Abstract
Guided Bone Regeneration (GBR) is a well-established procedure for the regeneration of alveolar bone defects. In the case of highly complex defect situations, however, inconsistent treatment results are often achieved. Hyaluronic Acid (HA) fulfills several relevant preliminary success criteria for improved regenerative treatment outcomes in complex defects: HA supports the creation of a toxin-free wound area, HA improves wound space stabilization, accelerates wound healing and supports regenerative processes crucial for bone regeneration. The novelty in the reported cases is the use of porcine derived bone substitute particulate hydrated with a cross-linked hyaluronic acid for simultaneous sinus grafting and lateral/vertical ridge augmentation in combination with a ribose cross-linked collagen membrane. The approval of the feasibility is provided with the clinical and histological observations. Three consecutive cases received the abovementioned material combination for staged sinus floor elevation and additional augmentation procedure by one operator according to a standardized protocol. All three sites constantly demonstrate superior clinical outcomes in terms of radiographically impressive tissue enhancement and implant function. The clinical outcomes are supported by qualitative histological analysis reflecting great similarity between samples regarding the observed process of new bone formation and bone substitute behavior. The specific staining allows for detection of osteoclastic activity and indicates the tendency of the particulate bone substitute to degrade over time once integrated.
Highlights
The lateral window approach introduced by Tatum 1986 allows for accessing the sinus cavity in atrophic maxillae with significantly reduced subantral amount of alveolar bone [1]
Hyaluronic Acid (HA) fulfills several relevant preliminary success criteria for improved regenerative treatment outcomes in complex defects: HA supports the creation of a toxin-free wound area, HA improves wound space stabilization, accelerates wound healing and supports regenerative processes crucial for bone regeneration
The clinical outcomes are supported by qualitative histological analysis reflecting great similarity between samples regarding the observed process of new bone formation and bone substitute behavior
Summary
The lateral window approach introduced by Tatum 1986 allows for accessing the sinus cavity in atrophic maxillae with significantly reduced subantral amount of alveolar bone [1]. Numerous xenogenic or synthetic bone substitutes, autogenous bone or allografts are considered suitable for grafting the sinus, sufficient cranial fixation of the Schneiderian membrane and support of new bone formation within the cavity [25]. The use of bone substitutes is considered effective in creating and maintaining space within the defect providing the membrane with the mechanical support OPEN ACCESS MEDICINE GROUP DENTISTRY. Combined Sinus Grafting and Lateral Augmentation by a Hyaluronic Acid-Facilitated Guided Bone Regeneration Protocol – Case Series Supported by Human Histologic Analysis. As in the GBR, the use of membrane for cover the lateral window is shown to mechanically stabilize the bone graft within the sinus cavity [11]. Et al [13] histologically monitored the bone formation within sinus cavities grafted with or without a membrane cover in a case series. The protease enzyme activity may harm the regenerative process, since tissues may not be completely mature in the beginning of healing if a soft tissue complication occurs [14]
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