Abstract
This study examines the effect of a hyaluronic acid (HyAc) containing tricalcium phosphate putty scaffold material (TCP-P) and of a particulate tricalcium phosphate (TCP-G) graft on bone formation, volume stability and osteogenic marker expression in biopsies sampled 6 months after bilateral sinus floor augmentation (SFA) in 7 patients applying a split-mouth design. 10% autogenous bone chips were added to the grafting material during surgery. The grain size of the TCP granules was 700 to 1400 µm for TCP-G and 125 to 250 µm and 500 to 700 µm (ratio 1:1) for TCP-P. Biopsies were processed for immunohistochemical analysis of resin-embedded sections. Sections were stained for collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Furthermore, the bone area and biomaterial area fraction were determined histomorphometrically. Cone-beam CT data recorded after SFA and 6 months later were used for calculating the graft volume at these two time points. TCP-P displayed more advantageous surgical handling properties and a significantly greater bone area fraction and smaller biomaterial area fraction. This was accompanied by significantly greater expression of Col I and BSP and in osteoblasts and osteoid and a less pronounced reduction in grafting volume with TCP-P. SFA using both types of materials resulted in formation of sufficient bone volume for facilitating stable dental implant placement with all dental implants having been in function without any complications for 6 years. Since TCP-P displayed superior surgical handling properties and greater bone formation than TCP-G, without the HyAc hydrogel matrix having any adverse effect on bone formation or graft volume stability, TCP-P can be regarded as excellent grafting material for SFA in a clinical setting. The greater bone formation observed with TCP-P may be related to the difference in grain size of the TCP granules and/or the addition of the HyAc.
Highlights
Over the last 15 years, the use of resorbable synthetic ceramic bone-grafting materials has received ever-increasing attention in implant dentistry
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The findings of our present study showed that the TCP putty material displayed superior surgical handling properties compared to TCP granules (TCP-G) without the hyaluronic acid (HyAc) hydrogel matrix having any adverse effect on bone formation, bone tissue maturation or graft volume stability, and thereby confirmed the hypothesis tested
Summary
Over the last 15 years, the use of resorbable synthetic ceramic bone-grafting materials has received ever-increasing attention in implant dentistry. Augmentation of the maxillary sinus floor with autogenous bone grafts has become a well-established pre-implantology procedure for alveolar ridge augmentation of the posterior maxilla. The success rates which have been achieved when using calcium phosphate-based bone substitute materials for sinus floor augmentation (SFA) demonstrate that these materials have become an excellent alternative graft choice compared to autogenous bone grafts, which have commonly been considered as the gold standard [1,2,3]. Among the bone substitutes materials available, β-tricalcium phosphate (β-TCP) ceramic has achieved widespread use for SFA procedures [6,7,8,9,10,11,12]. The macro-, meso- and micro-porosity, particle size and shape, geometry at the macro- and micro scale, mechanical properties, phase purity, solubility, and application form, i.e., blocks, granules, TCP-based cements or putties, as well as the presence of polymeric and other supplements—in the case of these TCP-based cements and putties—affect the osteogenic potential and degradation properties of these TCP-based biomaterials [2,7,13,14,15]
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