Effect of a Particulate and a Putty-Like Tricalcium Phosphate-Based Bone-grafting Material on Bone Formation, Volume Stability and Osteogenic Marker Expression after Bilateral Sinus Floor Augmentation in Humans

Abstract

This study examines the effect of a hyaluronic acid (HyAc) containing tricalcium phosphate putty scaffold material (TCP-P) and of a particulate tricalcium phosphate (TCP-G) graft on bone formation, volume stability and osteogenic marker expression in biopsies sampled 6 months after bilateral sinus floor augmentation (SFA) in 7 patients applying a split-mouth design. 10% autogenous bone chips were added to the grafting material during surgery. The grain size of the TCP granules was 700 to 1400 µm for TCP-G and 125 to 250 µm and 500 to 700 µm (ratio 1:1) for TCP-P. Biopsies were processed for immunohistochemical analysis of resin-embedded sections. Sections were stained for collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Furthermore, the bone area and biomaterial area fraction were determined histomorphometrically. Cone-beam CT data recorded after SFA and 6 months later were used for calculating the graft volume at these two time points. TCP-P displayed more advantageous surgical handling properties and a significantly greater bone area fraction and smaller biomaterial area fraction. This was accompanied by significantly greater expression of Col I and BSP and in osteoblasts and osteoid and a less pronounced reduction in grafting volume with TCP-P. SFA using both types of materials resulted in formation of sufficient bone volume for facilitating stable dental implant placement with all dental implants having been in function without any complications for 6 years. Since TCP-P displayed superior surgical handling properties and greater bone formation than TCP-G, without the HyAc hydrogel matrix having any adverse effect on bone formation or graft volume stability, TCP-P can be regarded as excellent grafting material for SFA in a clinical setting. The greater bone formation observed with TCP-P may be related to the difference in grain size of the TCP granules and/or the addition of the HyAc.

Applications of Hyaluronic Acid (HA) in Dental Implant Treatment: A Systematic Review

“…In this article, there are several ways that HA was used for bone graft material and sinus lift procedures. HA was mixed with bone graft material in several studies, with a particular interest in the maxillary sinus lift procedure (35,36,37,38,39). The use of HA added with the bone graft showed improved bone formation (39).…”

“…Implants were usually placed 9 months after the sinus lift procedure and utilizing PepGen P-15 putty and Hyaloss Matrix can reduce the time to only two to four months (35,39,40). Apart from the shorter healing time, addition of graft material with HA was also reported to have better handling to ease the filling of the maxillary sinus area (36,37,39). Another commercially available HA, Hyaloss Matrix was examined as a space maintainer in sinus lift procedure and combined with collagenated bone graft material (39,41).…”

Injectable platelet rich fibrin versus hyaluronic acid with bovine derived xenograft for alveolar ridge preservation. A randomized controlled clinical trial with histomorphometric analysis

“…Moreover, HA plays a vital role as a scaffolding material, enhancing the biological properties of scaffolds for bone regeneration. 21 HA has been used clinically to facilitate the healing of extraction sockets, manage osteoarthritis of the temporomandibular joint, and alleviate pain from recurrent aphthous ulcers. Moreover, HA has been recommended as an adjunctive therapy to nonsurgical or surgical periodontal treatments to mitigate inflammation and promote wound healing.…”

“…However, these effects depend on three key factors: the size of the HA molecules, their concentration, and the specific targeted cell type. Moreover, HA plays a vital role as a scaffolding material, enhancing the biological properties of scaffolds for bone regeneration 21 …”

Osteogenic Effect of a Bioactive Calcium Alkali Phosphate Bone Substitute in Humans

“…Over the last three decades, maxillary sinus floor grafting has become a widely used alveolar ridge augmentation procedure preceding dental implant placement in the atrophic posterior maxilla [1][2][3][4][5][6][7][8]. Bioactive calcium phosphate (CaP)-based glasses and ceramics are bone-bonding and enhance bone cell function and osseous tissue formation due to surface-mediated effects and effects mediated by ion dissolution products [4,9,10].…”