Maxillary Sinus Floor Augmentation Using Blood Without Graft Material. Preliminary Results in 10 Patients

A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study

PURPOSE

This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets.

MATERIALS AND METHODS

A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05.

RESULTS

No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30).

CONCLUSION

Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

Human platelet-derived growth factor-BB (rhPDGF-BB) with collagen matrix for sinus elevation without using a bone graft

BACKGROUND

This case report involves a 38-year-old male who presented to the clinic after experiencing complications from a tooth extraction, including a dislodged root segment in the sinus, a sinus wall fenestration on the palate, a residual bone height (RBH) of 3 mm, and inadequate healing of the soft tissue. He presented for implant placement.

METHODS

Recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) was applied to a wound dressing material and placed in the sinus cavity alongside a 4.8 × 10 mm dental implant (Straumann SP, Straumann, Andover, MA, USA.). As documented in the literature, a graftless sinus lift via a lateral window was performed using a split-thickness flap technique to elevate the sinus membrane, re-establish its integrity, and restore its barrier function.

RESULTS

An 8-month cone beam computed tomography assessment showed a 6.2 mm vertical bone gain and complete implant coverage.

CONCLUSION

This approach provided a successful alternative to shorten treatment duration and achieve favorable radiographic outcomes during early healing.

KEY POINTS

The use of rhPDGF-BB and a collagen matrix in a sinus lift procedure emerges as a practical therapeutic option when grafting might lack predictability and notably consume more treatment time, while also achieving the desired bone height when used with a simultaneously placed implant.

The bone lid technique in lateral sinus lift: a systematic review and meta-analysis

Objective

This systematic review aimed at assessing the effect of the repositioned bone lid on bone augmentation in lateral sinus lift in pre-clinical in vivo and clinical studies. Secondary aims were to report on the healing of the bone window and to assess the implant survival rate.

Material and methods

Animal and human studies comparing lateral maxillary sinus floor elevation in combination or not with the repositioned bone lid were retrieved from MEDLINE (PubMed), Web of Science and Cochrane online library. Studies published in English up to April 2022 and reporting on histological and/or radiographic outcomes were considered. Case reports, case series and reviews were excluded. A hand search was also conducted. Risk of bias was assessed and meta-analysis performed to investigate the effect of the bone lid on new bone formation.

Results

After screening, 5 animal studies (4 in rabbits, 1 in sheep) and 2 clinical studies (1 RCT, 1 case–control) were included. Meta-analysis confirmed a higher new bone formation in rabbits at 2 and 8 weeks using the bone lid. The two clinical studies investigated lateral sinus lift with concomitant implant placement and reported similar results and high short-term implant success rate in both test and control groups.

Conclusions

The meta-analysis provided moderate evidence that the repositioned bone lid favored the formation of new bone to a higher extent as compared to resorbable membranes in animal studies. Implant success seems not to be influenced by the technique in the short term.

Clinical and radiographic outcomes following transcrestal maxillary sinus floor elevation with injectable xenogenous bone substitute in gel form: a prospective multicenter study

Purpose

To investigate clinical and radiographic outcomes of transcrestal maxillary sinus floor elevation performed with an injectable xenograft in gel form, analyzing general, local and surgical variables possibly influencing the results.

Methods

Patients with residual crestal height < 5 mm underwent transcrestal sinus floor elevation with xenograft in gel form to allow the placement of a single implant. Simultaneous implant placement was performed when primary stability was ≥ 15 Ncm. Graft height was measured immediately after surgery (T0) and after 6 months of healing (T1). Univariate and multivariate regression models were built to assess associations between clinical variables with implant survival and graft height at T1.

Results

71 patients underwent transcrestal sinus floor elevation and 54 implants were simultaneously placed. Delayed implant placement (at T1) was possible in 5 cases out of 17 (29.4%), whereas in 12 patients (70.6%) implant insertion was not possible or required additional sinus grafting. Implant survival rate, with a follow-up varying from 12 to 32 months after loading, was 100%. Mean pre-operative bone height was 3.8 ± 1.0 mm, at T0 was 13.9 ± 2.2 mm and at T1 was 9.9 ± 2.8 mm. Bone height at T1 was negatively influenced by membrane perforation at surgery (p = 0.004) and positively influenced by immediate implant insertion (p < 0.001).

Conclusions

Transcrestal sinus floor elevation performed with injectable xenograft gel resulted in 100% implant survival rate. However, immediate implant insertion seems a crucial factor to preserve vertical bone gain: one-stage technique seems to be the most predictable approach to optimize clinical outcomes with this approach.

Trial registration clinicaltrials.gov, NCT05305521. Registered 31 March 2022—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05305521.

Clinical Outcome of Dental Implants after Maxillary Sinus Augmentation with and without Bone Grafting: A Retrospective Evaluation

(1) Background: The purpose of the present study was to retrospectively evaluate and compare the outcome of two sinus augmentation grafting protocols using a xenograft or blood clot alone over a 72-month follow-up. (2) Methods: Patients who received simultaneous lateral sinus floor augmentation and implant placement were included. Subjects were divided into two groups according to the grafting material, namely xenograft or blood clot, and into sub-groups based on the residual alveolar bone height (RABH) below the maxillary sinus, namely 4 to 6 mm or >6 mm. Kaplan-Meier survival estimates were calculated for each material group and for each sub-group at 1, 3, and 6 years. (3) Results: In total, 289 implants inserted in 136 patients with a one-stage procedure were considered. A total of 35 failures were registered. Overall survival rates were 94.2% for xenograft and 85.9% for blood clot alone at 1 year, 91.1% and 81.6% at 3 years, and 91.1% and 78.7% at 6 years. (4) Conclusions: In patients with 4-6 mm RABH, graftless interventions exploiting blood clot alone were not as successful as those using xenograft. When the RABH is low, sinus floor augmentation associated with grafting materials should be preferred whenever possible.

Comparison of Bone Formation After Sinus Membrane Lifting Without Graft or Using Bone Substitute "Histologic and Radiographic Evaluation"

PURPOSE

Sinus floor elevation without using autogenous bone graft or bone substitute will eliminate donor site morbidity and reduce the cost and the risk of infection. We evaluated the bone gain after sinus membrane elevation without graft or using bone substitute in the same maxilla. Dental implants were inserted simultaneously as a 1-stage procedure.

PATIENTS AND METHODS

In a split-mouth design, we conducted a randomized double-blinded clinical trial performing sinus lifts and simultaneous implant insertion in 10 healthy patients (n = 20). On the 1 site, we performed graft-less sinus lift (group 1) and on the other site Cerabone was used as bone substitute (group 2), respectively. The quantity and quality of bone gained in each sinus were evaluated and compared radiologically and histomorphometrically.

RESULTS

After 6 months, the average gain of bone height was 6.21 and 9.58 mm in group 1 and 2, respectively, as measured radiologically (P < .001, P < .001). Histomorphometric examination showed significantly higher thickness of trabeculae and bone formation in group 1 (P = .003 and P = .002). However, the neovascularization was higher, but not significantly (P = .288).

CONCLUSIONS

Radiological bone gain was similar in both groups. However, histomorphometric examination showed superior bone formation in graft-less group as compared to the Cerabone group. The blood clot seems to be an adequate filler and excellent medium for bone formation. More studies in split-mouth design are needed to compare different bone substitutes.

Evaluation of New Bone Formation in Sinus Floor Augmentation With Injectable Platelet-Rich Fibrin-Soaked Collagen Plug: A Pilot Study

INTRODUCTION

The objective of this study is to evaluate the new bone formation after sinus floor augmentation with collagen plugs used as carriers for injectable platelet-rich fibrin (i-PRF).

MATERIALS AND METHODS

Postoperative immediate and postoperative 6th month panoramic radiographies of patients treated between January 1, 2015, and February 1, 2018, with sinus floor augmentation using i-PRF-soaked collagen plugs were retrieved from the archives, and subantral bone heights of distal and mesial regions of simultaneously inserted implants were measured with a software program. Statistical analysis was performed to understand whether there is a significant change in new bone formation at 6th month follow-up control.

RESULTS

A total of 18 implants were inserted in 12 patients. There was significant new bone formation at 6th month follow-up radiography at mesial and distal regions of inserted implants (P < 0.05).

CONCLUSION

New bone was regenerated with i-PRF carried by collagen plugs in sinus floor augmentation.

Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review

PURPOSE

The aim was to determine the survival rate of dental implants installed in the posterior region of the maxilla after a graftless maxillary sinus lift via the lateral window approach and to identify the factors involved in the results.

MATERIALS AND METHODS

A systematic search was done on MEDLINE, EMBASE, LILACS, Scopus, and Science Direct up to June 2016; additional studies were identified through an analysis of references. Primary studies in English, Spanish, Portuguese, and French were included; the selection and data extraction process was conducted by 2 investigators independently, and the methodological quality was evaluated by means of the Effective Public Health Practice Project's Quality Assessment Tool.

RESULTS

The combined search identified 232 articles. After the selection process, 11 articles were identified, 9 of which were prospective and 2 were retrospective. In all of them, the graftless maxillary sinus lift was done with the immediate installation of the implant. All the studies included presented a low methodological quality. The mean survival rate of the implants was 97% with an average new intrasinus bone formation of 6.2 mm.

CONCLUSION

This technique has a high implant survival although it is not possible to identify its correct indication and contraindication.

Sinus Floor Augmentation With Ambient Blood and an Absorbable Collagen Sponge: A Prospective Pilot Clinical Study

PURPOSE

The aim of this study was to clinically, radiologically, and histologically evaluate a sinus augmentation technique using a resorbable collagen sponge to maintain space between the Schneiderian membrane and the residual crestal bone.

MATERIALS AND METHODS

Patients with partially edentulous maxillae were clinically and radiographically evaluated for implant placement. A total of 10 consecutive patients with the bone height for implant placement (<4.0 mm) were enrolled in the study. The lateral maxillary wall was surgically exposed and the Schneiderian membrane was carefully elevated. A collagen wound dressing was placed in the antral area between the sinus floor and the raised membrane. The vertical sinus floor height was calculated using cone-beam computed tomography before the surgical procedure (baseline) and at 6 months postoperative. Immediately after the second scan, a core biopsy was removed for histological evaluation. The biopsy site was then further prepared for implant placement in the same location.

RESULTS

Biopsies showed mature cancellous bone with a predominantly lamellar structure. Well-vascularized intertrabecular spaces were filled with connective tissue and bone marrow. Analysis of bone height changes showed significant mean (SD) differences before and after procedures in anterior (2.67 ± 0.62 mm and 11.15 ± 1.1 mm), medial (2.98 ± 0.55 mm and 10.96 ± 0.77 mm), and posterior (3.17 ± 0.91 mm and 10.63 ± 0.51 mm) maxillary jaw locations (P = 0.005).

CONCLUSION

The collagen sponge provided an effective substrate for osseous regeneration of the sinus floor.

Maxillary Sinus Membrane Elevation With Simultaneous Installation of Implants Without the Use of a Graft Material: A Systematic Review

OBJECTIVE

To compare implant treatment outcome after maxillary sinus membrane elevation with simultaneous installation of implants with or without the use of graft material applying the lateral window technique.

MATERIALS AND METHODS

MEDLINE/PubMed, Cochrane Library, and Embase search in combination with a hand-search of relevant journals was conducted from January 1, 2004 to January 1, 2016.

RESULTS

Thirteen studies fulfilled the inclusion criteria. Survival of suprastructures has not been compared within the same study. Short-term implant survival without graft material varied between 96% and 100% compared to 100% for autogenous bone or bone substitutes. No significant difference in bone gain was reported without graft material compared to autogenous bone. The density of newly formed bone increased significantly during the observation period. Bone density was significantly higher in sinuses augmented with blood clot compared to bone substitute, whereas no significant difference was found when compared to autogenous bone. Noncomparative studies demonstrated high long-term implant survival and new bone formation after sinus membrane elevation without graft material.

CONCLUSIONS

Sinus membrane elevation without the use of a graft material seems to enhance new bone formation with high implant survival, but long-term comparative studies are missing.

Lateral approach for maxillary sinus membrane elevation without bone materials in maxillary mucous retention cyst with immediate or delayed implant rehabilitation: case reports

This case series study demonstrates the possibility of successful implant rehabilitation without bone augmentation in the atrophic posterior maxilla with cystic lesion in the sinus. Sinus lift without bone graft using the lateral approach was performed. In one patient, the cyst was aspirated and simultaneous implantation under local anesthesia was performed, whereas the other cyst was removed under general anesthesia, and the sinus membrane was elevated in a second process, followed by implantation. In both cases, tapered 11.5-mm-long implants were utilized. With all of the implants, good stability and appropriate bone height were achieved. The mean bone level gain was 5.73 mm; adequate bone augmentation around the implants was shown, the sinus floor was moved apically, and the cyst was no longer radiologically detected. Completion of all of the treatments required an average of 12.5 months. The present study showed that sufficient bone formation and stable implantation in a maxilla of insufficient bone volume are possible through sinus lift without bone materials. The results serve to demonstrate, moreover, that surgical treatment of mucous retention cyst can facilitate rehabilitation. These techniques can reduce the risk of complications related to bone grafts, save money, and successfully treat antral cyst.

Clinical and biological analysis in graftless maxillary sinus lift

Maxillary sinus lift for dental implant installation is a well-known and versatile technique; new techniques are presented based on the physiology of intrasinus bone repair. The aim of this review was to determine the status of graftless maxillary sinus lift and analyze its foundations and results. A search was conducted of the literature between 1995 and 2015 in the Medline, ScienceDirect, and SciELO databases using the keywords "maxillary sinus lift," "blood clot," "graftless maxillary sinus augmentation," and "dental implant placement." Ten articles were selected for our analysis of this technique and its results. Despite the limited information, cases that were followed for at least six months and up to four years had a 90% success rate. Published techniques included a lateral window, elevation of the sinus membrane, drilling and dental implant installation, descent of the membrane with variations in the installation of the lateral wall access and suturing. The physiology behind this new bone formation response and the results of the present research were also discussed. We concluded that this is a promising and viable technique under certain inclusion criteria.

Graft-Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow-up (PILf), and peri-implant marginal bone loss (MBL) are also evaluated.

METHODS

Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random-effects model and mixed-effect meta-regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG.

RESULTS

Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow-up period (r = 0.02; R2 = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R2 = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm).

CONCLUSION

Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.

Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis

The present study aimed to conduct a systematic review and meta-analysis on the effectiveness of maxillary sinus floor elevation and immediate implant installation without the use of grafting material. An electronic search without date or language restriction ​​was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and the grey literature, to May 2016. Eligibility criteria encompassed prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials. The search and selection process yielded 18 studies, published between 2005 and 2016. A meta-analysis was conducted only for experimental studies comparing sinus floor elevation with and without grafting material; results were expressed as the standardized mean difference (SMD) or risk ratio (RR) with the 95% confidence interval (CI). An average gain in bone height of 4.7mm over an average 39.4 month period was observed in the sinus elevated without grafting material. Regarding implants, there was a cumulative average survival rate of 97%. On meta-analysis, bone gain (P=0.98) and implant survival (P=0.13) did not differ significantly between sinuses lifted with or without grafting material, with a SMD of 0.01 (95% CI -0.42 to 0.44) and with a RR of 0.55 (95% CI 0.26 to 1.19), respectively.

Continuous intra-sinus bone regeneration after nongrafted sinus lift with a PLLA mesh plate device and dental implant placement in an atrophic posterior maxilla: a case report

Background

Sinus lift is a bone augmentation procedure that improves the alveolar crest height in an atrophic posterior maxilla. However, the regenerated bone volume can vary and generally has a tendency to decrease after sinus operation. This article describes nongrafted maxillary sinus lift using a bioresorbable unsintered hydroxyapatite combined with poly l-lactide (HA/PLLA) mesh plate device and dental implant placement in an atrophic posterior maxilla, after which continuous bone gain was observed around the implant apex during a postoperative follow-up period of 3 years.

Case presentation

A 60-year-old healthy female was referred to our department for dental implant therapy in the right posterior maxilla. Clinical examination revealed that the maxilla was edentulous from the right first premolar to the second molar region. Radiographically, atrophy of the maxillary alveolar ridge in the same tooth site was observed. Sinus membrane elevation and simultaneous implant placement were performed through the lateral approach. HA/PLLA mesh was utilized to maintain space under the elevated sinus membrane and as a fixation device to replace the bone window. Six months later, new bone was generated in the secluded space maintained under the elevated sinus membrane. When observed 42 months after the implant insertion, bone volume around the implant apex had increased in vertical direction under the HA/PLLA mesh plate device, and there was continuous bone formation in the sinus over time.

Conclusion

This nongrafted sinus lift procedure using an HA/PLLA mesh device attained predictable bone formation. Stable membrane elevation by an HA/PLLA device might induce long-term, continuous bone formation in the sinus.

Graftless sinus augmentation with simultaneous dental implant placement: clinical results and biological perspectives

After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. The aim of this study was to evaluate the feasibility of bone formation following graftless sinus lifting with the simultaneous placement of dental implants. Thirty graftless sinus lifting procedures were performed and 72 dental implants placed in 18 consecutive patients, using the lateral window approach. Clinical and radiological follow-up was conducted throughout the 6-month healing period. Biopsies of 30 cases were collected at 6 months post-treatment: 15 biopsies were taken from the newly formed bone near the basal floor and 15 from the newly formed bone near the elevated membrane. New bone consolidation in the maxillary sinus was apparent radiologically and histologically at 6 months after sinus augmentation, providing an average 6.14±1.34mm of bone-gain. Based on histological analysis and histomorphometric data, the consolidated bone in the augmented sinus comprised 56.7±11.9% to 59.9±13.4% vital bone tissue. Out of the 72 implants placed, only four failed, indicating a 94% overall implant survival rate. Based on this case series, blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone.

Maxillary sinus augmentation using sinus membrane elevation without grafts - A Systematic Review

Implants have a predictable outcome and are the foremost treatment modality for prosthetic rehabilitation of edentulous patients. Due to loss of bone after extraction and pneumatization of maxillary sinus, there is insufficient bone volume for implant placement. The direct maxillary sinus lift procedure has been performed with different grafting materials (autogenous bone grafts, alloplasts, allografts, and xenografts) and without grafting material, having new bone formation around the implant. There is no evidence to prove the need for grafting material in all direct sinus lift procedures, hence the need for this review. Previous meta-analysis showed that survival rates of implants placed in grafted maxillary sinuses had similar survival rates whether autogenous, allogenous, or alloplastic grafts were used. This paper aims to review scientific data on the direct sinus elevation technique without use of any grafting material, volume of new bone formed, and also mechanism behind this technique. Articles were searched from 1997 to October 2014 in PubMed, Google Scholar, and Cochrane CENTRAL. The study eligibility criteria were (1) direct sinus lift procedure without any graft material during implant placement and (2) human or animal studies with a minimum follow-up of 6 months or more. Two authors independently scrutinized the literature and if any controversy was raised, third author's opinion was sought to arrive at a mutual consensus for including the study in the review. Due to the heterogeneity across all studies in all study designs, the data were not pooled and a meta-analysis was not performed. Taking into consideration all factors reviewed in this regard along with the outcomes, the direct sinus lift technique without grafting can be suggested as a viable treatment option keeping in mind the limitations involved. The average bone gain was seen across all studies ranging from 2.37 to 10 mm and with an implant survival rate ranging from 79.9% to 100% across studies.

Electrical Stimulation in the Bone Repair of Defects Created in Rabbit Skulls

Electrical stimulation has been used in different conditions for tissue regeneration. The aim of this study was to analyze the tissue response of defects created in rabbit skulls to electrical stimulation. Two groups were formed, each with 9 New Zealand rabbits; two 5 mm defects were made, one in each parietal, with one being randomly filled with autogenous bone extracted as particles and the other maintained only with blood clotting. The rabbits were euthanized at 8 weeks and 15 weeks to then study the samples collected histologically. In the 8-week analysis bone formation was observed in the defects in the test and control filled with bone graft, whereas the defects with clotting presented a very early stage of bone formation with abundant connective tissue. At 15 weeks an advanced stage of bone regeneration was identified in the defects with bone graft, whereas no significant differences were found in the electrically stimulated defects. In conclusion, electrical stimulus does not alter the sequence of bone formation; new studies could help establish patterns and influences of the stimulus on bone regeneration.

Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®

OBJECTIVES

Although the clinical success of Bio-Oss(®) and BoneCeramic(®) has been corroborated by histologic and histomorphometric findings, the biological events that occur during healing after maxillary sinus floor elevation (MSFE) are unknown. Here, we evaluated biopsies of grafted bone with a mixture of autologous bone and Bio-Oss(®) or BoneCeramic(®) after two different healing time periods to understand the molecular process underlying bone formation after MSFE.

MATERIAL AND METHODS

Seven patients, following a bilateral split-mouth design model and needing a MSFE to allow implant placement, were recruited for this study. Right or left sinuses were grafted with autologous maxillary bone combined either with Bio-Oss(®) or BoneCeramic(®) , respectively. Twenty biopsies were taken at the time of implant insertion after 4-5 months or 6-8 months of MSFE, and analyzed by micro-computed tomography (microCT) and gene-expression analysis.

RESULTS

MicroCT analysis revealed no differences in the morphometric parameters or BMD either after 4-5 months or 6-8 months of MSFE between Bio-Oss(®) and BoneCeramic(®) . At molecular level, a higher expression of bone forming gene Runx2 was observed after 4-5 months of MSFE in the Bio-Oss(®) compared with the BoneCeramic(®) group.

CONCLUSIONS

Our results indicate that differences found at the molecular level between Bio-Oss(®) and BoneCeramic(®) are not translated to important differences in the 3D microstructure and BMD of the grafted bone.