Oral Maxillofac Surg (2014) 18:4352

DOI 10.1007/s10006-012-0386-x

ORIGINAL ARTICLE

Impact of the use of plasma rich in growth factors (PRGF)

on the quality of life of patients treated with endodontic
surgery when a perforation of sinus membrane occurred
A comparative study
S. Taschieri & S. Corbella & I. Tsesis & M. Del Fabbro

Received: 2 February 2012 / Accepted: 20 December 2012 / Published online: 10 January 2013
# Springer-Verlag Berlin Heidelberg 2013

Abstract
Introduction The aim of this retrospective investigation was
to evaluate the postoperative quality of life after endodontic
surgery in maxillary molars when a sinus membrane perforation occurred and platelet concentrates were used.
Materials and methods Included patients were treated by
microsurgical endodontic treatment in molar and premolar
maxillary regions between 2007 and 2010. Patients who fulfilled the inclusion criteria were screened. Data from the
quality of life questionnaire were analyzed. The use of plasma
rich in growth factors (PRGF) (test group) was compared with
a control group when a Schneiderian membrane perforation
occurred during endodontic surgery performed with a modern
technique in maxillary molars and premolars.
Results A total of 20 patients (12 in the control group and eight
in the test group) fulfilled the inclusion criteria. No differences
were evaluated at baseline for clinical parameters. Significantly
improved patients' quality of life was observed in the test group
considering symptoms as swelling, bad breath or taste, and
pain. Functional activities were less impaired in the test group
and swelling was significantly higher in the control group. In
the test group, pain was significantly lower than the control
group during the first 6 days after surgery and also, the consumption of painkillers was lower for patients belonging to the
test group even if it was not statistically significant.
S. Taschieri : S. Corbella : M. Del Fabbro (*)
Department of Biomedical, Surgical and Dental Sciences, IRCCS
Istituto Ortopedico Galeazzi, Universit degli Studi di Milano,
Milan, Italy
e-mail: massimo.delfabbro@unimi.it
I. Tsesis
Department of Endodontology, Maurice and Gabriela
Goldschleger School of Dental Medicine, Tel Aviv, Israel

Discussion In general, a small sinus membrane perforation

(less than 6 mm) during endodontic surgery did not cause
severe complications. The use of platelet concentrates could
be effective in reducing the impact on patients' quality of life,
decreasing pain and surgery side effects as well as swelling.
Keywords Apicoectomy . Endodontic surgery . Platelet
concentrates . PRGF . Sinus membrane perforation

Introduction
The introduction of microsurgical devices and magnification
devices in the modern endodontic surgery [1] represented a
breakthrough for root-end management and for soft tissue
management [14]. A variability of treatment protocols was
described, considering both magnification devices as operative microscope [57], endoscope [8], or magnification loupes
[911] and root-end filling materials as mineral trioxide aggregate [5, 10], Super ethoxy benzoic acid (EBA) (Bosworth
Company, Skokie, IL, USA) [7, 11], or intermediate restorative material [5, 10]. Such heterogeneity makes it difficult to
evaluate the factors influencing the outcomes of apical surgery
and to define a precise treatment protocol [1].
Moreover, in a recent literature review, it has been shown
that the modern endodontic microsurgical approach could
be considered predictable in terms of lesion healing and
regression of clinical signs and symptoms [1, 2, 12]. It
was also hypothesized that a less invasive surgical approach
could be more tolerable for patients than the conventional
one [13]. In fact, pain, swelling, and hematoma could frequently occur after endodontic surgery [14].
The roots of maxillary molars are often in close relationship
with the floor of maxillary sinus. This requires particular

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Oral Maxillofac Surg (2014) 18:4352

attention when performing endodontic surgery in this region

[15]. In fact, an occasional perforation of the Schneiderian
membrane could occur during root-end management in cases
of proximity or invasion of the antrum space by a periapical
inflammatory tissue [1517]. Sinus membrane perforations
could cause several sequelae both physiological and clinical.
A trauma to the Schneiderian membrane can inhibit ciliar
activity predisposing to modifications of mucous aspect and
reducing the resistance to infection [18]. Furthermore, clinical
complications as nose bleeding, sinus obstruction due to inflammation, and acute or chronic sinus infections are relatively frequent in case of membrane perforation [1820].
Plasma rich in growth factors (PRGF) due to its mechanical and cohesive properties could represent a useful tool for
the management of sinus membrane perforation [21]. In
addition, PRGF has been related to low postoperative discomfort after periapical surgery [22].
In literature, no studies evaluating quality of life after
sinus membrane injuries occasionally occurred during periapical surgery procedure are present. The aim of this retrospective comparative investigation was to evaluate if the use
of PRGF in endodontic surgery of maxillary molars may
improve patient's quality of life when a perforation of sinus
membrane occurs.

Materials and methods

The endodontic surgeries involving maxillary molars were
performed between 2007 and 2010 by one experienced
surgeon (ST) and were performed both in an university
clinic and in private practice. The outcomes were evaluated
from patients' dental charts and through the use of periapical
radiographs taken before surgery, after surgery, after
6 months from the surgery and then yearly.
Patient selection and inclusion criteria
The following inclusion criteria were adopted for case
selection:
&
&
&
&
&
&

Patients without any general medical contraindications

for oral surgery procedures (ASA-1 and ASA-2)
The tooth showed a periradicular lesion of strictly endodontic origin and the nonsurgical retreatment was considered unfeasible or had previously failed
The tooth exhibited an adequate final restoration with no
clinical evidence of coronal leakage
The apical root canal had 6 mm or more without the
presence of a post
Patients who smoked less than 10 cigarettes a day
Patients with only one maxillary tooth that required
maxillary surgery

Fig. 1 Incision of the flap. It could be noticed the sinus tract apically
to the crown of the element 1.6

&
&
&
&

The minimum diameter of the bone defect (as determined with periapical radiograph) was at least 4 mm
and no greater than 15 mm
Patients who underwent endodontic surgery in the maxillary posterior regions and who experienced sinus membrane perforation during surgery
Patients who filled in the quality of life questionnaire
Patients who attended at least the 1-year follow-up visit.
The exclusion criteria for the surgery were:

&
&
&
&
&
&

Presence of any kind of pathology associated with vertical root fracture

Severe periodontal bone loss detected with a periodontal
probe (probing depth >5 mm)
Teeth with perforation of the furcation area or lateral
canal walls
Teeth with traumatic injuries
Bone defects involving both buccal and ligual bone
plates
Presence of sinusitis or any other sinusal pathosis as
endoantral syndrome as described by Selden [1719].

Data of all patients experiencing a sinus membrane rupture

were considered. If PRGF was used to treat the fenestration,
patient was placed in test group, otherwise in control group.
Clinical data of nine males and 11 females were included in the
study. The mean age was 40.412.1 (range from 29 to 55).
A total of 20 teeth were treated, 18 of them were first
molars and two were second molars. All treated teeth had only
lesions affecting one of the buccal roots. Sixteen lesions could

Fig. 2 Through the bone access for root-end management, the sinus
membrane perforation is visible

Oral Maxillofac Surg (2014) 18:4352

Fig. 3 An absorbable hemostatic gelatine sponge was placed into the

bone access to shield the membrane perforation during root-end cavity
management

be classified as Class III as described by Oberli [15] and four

as Class II. In the test group, age ranged from 29 to 55 (mean
42.613.8) and four males and four females were treated. The
average size of periapical lesion was 82 mm (range 4.5 mm
to 10 mm). Seven of the treated teeth were first molars, while
one was a second molar. One lesion was classified as Class II
and seven as Class III [15].
In the control group, five males and seven females,
whose age ranged from 32 to 52 (mean 37.614.8), were
treated. The average size of periapical lesion, measured
during surgery through the use of a periodontal probe, was
7.53.5 mm (range 4 mm to 11 mm). Eleven of the treated
teeth were first molars, while one was a second molar. Three
lesions were classified as Class II and nine as Class III [15].
All membrane perforations were less than 6 mm large as
measured with a surgical caliper (BTI Biotechnology
Institute, Vitoria, Alava, Spain).
This study was conducted according to the principles
embodied in the World Medical Association Helsinki
Declaration of 1975 for biomedical research involving human subjects, as revised in 2000 [23]. Ethical approval was
obtained from the Review Board of the IRCCS Istituto

Fig. 4 Surgical site embedded with PVRGF supernatant in fluid status

using a syringe

45

Fig. 5 The positioning of PRGF clot over the perforation

Ortopedico Galeazzi (number 3.152007). All patients

gave their written informed consent.
Preparation of PRGF
Peripheral blood (10 ml) was drawn presurgically prior to
the administration of local anesthesia and collected with
laboratory 5-cc glass tubes pretreated with 3.8 % trisodium
citrate, which acts as anticoagulant. The tube was centrifuged at 460g at room temperature for 8 min in a centrifuge unit specifically designed for use with this technique
(PRGF System, BTI Biotechnology Institute, Vitoria,
Alava, Spain). After centrifugation, the plasmatic component is separated in two fractions using a laboratory pipette.
The lower fraction of about 1 cc, immediately above the
buffy coat, is the PRGF, while the upper fraction (about
1 cc) is the plasma poor in growth factors (PPGF). The two
fractions are stored in a sterile glass container until use. The
total preparation time for this technique is approximately
1015 min.
A few minutes before use, 50 l of 10 % CaCl2
were added per cubic centimeter of PRGF to enable clot
formation. This allowed to create a gel with mechanical
consistency that is stable and easy to handle.

Fig. 6 The surgical site soon after filling the bone cavity with a
PRGF clot

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Oral Maxillofac Surg (2014) 18:4352

Fig. 9 Radiographic examination soon after surgery

Fig. 7 Soft tissue healing 1 week after surgery

Surgical procedure
All surgeries were performed by one experienced surgeon
(ST). Preoperatively, all patients rinsed with a 0.2 % chlorhexidine solution for a minute as an antiseptic treatment in order
to reduce the contamination of the surgical field.
Local anesthesia was administered with the use of articaine
4 % and epinephrine 1:100,000.
The flap consisted of one releasing vertical incisions and
a horizontal incision. The vertical incisions were placed at
least one tooth distal to the tooth being treated. The initial
portion of the vertical incision was placed perpendicular to
the marginal course of the gingiva toward the midsection of
the papilla and gradually turning the incision parallel to the
tooth axis. Subsequently, it ran vertical, parallel to the tooth
axis and to supraperiosteal blood vessels in the mucosa and
gingiva with paramedian-releasing incision (Fig. 1).
Two different incisions were performed at the base of
papilla resulting in a split thickness flap, as described by
Velvart [24]. Buccally, over the tooth, the interproximal spaces
were joined by an intrasulcular incision dissecting the gingival
to the crestal bone. The sulcular incision reached the start of
the nearest papil base incision from the releasing incision.

Fig. 8 Preoperative radiographic examination showing a guttapercha

point into the sinus tract. The patient was referred to the surgeon
specialist after a failed orthograde retreatment and final prostesis rehabilitation, with a large metal cast post, by a general practioner

A partial thickness dissection, beginning 2 mm apical to the

base of the bone defects, was extended in the mesiodistal and
apical directions to release residual muscle tension and facilitate
the passive coronal displacement of the flap. In both groups,
surgical loupes were used as a magnification device for flap
elevation procedure. The full mucoperiosteal flap was mobilized, reflected, and carefully retracted during the root-end
management. Surgical access to the root was then made
through the cortical bone using a round bur, when necessary.
Shaving of the bone was performed with a brush stroke approach, low rotary speed, and constant sterile water irrigation.
The periradicular lesion was removed with sharp bone curettes
and angled periodontal curettes. The curetted tissue was placed
in 10 % formalin solution for pathological diagnosis.
Due to the closeness between the lesion and the
Schneiderian membrane during the lesion excision, a
perforation of the membrane itself occurred (Fig. 2).
After root-end exposure, 2.53 mm of root end was
removed using a bur with a cut perpendicular with the
long axis of the root. The root ends were prepared
using zirconium nitride retrotips (Dentsply Maillefer
Instruments, Ballaigues, Switzerland), driven by an ultrasonic device unit (Piezon Master 700, EMS, Nyon,
Switzerland). The created cavities were then accurately
dried using paper points. Finally, a zinc oxide EBAreinforced cement (Bosworth SuperEBA, Harry J.
Bosworth Company, Skokie, IL, USA) was used to seal

Fig. 10 Periapical radiograph at 1 year follow-up showing a satisfactory

healing process

Oral Maxillofac Surg (2014) 18:4352

47

Table 1 Quality of life questionnaire responses during the first week after surgery. Highlighted areas represent statistically significant differences
between the two groups (p<0.05)
Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Very much

Quite a bit

Some

Little/none

10

12

12

Very much

Quite a bit

Some

Little/none

10

12

12

Very much

Quite a bit

Some

Little/none

12

12

Very much

Quite a bit

Mouth opening

Chewing

Foods cant eat

Speaking

the retrograde cavity. An endoscope was used to adequately visualize all the phases of root-end management
[8].
Before starting root-end management, the sinus was protected from the possible dispersion of dental materials by the
use of an adsorbable hemostatic gelatine collagen sponge
1 cm1 cm1 cm (Spongostan/Surgifoam, Ferrosan A/
S, Sydmarken 5, DK-2860 Soeborg, Denmark) (Fig. 3). The
sponge was removed after root-end management. The surgical
site was embedded using PVRGF supernatant (Fig. 4), a
PRGF clot was applied over the perforation (Fig. 5), and
another clot was used to fill the bone cavity (Fig. 6).
Reflected flap was then repositioned, compressed, and finally,

sutured with a microsurgical 5/0 bioresorbable polyamide

suture (Ethicon Inc., Johnson & Johnson, Piscataway, NJ,
USA). PRGF supernatant was then gently injected, using an
atraumatical needle, at the suture site.
Postsurgical follow-up protocol
Postoperative instructions
Patients were instructed not to do anything that will rapidly raise
or lower pressure in the sinus cavity as: sneeze with mouth
closed, blow the nose, fly, suck through a straw, go swimming,
do diving, blow up balloons, or play a wind instrument for

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Oral Maxillofac Surg (2014) 18:4352

Table 1 (continued)
Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Some

Little/none

10

11

12

12

Very much

Quite a bit

Some

Little/none

11

11

12

12

12

12

12

Yes

No

11

11

12

12

12

12

Very much

Quite a bit

Some

Little/none

12

12

12

12

12

Very much

Quite a bit

10

Some

Little/none

12

Sleeping

Missed work/
school

Daily activities

Swelling

Nausea
Very much

10 days. Furthermore, patients were instructed to avoid vigorous

mouth rinsing, hard and hot food, strenuous exertion, smoking,
and touching the gums for at least 3 days before surgery.
Ice packs were provided after surgery. Moreover,
patients were instructed to gently rinse with a 0.2 %

chlorhexidine digluconate solution twice a day for

10 days for plaque control. All patients were prescribed
nonsteroideal analgesics for pain relief and swelling
control, if needed. Sutures were removed 7 days after
surgery (Fig. 7).

Oral Maxillofac Surg (2014) 18:4352

49

Table 1 (continued)
Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Quite a bit

Some

Little/none

12

12

12

12

12

12

12

Very much

Quite a bit

Some

Little/none

11

11

12

12

12

Very much

Quite a bit

Some

Little/ none

12

12

Very much

Quite a bit

Some

Little/none

12

12

12

Bad taste/breath

Worst pain

Average pain

Parameters evaluation
A designed questionnaire, used in previously published studies [2527], was administered to all subjects to evaluate
postoperative functional limitations (e.g., in chewing, talking,
sleeping, daily routine, and missed work) as well as pain and
the presence of other symptoms (swelling, bleeding, nausea,
and bad taste/breath). For pain assessment, a 10-cm graduated
visual analog scale (VAS) was adopted, where 0 = no pain and
100 = unbearable pain. For other symptoms and functional
limitations, the answers were based on a five-point Likert-type
scale, ranging from 1 (none) to 5 (very much). Finally,
patients were asked if they had taken any analgesics on each
postoperative day. Patients received the questionnaire to fill in

daily starting on the day of surgery for a week. Questionnaires

were returned postage paid. Evidence of complications as
nose bleeding, sinusal or nasal obstruction, or sinusitis and
their duration was recorded.
Criteria for healing assessment
At 1-year followup, the outcome was categorized as: (1)
success, which includes two subcategories: complete healing
(radiographic and clinical normalcy) and incomplete healing
(clinical normalcy combined with a remarkable reduced radiolucency), (2) uncertain healing (persistence of radiolucency in
the absence of clinical signs and symptoms or presence of
clinical signs/symptoms (clinical questionable) associated with

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Oral Maxillofac Surg (2014) 18:4352

each postoperative day. For this test, 24 table was built for
each instance. The difference between the two groups for
pain on each postoperative day was assessed using an unpaired t test. The patient was considered as the unit of
analysis. A probability P=0.05 was considered as the level
of significance. The software Statistica (StatSoft, Inc.,
Tulsa, OK, USA) version 5.0 was used for statistical
analysis.

Results

Fig. 11 Perceived pain (visual analogue scale) over time. The asterisk
represents a statistically significant difference (p<0.05)

a not complete radiographic healing), and (3) failure (presence

of clinical signs and symptoms combined with persistent radiolucency) [14, 28, 29]. Periapical radiographs were taken at each
scheduled follow-up clinical appointment (3 and 6 months)
using paralleling technique.
The radiographic evaluation was performed by two
blinded examiners (MDF and SC), who independently evaluated the radiographs (preoperative, postoperative, and
1 year) at 4.3 magnification using magnifying loupes. In
case of disagreement between the two evaluators, a radiograph was reevaluated jointly (Figs. 8, 9, and 10). Only after
agreement between the two evaluators was a case assigned
to one of the healing scores.
Statistical analysis
Fisher's exact test was used to assess statistically the difference between groups for analgesics taken, for missed work,
and for any variable related to function and symptoms on

Fig. 12 Percentage of patients who took painkillers in the first week

postoperatively. The asterisk represents a statistically significant difference (p<0.05)

Twenty patients fulfilled the inclusion criteria and were

included in the investigation. Eight patients were treated
with PRGF and 12 patients were treated without the use of
any material. All patients filled in the questionnaire without
any dropout.
No statistically significant differences were observed
between the two groups considering class of the lesion
as described by Oberli [15], age, gender, presence/absence of systemic diseases that can cause metabolic
impairment as diabetes, smoking, and lesion size. No
significant effect of such variables was observed on the
outcomes.
The responses to the questionnaire are summarized in
Table 1. Significantly improved patients' quality of life
was observed in the test group considering symptoms as
swelling, bad breath or taste, and pain. Functional activities
like mouth opening, chewing, speaking, inability to eat
some foods, and ability to do daily activities were reported
to be better performed in the test group than in the control
group. Swelling was significantly greater in the control
group than in the test group for 6 days after surgery. No
significant difference could be observed for sleeping, nausea, and frequency of missed work/school.
Figure 11 shows the outcome for perceived pain reported
using a VAS scale. In the test group, pain was significantly
lower than the control group during the first 6 days after
surgery. The difference was more evident for the first 5 days
(p<0.001).
Similarly, the consumption of painkillers was also lower
for patients belonging to the test group (Fig. 12). Besides,
no statistically significant difference was observed (p=
0.057 for the first 2 days and p=0.474 in the third day).
Three patients in the control group experienced spontaneous bleeding during the first 24 h after surgery, while no
one did in the test group. After 1 year, all cases were
classified as successful in terms of healing.
At any scheduled follow-up evaluation, the Schnederian
membrane appeared normal and the sinus physiology
was healthy according to criteria recently proposed [30,
31]. Histologic diagnosis of the lesions was periapical
granuloma.

Oral Maxillofac Surg (2014) 18:4352

Discussion
The proximity of maxillary molar roots with the sinus floor
as well as the presence of an apical lesion extending into the
sinus cavity represent risk factors for perforation of the
Schneiderian membrane during periapical surgery [15, 16,
3234]. Frequencies of membrane perforation varied from
9.6 % reported in a retrospective investigation by Oberli in
2007 [15] to 50 % [32]. It was also demonstrated that a
Schneiderian membrane perforation during oral surgical
procedures involving maxillary sinus is not detrimental to
the clinical outcome of the treatment, on condition that
foreign materials and root apex are not allowed to enter
the sinus cavity during root-end preparation [35]. The use
of a gauze was described to provisionally obliterate the
perforation [36]. In this study, a bioresorbable collagen
sponge was used to completely exclude the possibility leaving any foreign material in the site and subsequently, it was
removed after root-end management in all the cases.
Besides, it was also described that when these perforations are smaller than 56 mm, no specific treatment is
needed, as they don't lead to particular complications in
the postsurgical period [36]. In this study, only patients with
lesions close to the sinus floor or invading the cavity, belonging to class II and class III lesions according to the
classification by Oberli [15], were included in the postsurgical examination. In all cases, the membrane perforations
occured after creating the bone access to the lesion or during
the removal of the lesion itself. Further treatment as elevation of the membrane in order to close the communication,
as described in literature [37], was never required.
Platelet concentrates are widely use in dentistry. They
have been demonstrated to be effective in periodontal regeneration [38] and, after tooth extraction, to improve healing of postextractive socket [39]. Favorable outcomes of
platelet concentrates were also observed as a concern in
maxillary sinus surgery [40] favoring hard and soft
tissue healing in the surgical site and enhancing bone
neoformation [41, 42].
In surgeries involving the sinus membrane and cavity,
several advantages of the use of PRGF were described by
scientific literature. First, high biocompatibility and hemostatic properties facilitate the surgical procedure [43] and
allow a minimally invasive sealing treatment in cases of
small perforations as those described in the present study.
Then, one of the main favorable aspects is that some of
the platelet-derived components have the capacity to reduce
the inflammatory responses after surgery, positively affecting the postoperative quality of life of the patients. The antiinflammatory property could be explained both by the suppression of proinflammatory chemokines as IL-1 [44, 45]
and by the observed antimicrobial effect [46]. Considering
these aspects, it is possible to consider that the properties of

51

PRGF had a main role in significantly reducing the most

common symptoms as pain and swelling as observed in
patients treated in this study. A previous study investigating
quality of life after periradicular surgery suggested that the
application of microsurgical techniques for soft tissues and
especially for interdental papilla may have an effect in
improving the patients' postoperative quality of life [25].
Data of the present study showed that the use of PRGF in
association with a modern endodontic surgery may positively affect the postoperative quality of life in patients treated
with periradicular surgery in maxillary molars that caused
small sinus membrane perforations. Furthermore, considering that none of the patients experienced severe complications after surgery, it is possible to hypothesize that small
Schneiderian membrane perforations didn't affect significantly the short-term outcome of periradicular surgery in
posterior maxilla. Further studies investigating sinus function modifications after these injuries will allow a better
comprehension of the consequences of the Schneiderian
membrane healing. Also, the use of 3D radiographic techniques (as computerized tomography (CT) and cone beam
(CT)) should be evaluated in order to adequately diagnose
the relationship between the lesion and the maxillary sinus,
preventing the invasion of the sinus lumen [15].
Conflict of interest None.

References
1. Tsesis I, Faivishevsky V, Kfir A, Rosen E (2009) Outcome of
surgical endodontic treatment performed by a modern technique:
a meta-analysis of literature. J Endod 35(11):15051511
2. Tsesis I, Rosen E, Schwartz-Arad D, Fuss Z (2006) Retrospective
evaluation of surgical endodontic treatment: traditional versus
modern technique. J Endod 32(5):412416
3. Velvart P (2002) Papilla base incision: a new approach to
recession-free healing of the interdental papilla after endodontic.
Int Endod J 35(5):453460
4. Setzer FC, Shah SB, Kohli MR, Karabucak B, Kim S (2010)
Outcome of endodontic surgery: a meta-analysis of the literature
part 1: comparison of traditional root-end surgery and endodontic microsurgery. J Endod 36(11):17571765
5. Chong BS, Pitt Ford TR, Hudson MB (2003) A prospective
clinical study of mineral trioxide aggregate and IRM when used
as root-end filling materials in endodontic surgery. Int Endod J 36
(8):520526
6. Kim E, Song JS, Jung IY, Lee SJ, Kim S (2008) Prospective
clinical study evaluating endodontic microsurgery outcomes for
cases with lesions of endodontic origin compared with cases with
lesions of combined periodontal-endodontic origin. J Endod 34
(5):546551
7. Pecora G, De Leonardis D, Ibrahim N, Bovi M, Cornelini R (2001)
The use of calcium sulphate in the surgical treatment of a through
and through periradicular lesion. Int Endod J 34(3):189197
8. Taschieri S, Del Fabbro M, Testori T, Francetti L, Weinstein R
(2006) Endodontic surgery using 2 different magnification

52
devices: preliminary results of a randomized controlled study. J
Oral Maxillofac Surg 64(2):235242
9. Taschieri S, Del Fabbro M, Testori T, Francetti L, Weinstein R
(2005) Endodontic surgery with ultrasonic retrotips: one-year
follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
100(3):380387
10. Lindeboom JA, Frenken JW, Valkenburg P, van den Akker HP
(2005) The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective
double-blind placebo-controlled study. Int Endod J 38(12):877
881
11. Maddalone M, Gagliani M (2003) Periapical endodontic surgery: a
3-year follow-up study. Int Endod J 36(3):193198
12. Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein
RL (2009) Magnification devices for endodontic therapy.
Cochrane Database Syst Rev 3:CD005969. doi:10.1002/
14651858.CD005969.pub2
13. Pecora G, Andreana S (1993) Use of dental operating microscope in
endodontic surgery. Oral Surg Oral Med Oral Pathol 75(6):751758
14. Gutmann JL, Harrison JW (1991) Surgical endodontics.
Blackwell, Boston, x, 468 p
15. Oberli K, Bornstein MM, von Arx T (2007) Periapical surgery and
the maxillary sinus: radiographic parameters for clinical outcome.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(6):848
853
16. Ericson S, Finne K, Persson G (1974) Results of apicoectomy of
maxillary canines, premolars and molars with special reference to
oroantral communication as a prognostic factor. Int J Oral Surg 3
(6):386393
17. Selden HS (1999) Endo-antral syndrome and various endodontic
complications. J Endod 25(5):389393
18. Pignataro L, Mantovani M, Torretta S, Felisati G, Sambataro G
(2008) ENT assessment in the integrated management of candidate
for (maxillary) sinus lift. Acta Otorhinolaryngol Ital 28:110119
19. Watzek G, Bernhart T, Ulm C (1997) Complications of sinus
perforations and their management in endodontics. Dent Clin N
Am 41:563583
20. Doud Galli S, Lebowitz R, Giacchi R, Glickman R, Jacobs J
(2001) Chronic sinusitis complicating sinus lift surgery. Am J
Rhinol 15:181186
21. Chen FM, Zhang J, Zhang M, An Y, Chen F, Wu ZF (2011) A
review on endogenous regenerative technology in periodontal
regenerative medicine. Biomaterials 32(12):31893209
22. Taschieri S, Rosano G, Weinstein T, Bortolin M, Del Fabbro M
(2012) Treatment of through-and-through bone lesion using autologous growth factors and xenogeneic bone graft: a case report.
Oral Maxillofac Surg 16(1):5764. doi:10.1007/s10006-010-0251-8
23. World Medical Association (2000) Declaration of Helsinki: ethical
principles for medical research involving human subjects. JAMA
284(23):30433045
24. Velvart P (2002) Papilla base incision: a new approach to
recession-free healing of the interdental papilla after endodontic
surgery. Int Endod J 35:453460
25. Del Fabbro M, Taschieri S, Weinstein R (2009) Quality of life after
microscopic periradicular surgery using two different incision
techniques: a randomized clinical study. Int Endod J 42(4):360
367
26. Shugars DA, Benson K, White RP Jr, Simpson KN, Bader JD
(1996) Developing a measure of patient perceptions of short-term
outcomes of third molar surgery. J Oral Maxillofac Surg 54
(12):14021408
27. Tsesis I, Shoshani Y, Givol N, Yahalom R, Fuss Z, Taicher S
(2005) Comparison of quality of life after surgical endodontic

Oral Maxillofac Surg (2014) 18:4352

28.

29.

30.

31.

32.
33.

34.

35.
36.

37.

38.

39.

40.

41.

42.

43.

44.

45.

46.

treatment using two techniques: a prospective study. Oral Surg

Oral Med Oral Pathol Oral Radiol Endod 99(3):367371
Molven O, Halse A, Grung B (1987) Observer strategy and the
radiographic classification of healing after endodontic surgery. Int
J Oral Macillofac Surg 16:432439
Molven O, Halse A, Grung B (1996) Incomplete healing (scar
tissue) after periapical surgery. Radiographics findings 812 years
after treatment. J Endod 22:264268
Doud Galli S, Lebowitz R, Giacchi R, Glickman R, Jacobs J
(2001) Chronic sinusitis complicating sinus lift surgery. Am J
Rhinol 15:181186
Pignataro L, Mantovani M, Torretta S, Felisati G, Sambataro G
(2008) ENT assessment in the integrated management of candidate
for (maxillary) sinus lift. Acta Otorhinolaringol Ital 28:110119
Persson G (1982) Periapical surgery of molars. Int J Oral Surg 11
(2):96100
Rud J, Rud V (1998) Surgical endodontics of upper molars:
relation to the maxillary sinus and operation in acute state of
infection. J Endod 24(4):260261
Freedman A, Horowitz I (1999) Complications after apicoectomy
in maxillary premolar and molar teeth. Int J Oral Maxillofac Surg
28(3):192194
Hauman CH, Chandler NP, Tong DC (2002) Endodontic implications of the maxillary sinus: a review. Int Endod J 35(2):127141
Garcia B, Martorell L, Marti E, Penarrocha M (2006) Periapical
surgery of maxillary posterior teeth. A review of the literature.
Med Oral Patol Oral Cir Bucal 11(2):E146E150
Testori T, Wallace SS, Del Fabbro M, Taschieri S, Trisi P, Capelli
M, Weinstein RL (2008) Repair of large sinus membrane perforations using stabilized collagen barrier membranes: surgical techniques with histologic and radiographic evidence of success. Int J
Periodontics Restor Dent 28(1):917
Del Fabbro M, Bortolin M, Taschieri S, Weinstein R (2011) Is
platelet concentrate advantageous for the surgical treatment of
periodontal diseases? A systematic review and meta-analysis. J
Periodontol 82(8):11001111
Del Fabbro M, Bortolin M, Taschieri S (2011) Is autologous platelet
concentrate beneficial for post-extraction socket healing? A systematic review. Int J Oral Maxillofac Surg 40(9):891900
Del Fabbro M, Bortolin M, Taschieri S, Weinstein RL (2011)
Effect of autologous growth factors in maxillary sinus augmentation: a systematic review. Clin Implant Dent Relat Res.
doi:10.1111/j.1708-8208.2011.00343.x
Anitua E, Prado R, Orive G (2009) A lateral approach for sinus
elevation using PRGF technology. Clin Implant Dent Relat Res 11
(Suppl 1):e23e31
Anitua E, Prado R, Orive G (2012) Bilateral sinus elevation
evaluating plasma rich in growth factors technology: a report of
five cases. Clin Implant Dent Relat Res 14(1):5160. doi:10.1111/
j.1708-8208.2009.00233.x
Anitua E, Sanchez M, Nurden AT, Nurden P, Orive G, Andia I
(2006) New insights into and novel applications for platelet-rich
fibrin therapies. Trends Biotechnol 24(5):227234
El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M,
Van Dyke TE (2007) Platelet-rich plasma: growth factors and proand anti-inflammatory properties. J Periodontol 78(4):661669
Woodall J Jr, Tucci M, Mishra A, Asfour A, Benghuzzi H (2008)
Cellular effects of platelet rich plasmainterleukin1 release from prp
treated macrophages. Biomed Sci Instrum 44:489494
Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Krol W,
Wielkoszynski T (2007) Antibacterial effect of autologous platelet
gel enriched with growth factors and other active substances: an in
vitro study. J Bone Joint Surg Br 89(3):417420

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