MATERIAL AND METHODS
perforations
CLOTS, CLOT, EROSION, PERIOSTEUM, BONE ISLANDS, STERILE, COLLAPSE, CAVITY, CREST
This double-blind clinical trial study was conducted using the split-mouth method. 9 patients aged 30-80 with bilateral posterior partial or edentulous maxilla referred to the Tabriz Faculty of Dentistry participated in this research.The sample size was determined according to Chitsazi MT The inclusion criteria were bilateral posterior partial edentulous or edentulous maxilla and height of remaining bone between the alveolar crest and sinus floor less than 5 mm [To prepare the CGF, immediately before surgery, intravenous blood was collected into plastic tubes (4-6 tubes) without anticoagulant but containing silicate as a clot activator (each tube 9 mm) and centrifuged using Medifuge (Silfradent Srl, Sofia, Italy) [Layers formed in a test tube.All surgeries were performed by one surgeon. Before injecting the anesthesia, 2% lidocaine, and 1:80,000 epinephrine, patients rinsed their mouth with chlorhexidine gluconate 0.12% for one minute.Full-thickness crestal incision and, if needed, vertical incision were carried out. To treat the maxillary posterior edentulous area, the lateral window sinus lift technique was applied so that after the reflection of the flap, the outline of the window was determined using the carbide round bur No. 8 in the lateral wall of the sinus bone. Then by the erosion method, the lateral wall window bone was gently removed using the carbide round bur No. 8 and 6, and the Schneiderian membrane was gently elevated (Preparing the bone window in the lateral wall.The Schneiderian membrane (which contains 3 layers: periosteum, connective tissue, and respiratory epithelium) was lifted to prevent the small possible perforations resulting from the sharpness of the edges of xenograft particles in the control group and increase the membrane thickness and to prevent its possible collapse in the intervention group. As the sinus membrane was lifted, a layer of acellular dermal matrix (ADM) (CenoDerm; Tissue Regeneration Corporation, Kish, Iran) with 1-1.4 mm thickness, immersed in sterile saline based on producers recommendations, was placed under the Schneiderian membrane and the grafting substitutes were placed into the cavity [After lifting the Schneiderian membrane, bovine xenograft was randomly applied on one side (for example, left maxillary sinus) (Bone +B; Nova Teb Pars, Marzanabad, Iran) [Placing the CGF clots in the sinus cavity.6 months later, CBCT radiography was performed for both groups. Then, the osteotomy area was specified during the surgery using the thin trephine bur with a 2.7 mm internal diameter (Preparing the biopsy sample after 6 months during the implant placement.Histological view of sinus augmentation area (H&E staining control group with 100x). A: New bone area with dense bone tissues and newly formed acidophilic bone islands; B: Primary bone of maxillary sinus in acidophilic form with lamellar bone, among which the osteocyte cells were molded; C: Connective tissue with connective tissue cells, collagen fibers, and lymphatic cells. Fibroblasts are seen between the collagen fibers; lipid cells and inflammatory cells like lymphocytes are observable among the collagen fibers; D: Loose connective tissue in the bone marrow, which is full of mesenchymal and lipid cells together with the blood cells; E: Remaining materials.Histological view of sinus augmentation area (H&E staining intervention group with 100x). A: Newly formed bone acidophil area with relatively irregular collagen fibers and osteocyte cells among the collagen fibers. B: Primary bone of maxillary sinus with osteocyte cells inside the clear lacuna among the bone acidophil lamellae. C: Irregular dense connective tissue together with inflammatory cells like lymphocytes and irregular collagen fibers, and fibroblast cells. D: Bone marrow with blood cells inside the mesenchymal tissue.Histological view of sinus augmentation area (alizarin red staining control group with 100x). A: New bone areas in acidophil stain that is differentiable from the previous bone tissue; B: Primary bone of maxillary sinus; C: Remaining xenograft materials are seen between the bone; D: Connective tissue.Histological view of sinus augmentation area (alizarin red staining intervention group with 100x). A: New bone areas in acidophil stain that is differentiable from the previous bone tissue; B: Primary bone of maxillary sinus.Another histological view of sinus augmentation area (staining intervention group with 100x). A: New bone areas in acidophil stain are differentiable from the previous bone tissue; B: Primary bone of maxillary sinus; C: Connective tissue.