Two groups of patients with partial edentulous posterior maxilla with pneumatized sinus
and need dental implant. First group will be subjected to open sinus lifting using
autogenous bone mixed with bone marrow aspirate concentrate cells from maxillary
tuberosity (the study group) and the second group will be subjected to open sinus lifting
using autogenous bone mixed with bovine bone (control group) Intervention Eligible
patients will be equally randomized in a parallel two arm groups . The study group (open
sinus lifting using bone marrow aspirate concentrate from maxillary tuberosity mixed with
bovine bone) Procedure will be performed under local anesthesia A 20 gauge needle will be
inserted in the maxillary tuberosity area through the palatal aspect until aspiration is
positive.
Aspirate will be collected in a heparin-treated tube (2000:1) using 1ml of anticoagulant
acid citrate dextrose solution for every 15ml of bone marrow aspiration.
Aspirate will be centrifuged at 3000 rpm for 10 minutes to separate the BMAC . The upper
layer containing plasma and platelets will be collected using a sterile pipette, leaving
the bone marrow aspirate bone marrow aspirate will be mixed with bovine bone and then the
mixture will be applied in open sinus lifting Control group (open sinus lifting using
autogenous bone from retromolar area mixed with bovine bone) After injection of local
anesthesia a crestal incision will be carried out from a point corresponding to the
occlusal surface along the external oblique ridge and extending anteriorly and inferiorly
through the buccal mucosa, parallel to the gingival margin of the mandibular molars.
The subperiosteal dissection will be extended to expose the ascending ramus and the
retromolar region.
Auto chip maker bur will be used to drill out some autogenous bone particulate from
retromolar which will be mixed with xenogeneic graft with a 50% to 50% ratio
respectively. this mixture will be packed into the grafted site .
Post operative instructions and follow up:
Administration of:
Antibiotics (Amoxicillin 1g twice daily for 5 days) to prevent any chance of
infection.
Anti-inflammatory drugs (NSAIDS; Ibuprofen 600mg three times daily for 5 days) to
avoid any chance of edema or pain or swelling
Antiseptic mouth rinse (0.12% Chlorhexidine oral rinse will be prescribed for 60
seconds two times a day for 14 days.
- The patient will be instructed to follow up for the next months before implant
placement
Patient self-care instructions:
Application of an ice bag to the treated area for the first 24 hours.
Avoid any brushing and trauma to the surgical site for one week
avoid smoking
The patient will be asked to keep on clear fluid diet for the first 24 hours then a
soft diet to be maintained for the next day.
Strict oral hygiene measures in the form of regular use of toothbrush and antiseptic
mouthwash starting week after surgery. Warm saline oral rinsing three times daily
for one week.
Postsurgical procedure (six months lateral sinus lifting) Local anaesthesia will be
administered by infiltration or nerve block to achieve the necessary anaesthesia.
A flap will be raised at the presurgical site. A core biopsy will be harvested by
introducing a core drill bit in place of an initial drill.
Sequential drilling will take place to prepare osteotomy to the right size to receive an
implant.
Implant will be placed in the osteotomy with the platform flush with the bone. Flap
closure will be achieved by interrupted 5-0 sutures. Outcomes Primary outcome quantity of
bone gain Secondary outcome quality of bone gain