Histomorphometry of human sinus floor augmentation using a porous β‐tricalcium phosphate: a prospective study

Abstract

Tricalcium phosphate (TCP) has been historically a well-accepted material for bone augmentation. We examined the use of a porous beta-TCP (100%) in a split mouth model for sinus floor augmentation. Five patients were treated bilaterally, receiving 1-2 mm-sized beta-TCP particles (Cerasorb) on one side (test side) and autologous chin bone particles on the other (control) side. Four other patients were treated with a unilateral sinus floor augmentation using 100% beta-TCP (no controls). Biopsies of the augmented sites were taken at 6 months. Histomorphometry measurements were carried out in order to quantify bone augmentation at test and control sides. The average bone volume (BV) formed in the augmented sinus at the control side was 41% (32-56%) and 17% (9-27%) in the test side when all nine patients were included (statistically significant, P=0.04). When only the five bilateral patients were included, mean BV of the test side was 19% (13-27%), which was also significantly different from the control side (P=0.009). Osteoid formation tended to be higher in the test side biopsies (1.3%) than in the controls (0.3%) (marginally significant, P=0.1), indicating ongoing bone formation in the TCP material. The amount of lamellar bone at the test side was less than half the amount in the control side, indicating that remodelling had only recently started in the TCP-augmented side. The resorption surface, however, did not differ significantly between the two sides. These histological results indicate that Cerasorb is an acceptable bone substitute material for augmentation of the maxillary sinus. Due to the osteoconductive, but not osteoinductive properties of this material, the rate of bone formation is somewhat delayed in comparison to autologous bone.

Maxillary sinus lift with solely autogenous bone compared to a combination of autogenous bone and growth factors or (solely) bone substitutes. A systematic review

“…b-Tricalciumphosphate (Cerasorb) was been used in the intervention groups in the studies by SUBA et al 26 , SZABO et al 27 , ZERBO et al 39 and ZIJDERVELD et al 40 . A meta-analysis of these revealed a significantly higher bone fraction 5-6 months after treatment when applying autogenous bone (P = 0.036).…”

“…In the controls, augmented with autogenous bone, the newly formed bone was mostly lamellar, mature bone (80%). In the b-tricalciumphosphate sites, the newly formed bone was at comparable time points more immature and had a predominantly woven character (74%) 39 .…”

“…SZABO et al 27 showed after a 6 month healing period comparable results for both groups. ZERBO et al 39 and ZIJDERVELD et al 40 concluded that in the controls, augmented with autogenous bone, the newly formed bone was significantly higher than in the b-tricalciumphosphate group after the same healing period.…”

“…Donor site morbidity is a problem associated with bone-harvesting techniques, which can be reduced or avoided when using bone substitutes 39 . Whether autogenous bone should still be considered as the grafting material of choice can be questioned.…”

Sinus Floor Augmentation Surgery Using Autologous Bone Grafts from Various Donor Sites: A Meta-Analysis of the Total Bone Volume

“…Before preparation of the implant bed to install dental implants, a biopsy of the reconstructed area can be easily taken, which implicates no extra burden for the patient. 28,29 Moreover, all surgical procedures, except the extraoral grafting procedure, can be performed under local anesthesia. The selection of a donor site is often made on considerations driven by the quantity needed for the individual case.…”