Autologous Periosteum-Derived Micrografts and PLGA/HA Enhance the Bone Formation in Sinus Lift Augmentation.

Ruggero Rodriguez Y Baena,Gabriele Ceccarelli,Riccardo D'Aquino,Antonio C Aloise,Letizia Trovato,Saturnino M Lupi,Antonio Graziano,André A Pelegrine,Gabriella Cusella

doi:10.3389/fcell.2017.00087

Abstract

Sinus lift augmentation is a procedure required for the placement of a dental implant, whose success can be limited by the quantity or quality of available bone. To this purpose, the first aim of the current study was to evaluate the ability of autologous periosteum-derived micrografts and Poly(lactic-co-glycolic acid) (PLGA) supplemented with hydroxyl apatite (HA) to induce bone augmentation in the sinus lift procedure. Secondly, we compared the micrograft's behavior with respect to biomaterial alone, including Bio-Oss® and PLGA/HA, commercially named Alos. Sinus lift procedure was performed on 24 patients who required dental implants and who, according to the study design and procedure performed, were divided into three groups: group A (Alos + periosteum-derived micrografts); group B (Alos alone); and group C (Bio-Oss® alone). Briefly, in group A, a small piece of periosteum was collected from each patient and mechanically disaggregated by Rigenera® protocol using the Rigeneracons medical device. This protocol allowed for the obtainment of autologous micrografts, which in turn were used to soak the Alos scaffold. At 6 months after the sinus lift procedure and before the installation of dental implants, histological and radiographic evaluations in all three groups were performed. In group A, where sinus lift augmentation was performed using periosteum-derived micrografts and Alos, the bone regeneration was much faster than in the control groups where it was performed with Alos or Bio-Oss® alone (groups B and C, respectively). In addition, the radiographic evaluation in the patients of group A showed a radio-opacity after 4 months, while after 6 months, the prosthetic rehabilitation was improved and was maintained after 2 years post-surgery. In summary, we report on the efficacy of periosteum-derived micrografts and Alos to augment sinus lift in patients requiring dental implants. This efficacy is supported by an increased percentage of vital mineralized tisssue in the group treated with both periosteum-derived micrografts and Alos, with respect to the control group of Alos or Bio-Oss® alone, as confirmed by histological analysis and radiographic evaluations at 6 months from treatment.

Highlights

The restoration of a partial or complete maxilla without teeth can be achieved via the positioning of dental implants, but this approach is commonly limited in success by the quantity or quality of available bone
We propose the use of autologous periosteum-derived micrografts as a new procedure during maxillary sinus lift to improve the rate of success for the placement of dental implants
It can be observed that in the group treated with periosteumderived micrografts and Alos, the ossification process was more increased compared to that in the control group B (Alos alone) or in group C (Bio-Oss R ; Geistlich Biomaterials, Wolhusen, Switzerland)

Summary

Introduction

The restoration of a partial or complete maxilla without teeth can be achieved via the positioning of dental implants, but this approach is commonly limited in success by the quantity or quality of available bone. There are only two main techniques to augment sinus lift: the transalveolar (crestal) and the lateral windows, but several modifications of these techniques have been proposed (Wallace and Froum, 2003; Woo and Le, 2004; Sotirakis and Gonshor, 2005) In this procedure, bone substitutes represent key players to increase the rate of success because they possess biocompatibility, permit bone migration and surface colonization by osteogenic cells, present greater capacity to mimic the physical properties of bone, and are available in a great amount at a reasonably low price (Barradas et al, 2011). Micrograft technology found application in oral-maxillofacial surgery, where micrografts derived from human dental pulp or periosteum were used for periodontal regeneration, bone regeneration of atrophic maxilla, and alveolar socket preservation (Brunelli et al, 2013; Graziano et al, 2013; D’Aquino et al, 2016)

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