Histomorphometric Analysis of a Biopsy Harvested 10 Years After Maxillary Sinus Augmentation With Anorganic Bovine Bone Matrix and Plasma Rich in Growth Factors: A Case Report Simón Pardiñas López, DDS, MS,* Stuart Froum, DDS,† and Ismael Khouly, DDS, MS, PhD‡ T he edentulous posterior maxilla is often a challenging site for implant placement because of atrophy of the alveolar ridge, poor bone quality, and increased pneumati- zation of the maxillary sinus. 1,2 Several augmentation techniques have been advocated to increase the alveolar volume using bone grafting of the maxillary sinus antral floor. 3–7 Max- illary sinus augmentation using the lat- eral window technique has proven to be a routine and highly predictable method of regenerating bone for implant place- ment in this area. Evidence-based re- views have reported positive outcomes using different graft materials for max- illary sinus augmentation. 3,8–11 The original protocol used autologous bone, which was considered by many to be the gold standard. 12,13 Unfortunately, har- vesting of the autologous bone graft was associated with several disadvan- tages, such as prolonged operating time, surgical complications, and increased morbidity. To overcome these disadvantages, various osteocon- ductive and osteoinductive bone replacement graft materials have been used for many years in the sinus lift pro- cedure. 14 These materials include allog- rafts, xenografts, alloplasts, and growth factors or a combination of these materials. 13,14 The use of growth factors, such as plasma rich in growth factors (PRGF), have demonstrated the potential to influence regeneration and healing, introducing a new era of bone regener- ation in regions such as the posterior maxilla. PRGF is an autologous plate- let-enriched plasma obtained from the patient’s own blood. 15–17 The PRGF has 4 to 8 times more platelet concentration than does normal blood. 18 This material contains active pro- teins that can influence and promote cell recruitment, growth, and differentia- tion. 19,20 A recent study confirmed that PRGF technology stimulated the essen- tial processes related to bone tissue regeneration. 21 In fact, studies have *Former Resident, Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY; Periodontist and Oral Surgeon, Private Practice, Clínica Pardiñas, A Coruña, Spain. †Director of Clinical Research and Clinical Professor, Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY. ‡Assistant Clinical Professor, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY; Associate Director of Periodontology & Implant Dentistry, Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY. Reprint requests and correspondence to: Simón Pardiñas López, DDS, MS, Clínica Pardiñas, C/Real 66, 3° 15003, A Coruña, Spain, Phone: +34981214000, E-mail: simonplz@hotmail.com ISSN 1056-6163/15/00000-001 Implant Dentistry Volume 0  Number 0 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ID.0000000000000289 Purpose: To evaluate the histo- logic and histomorphometric data 10 years after grafting of maxillary sinus in a case using anorganic bovine bone matrix (ABBM) and plasma rich in growth factors (PRGF). Materials and Methods: Histo- morphometric measures were per- formed for newly formed bone, ABBM particles remnants, marrow spaces, and the presence of osteo- blastic and osteoclastic activity. Results: Histologic analysis showed ABBM particles surrounded by new compact and mature vital bone. Osteocytes were noted within lacunae. Some osteoblastic and oste- oclastic activity could be identified. The histomorphometric results were 21.7% of newly formed bone, 33.9% of ABBM, and 44% was composed of marrow spaces. Conclusions: After 10 years postoperatively, the histologic eval- uation of this case report demon- strated slow replacement of the ABBM particles by newly formed bone, even with the addition of PRGF. The residual ABBM particles were found in close contact to the newly formed bone. (Implant Dent 2015;0:1–7) Key Words: maxillary sinus aug- mentation, anorganic bovine bone matrix, plasma rich in growth fac- tors, histology IMPLANT DENTISTRY /VOLUME 0, NUMBER 0 2015 1 Copyright Ó 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.