8 months is not from the biomlaterial !! The allograft contains high percentage of collagen fibers and it's the best biomaterial if you want to get bone faster.
Serach other reason: contamination, High LDL Cholesterol, Low serum vit D level.
I advise to add systematicalluy to the biomaterial, low dose of pure Metronidazole powder.
In your case, High LDL cholesterol is the most frequent origin: High LDL induces osteoblast apoptosis, inhibition of phosphatase alcalin and lower mineralisation.
greg steiner
1/7/2013
Dr. Choukroun
Interesting comments regarding elevated LDL. I have never heard that high LDL inhibits bone growth but I do know that a high fat diet significantly reduces bone growth in the rabbit model to an extent that I advise my regenerative patients to avoid a high fat diet during the regenerative phase. If you have any references about LDL and vitamin D levels and bone growth please pass them on to us. Greg Steiner Steiner Laboratories
Joseph CHOUKROUN
1/7/2013
article will be publish soon in Journal of oral Implantology.
For more articles send a request to the website.
Gerve ,msc
1/9/2013
I always make a mix of PRF and Allogenic bone (German osteograft).and cover with the PRF membrans inside sinus sneiderian membran befor lifting also close after lifting the window with PRF multiple layer membrans.thats make a wonderful healing anytime
greg steiner
1/9/2013
While in theory PRF and PRP sounds great but unfortunately studies comparing these materials have shown no statistical difference than when they are or are not used for bone regeneration. These materials are already present in the healing wound and upping their concentration above normal would have been an adaption made by the body if it was any benefit. This is another reason why growth factors have failed to improve bone regeneration. Greg Steiner Steiner Laboratories.
Joseph CHOUKROUN
1/9/2013
Greg, it's your personal opinion. In science , personal opinions are not welcome. I invite you to read the publications (in PRF, more than 112) and may be, you'll improve your knowledge and should be able to put better comments. Joseph
greg steiner
1/9/2013
Dr. Choukroun
I have no opinion, only the conclusions of the well done research I have read. Please provide me with just two well done studies that establish the efficacy of PRP and I will enjoy reading them with an open mind. Greg Steiner Steiner Laboratories
Joseph CHOUKROUN
1/9/2013
Greg, I have no experience on PRP. only in PRF. however, if you send a request to the website, I'll send you several articles with pleasure. My best. Joseph
greg steiner
1/9/2013
Thanks Dr. Choukroun please give me an idea on how I can find your web site. Thanks Greg
Oleg amayev
1/9/2013
So if PRP, PRGF, PRF don't work like you said then what would work in sinus lift.
Very nice discussion but no one yet provided procedure for use in sinus lift.
Richard Hughes, DDS, FAAI
1/10/2013
Dr. Choukroun,
I would also like to receive your articles.
I thank you for your kind attention.
Richard Hughes, DDS
OsseoNews
1/9/2013
If you click on someone's name, it will bring you to their website.
JOSEPH CHOUKROUN
1/10/2013
please send a request to the website ( through Contact) : http://www.processforprf.com/
Dr. Rick Lindeberg
1/10/2013
What about a resorbable collagen membrane over the access window? Tarnow and Froum showed improved bone quality when the window was covered.
Hossam Barghash
1/11/2013
dealing with bone grafting need to understand bone regeneration at the molecular level, second we need to know that there is a big difference between vitro studies and vivo reality. so answering the question does growth factors make difference in regeneration time and quality? the vitro answer is yes the vivo answer it depends on systemic and local factors( not all known yet). Is there is difference between PRP an PRF? yes regarding the molecular structure plus the advantages of preparation procedures and using as membrane make PRF superior.
should I use it in every case ? we are dealing with individuals so individual planning should be done according to scientific knowledge update
Richard Hughes, DDS, FAAI
1/11/2013
Thank you Dr. Choukroun.
Branko Trajkovski
2/13/2013
The nature does not want you to have bone in the sinus. Therefore, non-resorbable material like bovine Hydroxyapatite, especially sintered product like Cerabone, would guarantee stable integration into the newly formed bone and therefore stability for implant placement. The sintering process is increasing the hydroxyapatite crystals and therefore osteoclast would never dissolve that. Maybe some small percentage during the years passing by still not-biodegradable. There is 1 paper from the last year comparing non-sintered matrial Bio-oss to lose 33% bone volume after 4 years in sinus. The sinterded-Cerabone lost only 23% in volume.
The other option could be bi-phasic synthetic material, like Maxresorb. If you have pure ß-TCP, you will have bone, but due to remodeling, you will have much less bone volume than the bi-phasic material which is completely absorbable.
Third option, and my favorite, would be to combine non-degradable material like Cerabone and autograft or allograft material. Then very fast you will have a new and vital bone stabilized by the non-degradable particles.
