A retrospective preliminary histomorphometric and clinical investigation on sinus augmentation using enzyme-deantigenic, collagen-preserving equine bone granules and plasma rich in growth factors

Danilo Alessio Di Stefano,Enrico Felice Gherlone,Paolo Capparè,Raffaele Vinci

doi:10.1186/s40729-021-00336-9

Abstract

BackgroundEnzyme-deantigenic equine bone (EDEB) is a substitute of autogenous bone. Mixing it with plasma rich in growth factors (PRGF) seems a viable option to achieve enhanced bone formation in alveolar bone augmentation surgeries. This retrospective study aims to first report the histomorphometric and clinical outcomes achieved when using the EDEB/PRGF mixture for performing sinus augmentation procedures followed by delayed implant placement.Materials and methodsRecords of 11 patients who underwent 14 sinus augmentation surgeries using EDEB/PRGF followed by delayed implant placement were retrospectively collected and analyzed to assess histomorphometric data concerning newly formed bone (NFB) and residual biomaterial (RB) recorded at implant placement, marginal bone loss (MBL) values of implants placed in the augmented sinuses, and implant and prosthetic success and survival rates.ResultsAt 5.6 ± 1.1 months after grafting, NFB and RB were 34.0 ± 9.1% and 11.3 ± 2.2% respectively, and no histologic signs of inflammation or immune reaction were observed in any of the 34 bone biopsies being collected. Further, 86.5 ± 4.3 months after implant placement, MBL was 0.40 ± 0.07 mm. No implant or prosthesis failed, and the implant success and survival rates were 100%ConclusionsWithin the limitations of the present study, grafting EDEB/PRGF for lateral sinus augmentation and delayed implant placement seems to be safe. Compared to published data concerning EDEB alone, results of the present study do not suggest that the EDEB/PRGF combination may provide a histomorphometric or medium-/long-term clinical advantage.

Highlights

Sinus augmentation is a well-known approach to allow implant-supported rehabilitation in the atrophic posterior maxilla [1,2,3,4,5,6,7]
Compared to published data concerning Enzyme-deantigenic equine bone (EDEB) alone, results of the present study do not suggest that the EDEB/plasma rich in growth factors (PRGF) combination may provide a histomorphometric or medium-/ long-term clinical advantage
EDEB as well as other bone substitutes may be mixed with biological adjuncts, including cell extracts and preparations or blood derivatives, such as adipose-derived mesenchymal stem cells (ASCs), bone marrow aspirate or concentrate (BMA/ BMC), platelet-rich plasma (PRP), leukocyte/platelet-rich fibrin (L-PRF or PRF); plasma-rich in growth factor (PRGF); autogenous fibrin (AF); magnesium-enriched hydroxyapatite (MHA); and others [23,24,25,26,27,28,29,30,31,32]

Summary

Introduction

Sinus augmentation is a well-known approach to allow implant-supported rehabilitation in the atrophic posterior maxilla [1,2,3,4,5,6,7]. An alternative process based on using lytic enzymes working at lower temperatures (about 37 °C) is applied to manufacture enzyme-deantigenic equine bone (EDEB) This process, that involves selective degradation of antigens, allows preserving type I bone collagen intact [18]. Enzyme-deantigenic equine bone (EDEB) is a substitute of autogenous bone Mixing it with plasma rich in growth factors (PRGF) seems a viable option to achieve enhanced bone formation in alveolar bone augmentation surgeries. This retrospective study aims to first report the histomorphometric and clinical outcomes achieved when using the EDEB/PRGF mixture for performing sinus augmentation procedures followed by delayed implant placement

Objectives

Methods

Results

Discussion

Conclusion