The impact of deproteinized bovine bone particle size on histological and clinical bone healing outcomes in the augmented sinus: A randomized controlled clinical trial

Abstract

Objective: The effect of different deproteinized bovine bone mineral (DBBM) particle sizes on bone healing in maxillary sinus floor augmentation remains unclear. This study compared the newly formed tissue and angiogenesis-related bone healing after sinus floor augmentation using large or small DBBM particles.Materials and Methods: Overall 32 patients were randomly divided into two groups using either large (1-2 mm) or small (0.25-1 mm) DBBM particles for sinus floor augmentation. After 6 months, the mineralized tissue volume was calculated using micro-computed tomography (micro-CT) analysis. The newly formed tissue composition was histomorphometrically analyzed. Angiogenesis was also examined by means of vascular endothelial growth factor (VEGF) expression. Implant failure and marginal bone loss were measured at a 1-year follow-up. Statistical analysis was performed using independent samples t-test.Results: Micro-CT analysis demonstrated that grafting with large particles resulted in higher bone volume (6.99 ± 2.72 mm 3 , p = 0.002) and Bone Volume/Tissue Volume (0.25 ± 0.1, p = 0.03) compared with small particles (3.76 ± 1.83 mm 3 and 0.14 ± 0.13, respectively). Small particles showed higher non-mineralized tissue volume (26.31 mm 3 ) compared with large particle group (17.4 ± 5.34 mm 3 ) with p = 0.001. The histological data revealed significantly higher area of newly formed bone (32.15% ± 14.04% for the large particle and 15.99% ± 14.12% for the small particle groups, p = 0.004). Likewise, non-mineralized tissue was significantly greater in the small particle group (66.48% ± 20.97%) compared with the large particle group (44.36%, p = 0.016). Moreover, use of large particles resulted in a significantly higher VEGF staining intensity score and VEFG positive cells. No implant failure was recorded in both groups, while no difference was found in terms of marginal bone loss at the 1-year follow-up.Conclusions: Sinus floor augmentation using large DBBM particles resulted in more angiogenesis expression, higher bone volume, and new bone formation at 6 months after sinus augmentation. However, clinical outcomes with regards to implant placement were similar in both groups.

Gene expression, micro‐CT and histomorphometrical analysis of sinus floor augmentation with biphasic calcium phosphate and deproteinized bovine bone mineral: A randomized controlled clinical trial

“…As numerous clinical studies have evaluated different biomaterials for sinus augmentation, DBBM is at present a well-established standard for such procedures. 8,10,[13][14][15][23][24][25][26][29][30][31][32][42][43][44] Few clinical trials have compared the outcomes of DBBM with these of BCP, limited to the HA/β-TCP ratio of 60/40. Moreover, the regulation of osteogenic genes as a result of such comparative interventions has been scarcely reported.…”

“…The use of biomaterials is well‐documented for sinus augmentation and is shown to achieve stable bone volume, as required for implant placement and long‐term functional outcome of implant rehabilitation. As numerous clinical studies have evaluated different biomaterials for sinus augmentation, DBBM is at present a well‐established standard for such procedures 8,10,13–15,23–26,29–32,42–44 . Few clinical trials have compared the outcomes of DBBM with these of BCP, limited to the HA/β‐TCP ratio of 60/40.…”

“…7 Deproteinized Bovine Bone Mineral (DBBM) is a widely used xenograft, which has well documented clinical outcomes in maxillary sinus augmentation in animal and human studies. [11][12][13][14][15] Furthermore, DBBM having a slow resorption rate can act as a scaffold for the growth of new native bone, 8,16 maintaining the stability of the augmented volume.…”

Autologous leucocyte and platelet rich in fibrin (L-PRF) – is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF

“…For the sinus floor augmentation surgery, a comparison of the newly formed bone and angiogenesis-related bone healing was made in several studies. After 6 months of healing, new bone formation and higher bone volume with a greater angiogenesis expression by means of vascular endothelial growth factor (VEGF) expression were obtained with larger size particles, using micro-computed tomography and histomorphometrically analysis [ 37 ].…”

Potentials of pure xenograft materials in maxillary ridge augmentation: A case series

“…Nonetheless, such findings have different interpretations and consequences in different clinical scenarios. For instance, the use of large-granule xenografts in sinus floor augmentation was associated with new bone formation, higher bone volume, and higher levels of angiogenesis; however, the clinical success rate of implants placed in augmented bone with large- and small-granule xenografts was comparable ( Kamolratanakul et al, 2022 ).…”