Histologic and Histomorphometric Comparison between Sintered Nanohydroxyapatite and Anorganic Bovine Xenograft in Maxillary Sinus Grafting: A Split-Mouth Randomized Controlled Clinical Trial.

Claudio Stacchi,Teresa Lombardi,Tonino Traini,Andrea Alberghini Maltoni,Francesco Oreglia

doi:10.1155/2017/9489825

Claudio Stacchi, Teresa Lombardi + Show 3 more

Open Access

https://doi.org/10.1155/2017/9489825

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Abstract

The presence of vital bone after maxillary sinus augmentation is crucial to enhance the quality of bone-implant interface, ensuring predictable long-term results. The aims of this RCT with split-mouth design were the histologic and histomorphometric comparison of two different biomaterials in sinus elevation after 6 months of healing and the evaluation of the clinical outcomes of implants inserted in the augmented areas after 12 months of prosthetic loading. Twenty-eight patients (10 females, 18 males) were treated with bilateral sinus floor elevation with lateral approach. Pure sintered nanohydroxyapatite (NHA) and anorganic bovine bone (ABB) were used as test and active control, respectively. After six months, 52 bone biopsies were harvested from 26 patients, and 107 implants were inserted in the augmented areas. Histomorphometry showed that, in the two groups, vital bone percentages were 34.9 ± 15% (NHA) and 38.5 ± 17% (ABB) (p = 0.428), marrow spaces percentages were 44.5 ± 18% (NHA) and 43.5 ± 23% (ABB) (p = 0.866), and residual graft percentages were 20.6 ± 13% (NHA) and 22.3 ± 12% (ABB) (p = 0.638). After 6 months of healing, no statistically significant difference was present in histomorphometric outcomes between NHA and ABB groups. Implant survival rate in NHA group after 12 months of loading was 96.4%, showing no statistically significant differences with ABB group.

Highlights

Bone resorption and sinus pneumatization are common occurrences in the posterior maxilla after tooth extraction: they may cause both a quantitative reduction and qualitative deterioration of bone, resulting in an inadequate bone volume for dental implant placement [1]
Patients were thoroughly informed about the protocol, the treatment and its alternatives, the benefits, and the possible risks and signed written informed consent for the participation in the study. This superiority trial tested the null hypothesis of no differences in new bone formation and dental implant survival between NHA bone grafts and anorganic bovine bone (ABB) grafts in atrophic maxillae treated with sinus floor elevation with lateral approach
The sections of the harvested biopsies had a mean surface of 9.05 ± 2.7 mm2 for NHA group and 10.31 ± 2.9 mm2 for ABB group

Summary

Introduction

Bone resorption and sinus pneumatization are common occurrences in the posterior maxilla after tooth extraction: they may cause both a quantitative reduction and qualitative deterioration of bone, resulting in an inadequate bone volume for dental implant placement [1]. Sinus floor elevation technique had been described more than 35 years ago [2] and extensively studied afterwards, demonstrating high predictability in regenerating bone and allowing for reliable implant supported rehabilitation [3, 4]. Accurate presurgical planning is a mandatory step: sinus three-dimensional conformation, eventual presence of Underwood septa, and precise localization of the alveolar-antral artery should be assessed and carefully evaluated in order to minimize intraoperative complications and optimize surgical techniques [5,6,7]. An adequate biomaterial choice is the first crucial step in bone-implant interface engineering to ensure positive clinical long-term results

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