Maxillary sinus augmentation with three different biomaterials: Histological, histomorphometric, clinical, and patient‐reported outcomes from a randomized controlled trial

Abstract

Background Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior‐upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used. Methods Twenty‐four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient‐reported outcome measures. Results Although the percentage of new bone was not statistically different between the three groups (P = .191), the percentages of residual biomaterial was significantly higher (P < .000) and nonmineralized tissue significantly lower (P < .000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P < .0005). The rest of the secondary outcomes were not significantly different between the groups. Conclusion MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes.

Long-Term Clinical Study of Implants Placed in Maxillary Sinus Floor Augmentation Using Beta-Tricalcium Phosphate

“…Scientific evidence showed that MSFA predictably leads to high implant survival rates, limited peri-implant marginal bone loss, and resulted in few overall surgical and prosthetic complications in maxillary patients [ 3 , 4 , 5 , 6 , 7 , 8 ]. The lateral osteotomy technique to approach the MFSA for increasing bone volume in the posterior maxilla is a well-established and documented surgical procedure allowing for implant placement [ 3 , 13 , 14 , 31 ]. Irrespective of the grafting materials applied (i.e., autogenous bone, allografts, xenografts, alloplastic), MFSA is accompanied by increased implant stabilization and new bone formation [ 13 , 14 , 15 ].…”

“…The lateral osteotomy technique to approach the MFSA for increasing bone volume in the posterior maxilla is a well-established and documented surgical procedure allowing for implant placement [ 3 , 13 , 14 , 31 ]. Irrespective of the grafting materials applied (i.e., autogenous bone, allografts, xenografts, alloplastic), MFSA is accompanied by increased implant stabilization and new bone formation [ 13 , 14 , 15 ].…”

“…A wide variety of grafting materials have been used in MSFA, including an autogenous bone graft and bone substitutes that are generally categorized as natural transplants (allografts and xenografts) and synthetic materials (alloplastic) [ 14 , 15 , 16 ]. An autogenous bone graft is generally considered the ideal grafting material because of its osteogenic, osteoinductive, and osteoconductive properties.…”

Polymeric Scaffolds for Dental, Oral, and Craniofacial Regenerative Medicine

“…Theoretically, the superior osteogenic and osteoinductive capacities of autogenous bone could be beneficial in short-term healing. Clinically, no significant differences in new bone formation were observed in using allogeneic, xenogeneic, or synthetic bone substitutes with or without autogenous bone [67,96,100]. Possible clinical considerations of usage of bone substitutes over autografts include reducing invasiveness of surgery and surgical time [67].…”

“…Conflicting findings exist in regard to comparing healing periods between these two groups and if the success of the maxillary sinus augmentation is dependent on the graft materials used [96]. Overall, regardless of which biomaterials are used, maxillary sinus augmentation is safe and well-tolerated by patients [100].…”