Autologous tooth graft for maxillary sinus augmentation: A multicenter clinical study

Abstract

Aim: The aim of this pilot study was to assess the performance of autologous tooth matrix, used as a graft material for maxillary sinus augmentation, after at least 1-year of follow-up. Settings and Design: The patients included in this prospective case series study were treated in four clinical centers using standardized clinical procedures. Materials and Methods: Patients with atrophic posterior maxilla in need of sinus augmentation before rehabilitation with implant-supported prostheses, and with compromised teeth to be extracted, were included. The extracted tooth was cleaned and processed by a recently introduced automated device, which allows fragmentation and partial demineralization of the tooth matrix, and used as a graft material for sinus augmentation. A covering membrane was used to protect the graft. Implants were placed after 6 months of healing. Five bone biopsies of the grafted sites were taken at the time of implant surgery, for histological analysis. Implants were followed for at least 1 year after placement. Cone-beam computed tomography and/or standardized periapical radiographs were used to assess the ridge height before and after grafting, up to 1-year postimplantation. Statistical Analysis: Descriptive statistics were used to synthesize the results, using mean values and standard deviations. Results: Twenty-three patients (9 males, mean age at surgery 57.1 ± 9.4 years) were treated and 40 implants were placed in grafted sites. Residual ridge height was 5.22 ± 2.04 mm and increased to 14.72 ± 2.83 mm after grafting. One implant failed during healing phase. Cumulative implant survival rate was 97.5% after 19.1 ± 8.0 months of follow-up (range 12.3–44.1 months). After 6 months of healing, the graft height appeared stable. No signs of sinus infection were present. The histologic analysis revealed neither inflammatory nor infective reaction against tooth graft. Granules appeared surrounded by newly formed bone and partially resorbed, indicating ongoing remodeling. Conclusion: Autologous human tooth matrix can be successfully used as graft material in sinus augmentation procedure.