\u03b2-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies

James Carlos Nery,Cassio Rocha Scardueli,George Furtado Guimarães,Andreas Stavropoulos,Fabiana Mantovani Gomes França,Rubens Spin-Neto,Luís Antônio Violin Dias Pereira

doi:10.1186/s40729-017-0080-8

Abstract

BackgroundIt is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.MethodsIn ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the other side using only β-TCP/HA (BC). After 6 months, biopsies were harvested from grafted areas during implant installation, being histologically and histomorphometrically analyzed. Differences between the groups considering new bone formation, soft tissues, and remaining BC were statistically evaluated.ResultsAll patients showed uneventful healing after MSFA, and dental implant installation was possible in all patients after 6 months. Histological analysis showed newly formed bone that was primarily woven in nature; it was organized in thin trabeculae, and it was occasionally in contact with residual bone substitute particles, which appeared in various forms and sizes and in advanced stage of degradation. Mean bone area was 43.4% (CI95 38.9; 47.8) for the BC group and 43.0% (CI95 36.6; 49.5) for the BC + EMD group. Mean soft tissue area was 21.3% (CI95 16.5; 26.2) for BC group and 21.5% (CI95 17.7; 25.3) for BC + EMD group, while the remaining biomaterial was 35.3% (CI95 36.6; 49.5) and 35.5% (CI95 29.6; 41.3) for BC and BC + EMD group, respectively.ConclusionsMSFA with BC resulted in adequate amounts of new bone formation allowing successful implant installation; adding EMD did not have a significant effect.

Highlights

It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing
In all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implants had appropriate primary stability as judged clinically
Even though bone substitute particles could still be recognized in the retrieved biopsy, all particles appeared well integrated in the biopsy tissue

Summary

Introduction

It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans. Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Bone Ceramic® (BC; Straumann, Basel, Switzerland) is among the biphasic calcium phosphates currently available in the market. It is a fully synthetic bone graft substitute of medical grade purity in particulate form (particle size 500–1000 μm), consisting of 60% hydroxyapatite (HA) and 40% beta tri-calcium phosphate. Studies have shown that BC acts as osteoconductive material when used for maxillary sinus floor augmentation [4, 10]

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