Clinical, radiographic, and histological analyses of calcium phosphate cement as filling material in maxillary sinus lift surgery

Abstract

The installation of dental implants in the posterior maxilla is often faced with resorbed alveolar processes, resulting from a combination of pneumatization of the maxillary sinus, the effects of periodontal disease, and physiological bone resorption. The sinus lift surgery has been practiced since 1980 with the aim to increase bone height in this region for an implant supported prosthetic rehabilitation, and various filling materials have been used for such. This study aimed to clinically, radiographically, and histologically evaluate a preparation of calcium phosphate cement (Bone Source(®), BS) used as filling material in maxillary sinus elevation surgery. Ten patients were operated requiring maxillary sinus graft for future placement of osseointegrated implants. After a period ranging from 9 to 16 months, a clinical evaluation and biopsy of the grafted area in the region adjacent to the axis of the implant to be inserted were performed. Clinically and radiographically, no evidence of resorption/substitution of BS was noticed. Although no patients have had postoperative complications and the material presented fully biocompatible characteristics with woven bone in intimate contact with BS, it was not possible to place any implants due to minimal bone formation and friability of the material. It was concluded that despite the osteoconductive capacity of BS, this conventional calcium phosphate preparation does not support sufficient amount of new bone formation that could allow its use as filling material for maxillary sinus floor lift and subsequent dental implant placement.