Changes of mineralization of free autogenous bone grafts used for sinus floor elevation

Abstract

For augmentations before implant placement in areas of minor bone quantity, autogenous bone is considered the reference to all bone substitutes used alternatively. Autogenous bone transplants originate from various donor areas and can be prepared in different ways before augmentation. They may either be used as block grafts or may be milled to granules that can be used solitarily or in combination with a bone substitute. In a prospective study, 61 patients of the Maxillofacial Surgery Department of our University receiving two-stage sinus floor elevation because of insufficient bone supply were randomly selected. At first-stage surgery, the local augmentation procedure, monocortical probes were obtained on the site of bone harvesting. At second-stage surgery, the implant insertion 6 months after the elevation procedure, bone cores were harvested in the areas of implant placement. Donor regions were the following three areas: the posterior (N=28) and anterior pelvic region (N=15) and the chin region (N=18). The implanted bone in all three groups was particulated to granules of 2-3 mm(2) using a bone mill. All biopsies were analyzed by means of microradiography. The anterior pelvic bone grafts showed a mineralized tissue grade of 35.1+/-7.6% before milling and augmentation. The posterior pelvic bone grafts exhibited a mineralization of 30.7+/-9.5% and the chin bone grafts 74.6+/-8.6%. At second-stage surgery after 6 months, the mineralization was 36.1+/-7.59% in the areas where bone grafts from the anterior pelvic crest were used. Probes harvested from sites with posterior pelvic bone augmentations showed a mineralization rate of 34.5+/-6.5%, and sites were chin bone grafts were applied expressed a mineralization of 54+/-8.6% (P=0.003 compared with the pre-operative value). The comparison of the microradiographical results demonstrated significant differences in the mineralization grades depending on the origin of the graft. The origin of the grafts and their remodeling influenced the mineralization rates found at 6 months. How these data may influence the long-term clinical outcome considering implant survival and bone resorption has to be examined in further long-term studies.