Sinus floor augmentation with simultaneous placement of dental implants using a combination of deproteinized bone xenografts and recombinant human osteogenic protein‐l. A histometric study in miniature pigs.

Abstract

Maxillary sinus floor augmentation with autogenous bone has become a widely accepted procedure in implant dentistry. The use of osteoconductive bone substitutes in this indication is controversial, since their use can lead to a prolonged healing time, inhomogenous ossification, foreign body reaction, migration of particles and low bone-implant contact (BIC). The purpose of this study was to examine whether the combination of an osteoinductive protein (recombinant human osteogenic protein-1 (rhOP-1 = bone morphogenetic protein-7) with natural bovine bone mineral (BioOss) would improve ossification and the bone-implant contact (BIC) in a sinus floor augmentation with simultaneous placement of implants. In this study, the maxillary sinus floors in 5 miniature pigs were augmented with 3 ml BioOss containing 420 micrograms rhOP-1 on the test side and 3 ml BioOss alone on the control side. At the time of augmentation a titanium implant (ITI) was inserted from a laterocaudal direction. After 6 months of healing the sites of augmentation were removed and examined in non-decalcified sections by microradiography, fluorescence microscopy of sequentially labelled specimens and by histometry. On both sides, significant amounts of newly-formed bone were observed. However, on the test sites, the percentage of BIC in the augmented area was 80.0% versus 38.6% on control sites. It can be concluded that the application of bone morphogenetic proteins caused a more rapid and enhanced osseointegration of simultaneously placed implants when compared to the bone substitute alone. Therefore recombinant human osteogenic protein-1 delivered by natural bone mineral has the potential to become a clinical alternative for autogenous bone grafts in sinus floor augmentation.

Influence of rhBMP-2 on bone formation and osseointegration in different implant systems after sinus-floor elevation. An in vivo study on sheep

“…BMPs) which have osteogenic and osseoconductive effects (Rahn and Perren, 1970;Rahn, 1976;Allegrini et al, 2003). The osseoinductive effect of rhBMP-2 depends on the amount of cells in the region of augmentation which in turn depends on the species, the age and the vascularity of the area (Terheyden et al, 1999;Yamaji et al, 2007). Sinus-lift procedures in a sheep model are a reliable method for evaluating bone formation (Aral et al, 2008;Estaca et al, 2008).…”

“…During this study a total of 0.8 mg rhBMP-2 in a concentration of 0.4 mg/ml was used while Terheyden et al (1999) and Roldán et al 2004 used a concentration of 0.4 mg/ml rhBMP-7 for their study on mini pigs, normal bone contains only 0.002 mg/kg of BMP (Rengachary, 2002). Other studies showed that large bone defects could be repaired using rhBMP-2 on a PLPG sponge (Marukawa et al, 2001).…”

“…The study did however show that the newly generated bone had the same quality for implant placement as the original bone. Terheyden et al (1999) showed the impact of rhBMP-7 on osseointegration after sinus-floor augmentation in mini pigs. At 6 months, BIC was 80% on the test side and only 38.6% on the control side (BioOss Ò ) (Terheyden et al, 1999;Roldán et al, 2004) compared the influence of rhBMP-7 with Platelet-Rich-Plasma (PRP) on five mini pigs.…”

“…Terheyden et al (1999) showed the impact of rhBMP-7 on osseointegration after sinus-floor augmentation in mini pigs. At 6 months, BIC was 80% on the test side and only 38.6% on the control side (BioOss Ò ) (Terheyden et al, 1999;Roldán et al, 2004) compared the influence of rhBMP-7 with Platelet-Rich-Plasma (PRP) on five mini pigs. After 6 weeks, BIC was 45.8% on the rhBMP-7 side and only 5.7% on the PRP side (Roldán et al, 2004).…”

Various Ways to Enhance the Results of Maxillary Sinus Augmentation Procedures

“…Hydroxyapatite, biphasic tri-calcium phosphate-hydroxyapatite, and natural coral are r e p o r t e d t o b e e q u a l l y g o o d a s f r a m i n g material for bone morphogenetic protein (Pekkarinen et al, 2005). Deproteinized bovine bone mineral is known to show excellent osteoconductive properties, and it has been used for sinus augmentation clinically (Terheyden et al, 1999). The bovine xenograft composite promotes formation of new bone in a similar fashion to autogenous bone when bone morphogenetic proteins were bound to the graft material, and could therefore be considered a biomaterial with potential applications as a bone substitute in maxillary sinus floor augmentation (Sicca et al, 2008).…”