The Influence of Residual Alveolar Bone Height on Graft Composition after Maxillary Sinus Augmentation Using Two Different Xenografts: A Histomorphometric Comparative Study.

Silvio Taschieri,Moses Ofer,Luca Francetti,Gianluca Tartaglia,Carlos Nemcovsky,Massimo Del Fabbro,Elena Canciani,Claudia Dellavia,Tiziano Testori,Stefano Corbella

doi:10.3390/ma13225093

Abstract

Aim: To evaluate the hypothesis of a correlation between the preoperative residual alveolar bone height (RBH) and graft maturation after maxillary sinus floor augmentation procedures using two different bone substitutes. Methods: A total of 20 patients who underwent unilateral maxillary sinus floor augmentation with either mineralized deproteinized bovine bone (DBBM) or a xenograft enriched with polymer and gelatin (NBS) were included in this prospective study. Six months after sinus surgery, bone biopsies were harvested with a 3.2 mm diameter trephine bur, prior to dental implant placement. Histomorphometric analysis was performed, and the results were correlated with the individual RBH. Implants were loaded after 5 months of insertion, and 1-year implant success and marginal bone level change were assessed. Results: RBH was 2.17 ± 1.11 mm (range 0.5–3.5 mm) and 2.14 ± 0.72 mm (range 0.5–3.0 mm) in the NBS and DBBM group, respectively. The biopsy analyses for the DBBM group showed woven bone increases by 5.08% per 1-mm increment of RBH; medullary spaces decreased by 9.02%, osteoid decreased by 4.4%, residual biomaterial decreased by 0.34%, and lamellar bone increased by 5.68% per 1-mm increase of RBH. In the NBS group, samples showed woven bone increases by 8.08% per 1-mm increase of RBH; medullary spaces decreased by 0.38%; osteoid increased by 1.34%, residual biomaterial decreased by 0.58%, and lamellar bone decreased by 5.50% per 1-mm increase of RBH. There was no statistically significant difference in the correlation between RBH and lamellar bone, woven bone, and osteoid, independently of the material used. Implant success was 100% in both groups, and marginal bone loss was 1.02 ± 0.42 mm in DBBM and 0.95 ± 0.31 mm in the NBS group after the 1-year follow-up. Conclusion: In spite of the absence of significance, the observed trend for woven bone to increase and medullary spaces to decrease when RBH increases deserves attention. Residual bone dimension might be a determinant in the bone graft maturation after maxillary sinus augmentation.

Highlights

Oral rehabilitation with osseointegrated implants is a successful and widely used treatment option for patients presenting partial or edentulous arches
No significant differences in height of residual bone were found between the two groups
Woven bone increased by 5.08% per 1-mm increment of residual alveolar bone height (RBH), medullary spaces decreased by 9.02% per 1-mm increase of RBH, and osteoid decreased by 4.4% per 1-mm increase of RBH in sinuses grafted by mineralized deproteinized bovine bone

Summary

Introduction

Oral rehabilitation with osseointegrated implants is a successful and widely used treatment option for patients presenting partial or edentulous arches. Bone resorption process ( in some areas leading to pneumatization of the maxillary sinuses) could result in limited bone volume, requiring bone augmentation procedures allowing placement of dental implants [1,2]. In cases of inadequate bone volume in the posterior maxilla, the treatment protocols will involve maxillary sinus floor augmentation using various techniques and biomaterials. The survival rates of implants placed in augmented sinuses are similar to those placed in the native bone in the posterior maxilla and remain relatively high [9,10,11,12]. The sinus-lift technique, selection of grafting materials, and the timing of implant placement have an impact on the bone remodeling [13,14,15]

Objectives

Methods

Results

Discussion

Conclusion