A reduced healing protocol for sinus floor elevation in a staged approach with deproteinized bovine bone mineral alone: A randomized controlled clinical trial of a 5‐month healing in comparison to the 8‐month healing

Abstract

Purpose: To investigate the feasibility of reducing the healing time of maxillary sinus floor elevation (MSFE) by a two-stage approach using deproteinized bovine bone mineral (DBBM) alone, based on clinical, histomorphometric, and microradiographic evaluations. Materials and Methods: Twenty consecutive cases with an atrophic posterior edentulous maxilla were randomly assigned to two groups at a ratio of 1:1. The lateral window approach to MSFE with DBBM alone was followed by an 8-month bonehealing period in the control group compared to 5 months in the test group. During implant placement, bone biopsies were harvested from implant osteotomy sites for micro-computed tomography (CT), histological, and histomorphometric evaluations. Cone beam CT (CBCT) scans were performed before and immediately after MSFE and after the bone-healing periods. The implant stability quotient (ISQ) was measured sequentially at implant placement and 1, 3, and 6 months thereafter. Results: The histomorphometric and microradiographic results showed no significant differences in new bone formation on the augmented sinus floor between the two groups (all Ps > .05), except that trabecular thickness was significantly reduced and trabecular separation significantly increased in the test group (both Ps < .05). The ISQs of both groups increased continuously after implant placement, but the difference was not significant between the groups at each time point. CBCT analyses showed that the extent of volumetric loss was comparable after bone healing for 5 and 8 months (P > .05). Conclusions: Within the limitations of this study, the bone-healing time of MSFE with DBBM alone for staged implant placement could be reduced to 5 months instead of 8 or 9 months, based on the histomorphometric, microradiographic, and clinical outcomes; however, impact on long-term implant survival remains unknown and needs further investigation with long-term follow-ups.

Remodelling of sinus bone grafts according to the distance from the native bone: A histomorphometric analysis

“…Healing time is also an important variable to consider when analysing the different outcomes of the histomorphometric data presented in the literature, since the increase in the healing time is directly related to increased bone formation (Bouwman, Bravenboer, Frenken, Ten Bruggenkate, & Schulten, 2017). The healing period of 8 months selected in the present study can be considered long compared to that selected in other studies that performed implant placement after 5 to 6 months in maxillary sinuses grafted solely with ABB (Alayan, Vaquette, Farah, et al, 2016;Liu et al, 2020;Suwanwela, Puangchaipruk, Wattanasirmkit, Kamolratanakul, & Jansisyanont, 2017). A randomized clinical trial that compared the healing of the maxillary sinus grafted with ABB after a healing time of 5 and 8 months showed no differences regarding the composition of biopsy sample (Liu et al, 2020).…”

“…The healing period of 8 months selected in the present study can be considered long compared to that selected in other studies that performed implant placement after 5 to 6 months in maxillary sinuses grafted solely with ABB (Alayan, Vaquette, Farah, et al, 2016;Liu et al, 2020;Suwanwela, Puangchaipruk, Wattanasirmkit, Kamolratanakul, & Jansisyanont, 2017). A randomized clinical trial that compared the healing of the maxillary sinus grafted with ABB after a healing time of 5 and 8 months showed no differences regarding the composition of biopsy sample (Liu et al, 2020). However, the bone tissue formed after 8 months presented a larger number of bone trabeculae and decreased space between the trabeculae compared with the biopsy samples harvested after a healing period of 5 months (Liu et al, 2020).…”

“…A randomized clinical trial that compared the healing of the maxillary sinus grafted with ABB after a healing time of 5 and 8 months showed no differences regarding the composition of biopsy sample (Liu et al., 2020). However, the bone tissue formed after 8 months presented a larger number of bone trabeculae and decreased space between the trabeculae compared with the biopsy samples harvested after a healing period of 5 months (Liu et al., 2020). One could speculate that the impact of the distance from the grafted area to the native bone would be more relevant considering those shorter periods of healing.…”

“…Among those materials, anorganic bovine bone (ABB) is a well‐documented option and one of the most used bone substitute materials for sinus lifting procedures (Dos Anjos et al., 2016; de Molon et al., 2019; Pignaton et al., 2019). ABB particles are biocompatible and present osteoconductive characteristics, providing a scaffold for bone formation (Araujo, Liljenberg, & Lindhe, 2010; Liu et al., 2020; Tadjoedin, de Lange, Bronckers, Lyaruu, & Burger, 2003).…”

“…However, as the patient-centred outcomes became more important (De Bruyn, Raes, Matthys, & Cosyn, 2015), bone substitute materials gained space as an alternative for autogenous bone grafts (Franceschetti et al, 2020;Stacchi et al, 2020). Diverse bone substitute materials have been used for sinus lifting procedures, with results comparable to those achieved when using autologous bone grafts (Franceschetti et al, 2020;Galindo-Moreno et al, 2020;Liu et al, 2020). Among those materials, anorganic bovine bone (ABB) is a well-documented option and one of the most used bone substitute materials for sinus lifting procedures (Dos Anjos et al, 2016;de Molon et al, 2019;Pignaton et al, 2019).…”