Frontal sinus and skull bone defect obliteration with three synthetic bioactive materials. A comparative study

Abstract

Three synthetic bioactive materials were studied in an experimental model to compare their usability in a frontal sinus and a skull bone defect obliteration. Bioactive glass number 9 (BAG(1)), bioactive glass number 13 (BAG(2)), and hydroxyapatite (HA) granules were investigated. BAG(1) and HA granules have been previously tested clinically. The clinical usefulness of BAG(2) granules has not been tested. Upper bony walls of 45 Elco rabbits' frontal sinuses were drilled open from four separate holes with the use of a standard method. The skull bone defects and the sinuses in frontal bone were filled with BAG(1) or BAG(2) on one side, and with HA on the other side. Two parallel posterior defects were covered with a pedicled periosteum flap, and two anterior defects with a free flap. The resorption of materials, new bone, and fibrous-tissue formation were observed with a histomorphometric method at 1, 3, and 6 months postoperatively. Scanning-electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR) were done at 6 months. In histomorphometry, the new bone formation increased with all the investigated materials throughout the study (p < 0.001), but the results showed higher new bone formation in the defects filled with BAG(1) than in corresponding BAG(2)- or HA- filled defects. New bone formation and resorption of materials were faster in defects covered by pedicled than by free periosteum flaps (p < 0.001). Intimate contact between the used materials and new bone was confirmed by SEM. FTIR analysis of bone produced by BAG(1) and BAG(2) was of the same type as natural frontal bone. BAG(2) can be manufactured in various shapes, and thus, could possibly be used in clinical conditions requiring a special anatomical implant shape. However, more research is needed regarding this property of BAG(2).

Bioactive glass S53P4 in frontal sinus obliteration: A long‐term clinical experience

“…As the healing process progressed, connective tissue was seen between the BAG granules and, furthermore, fibrous tissue was replaced by lamellar new bone formation, which was seen as a slight increase of HU in ROI analysis. In experimental studies, BAG produces more new bone than hydroxyapatite, [32][33][34] and the bone produced by BAG is very similar to natural frontal bone. 32 In this clinical study, the FTIR studies showed bone produced by BAG to be very similar to natural human frontal bone.…”

“…In experimental studies, BAG produces more new bone than hydroxyapatite, [32][33][34] and the bone produced by BAG is very similar to natural frontal bone. 32 In this clinical study, the FTIR studies showed bone produced by BAG to be very similar to natural human frontal bone. The properties of BAG are important factors in obliteration material, that is, in chronic infected frontal sinuses, with a relative risk of reinfection.…”

“…30 Comparison and evaluation of the differences between the synthetic materials in an experimental frontal sinus and skull bone defect obliteration were carried out. 31,32 The control materials were hydroxyapatite and bioactive glass . In these studies, BAG produced more new bone than the control materials during the observation periods of 1, 3, 6, and 12 months.…”

Frontal Sinus Obliteration with Iliac Crest Bone Grafts. Review of 8 Cases

“…When used without reconstruction of the anterior table with bone or titanium mesh they may lead to long-term defects of contour. 1,17,19,22,23,[26][27][28][29]34,36 Autologous fat and cancellous bone are frequently used to obliterate the frontal sinus when treating frontal sinus fractures. Successful obliteration requires meticulous extirpation of the sinus mucosa and obliteration of the drainage system.…”

“…Those materials have presented varying degrees of success for frontal sinus obliteration. [27][28][29][30][31][32][33][34][35][36][37][38] This article reviews patients who sustained frontal sinus fractures treated by obliteration of the sinus with autogenous cancellous bone.…”