Abstract
The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a = 0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75% ± 17.16% and 37.25 ± 17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p = 0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.
Highlights
The use of osseointegrated implants is a widely used procedure to restore the functional and aesthetic of the patients, with a high survival rate
The autogenous bone graft inserted in the maxillary sinus is mostly integrated into the region
fractal dimension (FD) is a sensitive method of image texture analysis [13], which can predict the quality of trabecular bone from 2D radiographies with low doses of radiation [11]
Summary
The use of osseointegrated implants is a widely used procedure to restore the functional and aesthetic of the patients, with a high survival rate. Alveolar bone resorption after tooth extraction, and/or pneumatization of the maxillary sinus, result in insufficient horizontal and vertical bone dimension for the implant placement in an ideal three-dimensional position [1]. Firstly described by Boyne and James [2], is a surgical approach that enables the placement of appropriate length implants due to the elevation of the sinus membrane from the maxillary sinus, allowing the interposition of bone grafts, increasing the bone height in the posterior edentulous maxilla [3] for the long term implant stability
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