Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study
DOI:
https://doi.org/10.1590/1678-7757-2023-0406Keywords:
Maxillary sinus floor elevation, Bone grafts, CTAn software, Trabecular bone parameters, Osteogenic effectAbstract
Objective: The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. Methodology:
A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. Results: In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). Conclusion: MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.
Downloads
References
Zhuang G, Mao J, Yang G, Wang H. Influence of different incision designs on bone increment of guided bone regeneration (Bio-Gide collagen membrane +Bio-OSS bone powder) during the same period of maxillary anterior tooth implantation. Bioengineered. 2021;12(1):2155-63. doi: 10.1080/21655979.2021.1932209
Hamed HA, Marzook HA, Ghoneem NE, El-Anwar MI. angulated dental implants in posterior maxilla FEA and experimental verification. Open Access Maced J Med Sci. 2018;6(2):397-401. doi: 10.3889/oamjms.2018.077
Xu Z, Yang Z, Yang J. Digital workflow for the design, manufacture, and application of custom-made short implants with wing retention device. Front Bioeng Biotechnol. 2022;10:885746. doi:10.3389/fbioe.2022.885746
Baldini N, D’Elia C, Bianco A, Goracci C, de Sanctis M, Ferrari M. Lateral approach for sinus floor elevation: large versus small bone window - a split-mouth randomized clinical trial. Clin Oral Implants Res. 2017;28(8):974-81. doi: 10.1111/clr.12908
Block MS. The crestal window approach for sinus floor grafting with delayed implant placement: a preliminary report. J Oral Maxillofac Surg. 2018;76(11):2319-30. doi: 10.1016/j.joms.2018.06.171
Chen H, Zhou L, Wu D, Zhang J, Zheng Y, Chen Y. Osteotome sinus floor elevation with concentrated growth factor and simultaneous implant placement with or without bone grafting: a retrospective study. Int J Oral Max Surg 2022;51(8):1078-84. doi: 10.1016/j.ijom.2021.10.010
Si MS, Mo JJ, Zhuang LF, Gu YX, Qiao SC, Lai HC. Osteotome sinus floor elevation with and without grafting: an animal study in Labrador dogs. Clin Oral Implants Res. 2015;26(2):197-203. doi: 10.1111/clr.12313
Starch-Jensen T, Deluiz D, Bruun NH, Tinoco EMB. Maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials: a systematic review and meta-analysis focusing on histomorphometric outcome. J Oral Maxillofac Res. 2020;11(3):e2. doi: 10.5037/jomr.2020.11302
Shi JY, Qian SJ, Gu YX, Qiao SC, Tonetti MS, Lai HC. Long-term outcomes of osteotome sinus floor elevation without grafting in severely atrophic maxilla: a 10-year prospective study. J Clin Periodontol. 2020;47(12):1528-35. doi: 10.1111/jcpe.13365
Song DS, Kim CH, Kim BJ, Kim JH. Tenting effect of dental implant on maxillary sinus lift without grafting. J Dent Sci. 2020;15(3):278-85. doi: 10.1016/j.jds.2020.05.008
Pjetursson BE, Ignjatovic D, Matuliene G, Bragger U, Schmidlin K, Lang NP. Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: Radiographic tissue remodeling. Clin Oral Implants Res. 2009;20(7):677-683. doi: 10.1111/j.1600-0501.2009.01721.x
Chaushu L, Silva ER, Balan VF, Chaushu G, Xavier SP. Sinus augmentation - autograft vs. fresh frozen allograft: bone density dynamics and implant stability. J Stomatol Oral Maxillofac Surg. 2021;122(5):467-71. doi: 10.1016/j.jormas.2020.08.012
Bouwman WF, Bravenboer N, Frenken J, Ten Bruggenkate CM, Schulten E. The use of a biphasic calcium phosphate in a maxillary sinus floor elevation procedure: a clinical, radiological, histological, and histomorphometric evaluation with 9- and 12-month healing times. Int J Implant Dent. 2017;3(1):34. doi: 10.1186/s40729-017-0099-x
Zhou W, Wang F, Magic M, Zhuang M, Sun J, Wu Y. The effect of anatomy on osteogenesis after maxillary sinus floor augmentation: a radiographic and histological analysis. Clin Oral Investig. 2021;25(9):5197-204. doi: 10.1007/s00784-021-03827-6
Palma VC, Magro-Filho O, Oliveria JA, Lundgren S, Salata LA, Sennerby L. Bone reformation and implant integration following maxillary sinus membrane elevation: an experimental study in primates. Clin Implant Dent Relat Res. 2006;8(1):11-24. doi: 10.2310/6480.2005.00026
Nedir R, Nurdin N, Abi Najm S, El Hage M, Bischof M. Short implants placed with or without grafting into atrophic sinuses: the 5-year results of a prospective randomized controlled study. Clin Oral Implants Res. 2017;28(7):877-86. doi: 10.1111/clr.12893
Iida T, Baba S, Botticelli D, Masuda K, Xavier SP. Comparison of histomorphometry and microCT after sinus augmentation using xenografts of different particle sizes in rabbits. Oral Maxillofac Surg. 2020;24(1):57-64. doi: 10.1007/s10006-019-00813-x
He RT, Tu MG, Huang HL, Tsai MT, Wu J, Hsu JT. Improving the prediction of the trabecular bone microarchitectural parameters using dental cone-beam computed tomography. BMC Med Imaging. 2019;19(1):10. doi: 10.1186/s12880-019-0313-9
Van Dessel J, Huang Y, Depypere M, Rubira-Bullen I, Maes F, Jacobs R. A comparative evaluation of cone beam CT and micro-CT on trabecular bone structures in the human mandible. Dentomaxillofac Radiol. 2013;42(8):20130145. doi: 10.1259/dmfr.20130145
González-García R, Monje F. The reliability of cone-beam computed tomography to assess bone density at dental implant recipient sites: a histomorphometric analysis by micro-CT. Clin Oral Implants Res. 2013;24(8):871-9. doi: 10.1111/j.1600-0501.2011.02390.x
Zou Z, Wang L, Zhou Z, Sun Q, Liu D, Chen Y, et al. Simultaneous incorporation of PTH(1-34) and nano-hydroxyapatite into Chitosan/Alginate Hydrogels for efficient bone regeneration. Bioact Mater. 2021;6(6):1839-51.doi: 10.1016/j.bioactmat.2020.11.021
Ibrahim N, Parsa A, Hassan B, van der Stelt P, Rahmat RA, Ismail SM, et al. Comparison of anterior and posterior trabecular bone microstructure of human mandible using cone-beam CT and micro CT. BMC Oral Health. 2021;21(1):249. doi: 10.1186/s12903-021-01595-z
Lozano-Carrascal N, Anglada-Bosqued A, Salomó-Coll O, Hernández-Alfaro F, Wang HL, Gargallo-Albiol J. Short implants (<8mm) versus longer implants (≥8mm) with lateral sinus floor augmentation in posterior atrophic maxilla: A meta-analysis of RCT’s in humans. Med Oral Patol Oral Cir Bucal. 2020;25(2):e168-e79. doi: 10.4317/medoral.23248
Schiavon L, Perini A, Brunello G, Ferrante G, Del Fabbro M, Botticelli D, et al. The bone lid technique in lateral sinus lift: a systematic review and meta-analysis. Int J Implant Dent. 2022;8(1):33. doi: 10.1186/s40729-022-00433-3
Shanbhag S, Karnik P, Shirke P, Shanbhag V. Cone-beam computed tomographic analysis of sinus membrane thickness, ostium patency, and residual ridge heights in the posterior maxilla: implications for sinus floor elevation. Clin Oral Implants Res. 2014;25(6):755-60. doi: 10.1111/clr.12168
Mangu SR, Patel K, Sukhdeo SV, Savitha MR, Sharan K. Maternal high-cholesterol diet negatively programs offspring bone development and downregulates hedgehog signaling in osteoblasts. J Biol Chem. 2022;298(9):102324. doi: 10.1016/j.jbc.2022.102324
Nam JH, Almansoori AA, Kwon OJ, Seo YK, Kim B, Kim YK, et al. Sinus augmentation with poly(ε)caprolactone-β tricalcium phosphate scaffolds, mesenchymal stem cells and platelet rich plasma for one-stage dental implantation in minipigs. J Periodontal Implant Sci. 2023;53(3):218-32. doi: 10.5051/jpis.2300660033
Kamadjaja DB, Sumarta NP, Rizqiawan A. Stability of tissue augmented with deproteinized bovine bone mineral particles associated with implant placement in anterior maxilla. Case Rep Dent. 2019;2019:5431752. doi: 10.1155/2019/5431752
Starch-Jensen T, Jensen JD. Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities. J Oral Maxillofac Res. 2017;8(3):e3.doi: 10.5037/jomr.2017.8303
Avila G, Wang HL, Galindo-Moreno P, Misch CE, Bagramian RA, Rudek I, et al. The influence of the bucco-palatal distance on sinus augmentation outcomes. J Periodontol. 2010;81(7):1041-50. doi: 10.1902/jop.2010.090686
Ghayor C, Chen TH, Bhattacharya I, Özcan M, Weber FE. Microporosities in 3D-printed tricalcium-phosphate-based bone substitutes enhance osteoconduction and affect osteoclastic resorption. Int J Mol Sci. 2020;21(23):9270 doi: 10.3390/ijms21239270
Ivanova V, Chenchev I, Zlatev S, Mijiritsky E. Correlation between primary, secondary stability, bone density, percentage of vital bone formation and implant size. Int J Environ Res Public Health. 2021;18(13).6994. doi: 10.3390/ijerph18136994
Chang HH, Yeh CL, Wang YL, Fu KK, Tsai SJ, Yang JH, et al. Neutralized dicalcium phosphate and hydroxyapatite biphasic bioceramics promote bone regeneration in critical peri-implant bone defects. Materials (Basel). 2020;13(4):823. doi: 10.3390/ma13040823
Handschel J, Simonowska M, Naujoks C, Depprich RA, Ommerborn MA, Meyer U, et al. A histomorphometric meta-analysis of sinus elevation with various grafting materials. Head Face Med. 2009;5:12. doi: 10.1186/1746-160x-5-12
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Journal of Applied Oral Science
This work is licensed under a Creative Commons Attribution 4.0 International License.
Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons do tipo atribuição CC-BY.