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15-Year Retrospective Study on the Success Rate of Maxillary Sinus Augmentation and Implants: Influence of Bone Substitute Type, Presurgical Bone Height, and Membrane Perforation during Sinus Lift. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9144661. [PMID: 36860810 PMCID: PMC9970713 DOI: 10.1155/2023/9144661] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
Objectives To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study. Results The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years. Conclusions Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.
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Block MS. The Processing of Xenografts Will Result in Different Clinical Responses. J Oral Maxillofac Surg 2019; 77:690-697. [DOI: 10.1016/j.joms.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/06/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
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Gonzaga MG, Santos Kotake BG, Figueiredo FAT, Feldman S, Ervolino E, Santos MCG, Issa JPM. Effectiveness of rhBMP‐2 association to autogenous, allogeneic, and heterologous bone grafts. Microsc Res Tech 2019; 82:689-695. [DOI: 10.1002/jemt.23215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Miliane Gonçalves Gonzaga
- Ribeirão Preto Medical School, Department of Biomechanics, Medicine and Rehabilitation of LocomotorUniversity of São Paulo São Paulo Brazil
| | - Bruna Gabriela Santos Kotake
- Ribeirão Preto Medical School, Department of Biomechanics, Medicine and Rehabilitation of LocomotorUniversity of São Paulo São Paulo Brazil
| | | | - Sara Feldman
- School of Medicine, LABOATEM ‐ Osteoarticular Biology, Tissue Engineering and Emerging Therapies LaboratoryNational Rosario University Santa Fe Argentina
| | - Edilson Ervolino
- Faculty of Dentistry, Department of Basic SciencesSão Paulo State University São Paulo Brazil
| | - Maria Cecília Gorita Santos
- School of Dentistry of Ribeirão Preto, Department of Pediatric DentistryUniversity of São Paulo São Paulo Brazil
| | - João Paulo Mardegan Issa
- School of Dentistry of Ribeirão Preto, Department of Pediatric DentistryUniversity of São Paulo São Paulo Brazil
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Histologic and Histomorphometric Analysis of Bone Regeneration with Bovine Grafting Material after 24 Months of Healing. A Case Report. J Funct Biomater 2018; 9:jfb9030048. [PMID: 30096773 PMCID: PMC6163257 DOI: 10.3390/jfb9030048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
Anorganic bovine bone mineral matrix (ABBMM) has been reported to have osteoconductive properties and no inflammatory or adverse responses when used as grafting material in sinus augmentation procedures. However, controversy remains in regard to degradation rate of ABBMM. The aim of this study was to histologically and histomorphometrically evaluate the degradation of ABBMM in human bone samples obtained in one patient 24 months after sinus augmentation. Materials and Methods: The histologic and histomorphometric analysis was performed by means of light microscopy in three specimens harvested from the same patient, Results: After 24 months the tissue pattern appeared to be composed of residual particles, some in close contact with the newly formed bone, others separated by translucent areas and osteoid tissues. Newly-formed bone presented different levels of maturation and numerous osteocytes, with greater numbers in bone closer to the grafted particles (27.3% vs. 11.2%, p < 0.05). The histomorphometric analysis showed mean values of 40.84% newly-formed bone, 33.58% residual graft material, 23.84% marrow spaces, and 1.69% osteoid tissue, Conclusions: Even though ABBMM underwent considerable resorption, a great amount of residual grafting material was still present after two years of healing following sinus augmentation. This study confirms that the bovine grafts can be classified as long-term degradation materials.
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Two Composite Bone Graft Substitutes for Maxillary Sinus Floor Augmentation: Histological, Histomorphometric, and Radiographic Analyses. IMPLANT DENT 2017; 25:313-21. [PMID: 26836126 DOI: 10.1097/id.0000000000000378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To histologically, histomorphometrically, and radiographically compare clinical performance of 2 composite bone graft substitutes for maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS Partially or totally edentulous patients requiring MSFA underwent grafting procedures using a 2:1 mixture of biphasic calcium sulfate (CS) and deproteinized bovine bone (group CB) or biphasic CS and alloplast (group CA). Grafts were allowed to heal for 5 months before placing the implants. During implant surgery, bone samples were collected from grafted areas for histology and histomorphometry. Graft height was analyzed using cone beam computed tomography. RESULTS Sixteen patients completed the study. Mean percentages of new bone were 34.40% ± 18.91% and 36.71% ± 15.32% for the CA and CB groups, respectively; percentages of residual graft particles were 6.98% ± 5.09% and 5.52% ± 4.12%, respectively. The only significant finding was a greater graft height loss in the CA group (24.44% ± 6.52% vs 14.60% ± 4.58%). CONCLUSION Both graft substitutes were integrated in bone, confirming their biocompatibility and effectiveness for MSFA. The CB group showed less bone height loss than the CA group.
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Do Porous Titanium Granule Grafts Affect Bone Microarchitecture at Augmented Maxillary Sinus Sites? A Pilot Split-Mouth Human Study. IMPLANT DENT 2017. [PMID: 26200164 DOI: 10.1097/id.0000000000000275] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this randomized controlled clinical study was to analyze the bone microarchitecture at augmented maxillary sinus sites by using different materials in patients to compare the effect of porous titanium granules as a sinus augmentation material with bone microstructural features. MATERIALS AND METHODS Eight subjects with bilateral atrophic posterior maxilla of residual bone height <4 mm included in this study and each patient was treated with bilateral sinus augmentation procedure using xenograft with equine origin (Apatos, Osteobiol; Tecnoss Dental) and xenograft (1 g) + porous titanium (1 g) granules (Natix; Tigran Technologies AB). Sixteen human bone biopsy samples were taken from patients receiving two-stage sinus augmentation therapy during implant installation and analyzed using microcomputerized tomography. Three-dimensional bone structural parameters were analyzed in details: tissue volume, bone volume, percentage of bone volume, bone surface and bone surface density, bone specific surface, trabecular thickness trabecular separation, trabecular number, trabecular pattern factor, structural model index, fractal dimension, and bone mineral density. RESULTS No statistically significant differences were found between groups according to bone structural parameters. CONCLUSIONS Porous titanium grafts may ensure a space for new bone formation in the granules, which may be a clinical advantage for long-term success.
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Issa JP, Gonzaga M, Kotake BG, de Lucia C, Ervolino E, Iyomasa M. Bone repair of critical size defects treated with autogenic, allogenic, or xenogenic bone grafts alone or in combination with rhBMP-2. Clin Oral Implants Res 2015; 27:558-66. [DOI: 10.1111/clr.12622] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 12/15/2022]
Affiliation(s)
- João Paulo Issa
- Department of Morphology, Physiology and Basic Pathology; University of São Paulo; São Paulo Brazil
| | - Miliane Gonzaga
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor- School of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - Bruna Gabriela Kotake
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor- School of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - Conrado de Lucia
- Department of Morphology, Physiology and Basic Pathology; University of São Paulo; São Paulo Brazil
| | - Edilson Ervolino
- Department of Basic Science at the School of Dentistry of Araçatuba; São Paulo State University; São Paulo Brazil
| | - Mamie Iyomasa
- Department of Morphology, Physiology and Basic Pathology; Faculty of Dentistry; University of São Paulo; São Paulo Brazil
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Hameed N, Glattauer V, Ramshaw JAM. Evaluation of polyvinyl alcohol composite membranes containing collagen and bone particles. J Mech Behav Biomed Mater 2015; 48:38-45. [PMID: 25913606 DOI: 10.1016/j.jmbbm.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 12/15/2022]
Abstract
Composite biomaterials provide alternative materials that improve on the properties of the individual components and can be used to replace or restore damaged or diseased tissues. Typically, a composite biomaterial consists of a matrix, often a polymer, with one or more fillers that can be made up of particles, sheets or fibres. The polymer matrix can be chosen from a wide range of compositions and can be fabricated easily and rapidly into complex shapes and structures. In the present study we have examined three size fractions of collagen-containing particles embedded at up to 60% w/w in a poly(vinyl alcohol) (PVA) matrix. The particles used were bone particles, which are a mineral-collagen composite and demineralised bone, which gives naturally cross-linked collagen particles. SEM showed well dispersed particles in the PVA matrix for all concentrations and sizes of particles, with FTIR suggesting collagen to PVA hydrogen bonding. Tg of membranes shifted to a slightly lower temperature with increasing collagen content, along with a minor amount of melting point depression. The modulus and tensile strength of membranes were improved with the addition of both particles up to 10 wt%, and were clearly strengthened by the addition, although this effect decreased with higher collagen loadings. Elongation at break decreased with collagen content. Cell adhesion to the membranes was observed associated with the collagen particles, indicating a lack of cytotoxicity.
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Affiliation(s)
- Nishar Hameed
- Institute for Frontier Materials, Deakin University, Pigdons Road, Waurn Ponds, Geelong 3216, Australia.
| | | | - John A M Ramshaw
- CSIRO Manufacturing Flagship, Bayview Avenue, Clayton 3169, Australia.
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Heinemann F, Hasan I, Bourauel C, Biffar R, Mundt T. Bone stability around dental implants: Treatment related factors. Ann Anat 2015; 199:3-8. [PMID: 25770887 DOI: 10.1016/j.aanat.2015.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/15/2022]
Abstract
The bone bed around dental implants is influenced by implant and augmentation materials, as well as the insertion technique used. The primary influencing factors include the dental implant design, augmentation technique, treatment protocol, and surgical procedure. In addition to these treatment-related factors, in the literature, local and systemic factors have been found to be related to the bone stability around implants. Bone is a dynamic organ that optimises itself depending on the loading condition above it. Bone achieves this optimisation through the remodelling process. Several studies have confirmed the importance of the implant design and direction of the applied force on the implant system. Equally dispersed strains and stresses in the physiological range should be achieved to ensure the success of an implant treatment. If a patient wishes to accelerate the treatment time, different protocols can be chosen. However, each one must consider the amount and quality of the available local bone. Immediate implantation is only successful if the primary stability of the implant can be provided from residual bone in the socket after tooth extraction. Immediate loading demands high primary stability and, sometimes, the distribution of mastication forces by splinting or even by inserting additional implants to ensure their success. Augmentation materials with various properties have been developed in recent years. In particular, resorption time and stableness affect the usefulness in different situations. Hence, treatment protocols can optimise the time for simultaneous implant placements or optimise the follow-up time for implant placement.
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Affiliation(s)
- Friedhelm Heinemann
- Department of Prosthodontics, Gerodontology and Biomaterials, University of Greifswald, Rotgerberstr. 8, 17489 Greifswald, Germany.
| | - Istabrak Hasan
- Endowed Chair of Oral Technology, Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany; Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Christoph Bourauel
- Endowed Chair of Oral Technology, Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerodontology and Biomaterials, University of Greifswald, Rotgerberstr. 8, 17489 Greifswald, Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials, University of Greifswald, Rotgerberstr. 8, 17489 Greifswald, Germany
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Sartori M, Giavaresi G, Tschon M, Martini L, Dolcini L, Fiorini M, Pressato D, Fini M. Long-term in vivo experimental investigations on magnesium doped hydroxyapatite bone substitutes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1495-1504. [PMID: 24554305 DOI: 10.1007/s10856-014-5177-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
Despite several efforts to find suitable alternatives to autologous bone, no bone substitute currently available provides the same characteristics and properties. Nevertheless, among the wide range of materials proposed as bone substitutes, calcium phosphate materials represent the most promising category and the present study is aimed at improving the knowledge on non-stoichiometric magnesium-doped hydroxyapatite substitutes (Mg-HA), tested in two different formulations: Mg-HA Putty and Mg-HA Granules. These bone substitutes were implanted bilaterally into iliac crest bone defects in healthy sheep and comparative histological, histomorphometric, microhardness and ultrastructural assessments were performed 9, 12, 18 and 24 months after surgery to elucidate bone tissue apposition, mineralization and material degradation in vivo. The results confirmed that the biomimetic bone substitutes provide a histocompatible and osteoconductive structural support, during the bone formation process, and give essential information about the in vivo resorption process and biological behavior of biomimetic bone substitutes.
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Affiliation(s)
- M Sartori
- Laboratory of Biocompatibility, Innovative Technologies and Advanced Therapies, RIT-Rizzoli Orthopaedic Institute Bologna, Via Di Barbiano, 1/10, 40136, Bologna, Italy,
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Haïat G, Wang HL, Brunski J. Effects of biomechanical properties of the bone-implant interface on dental implant stability: from in silico approaches to the patient's mouth. Annu Rev Biomed Eng 2014; 16:187-213. [PMID: 24905878 DOI: 10.1146/annurev-bioeng-071813-104854] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dental implants have become a routinely used technique in dentistry for replacing teeth. However, risks of failure are still experienced and remain difficult to anticipate. Multiscale phenomena occurring around the implant interface determine the implant outcome. The aim of this review is to provide an understanding of the biomechanical behavior of the interface between a dental implant and the region of bone adjacent to it (the bone-implant interface) as a function of the interface's environment. First, we describe the determinants of implant stability in relation to the different multiscale simulation approaches used to model the evolution of the bone-implant interface. Then, we review the various aspects of osseointegration in relation to implant stability. Next, we describe the different approaches used in the literature to measure implant stability in vitro and in vivo. Last, we review various factors affecting the evolution of the bone-implant interface properties.
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Affiliation(s)
- Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multiéchelle, UMR CNRS 8208, 94010 Créteil, France;
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Caubet J, Ramis JM, Ramos-Murguialday M, Morey MÁ, Monjo M. Gene expression and morphometric parameters of human bone biopsies after maxillary sinus floor elevation with autologous bone combined with Bio-Oss® or BoneCeramic®. Clin Oral Implants Res 2014; 26:727-35. [PMID: 24684367 DOI: 10.1111/clr.12380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Jorge Caubet
- Bone regeneration and Oral and Maxillofacial Surgery Unit (GBCOM), Palma de Mallorca, Spain
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Influence of material properties on rate of resorption of two bone graft materials after sinus lift using radiographic assessment. Int J Dent 2012; 2012:737262. [PMID: 22899930 PMCID: PMC3415107 DOI: 10.1155/2012/737262] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/24/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose. The aim of this study was to investigate the influence of chemical and physical properties of two graft materials on the rate of resorption. Materials and Methods. Direct sinus graft procedure was performed on 22 patients intended for implant placement. Two types of graft materials were used (Bio-Oss and Cerabone) and after 8 months healing time the implants were inserted. Radiographic assessment was performed over the period of four years. Particle size, rate of calcium release, and size and type of crystal structure of each graft were evaluated. Results. The average particle size of Bio-Oss (1 mm) was much smaller compared to Cerabone (2.7 mm). The amount of calcium release due to dissolution of material in water was much higher for Bio-oss compared to Cerabone. X-ray image analysis revealed that Bio-Oss demonstrated significantly higher volumetric loss (33.4 ± 3.1%) of initial graft size compared to Cerabone (23.4 ± 3.6%). The greatest amount of vertical loss of graft material volume was observed after one year of surgery. Conclusion. The chemical and physical properties of bone graft material significantly influence resorption rate of bone graft materials used for sinus augmentation.
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