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Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone.
2010 (English)In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 21, no 9, p. 961-70Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The purpose of the present study was to histologically and histomorphometrically evaluate the long-term tissue response to deproteinized bovine bone (DPBB) particles used in association with autogenous bone and to compare particle size after 6 months and 11 years, in the same patients, in order to determine possible resorption.

MATERIAL AND METHODS: Twenty consecutive patients (14 women and six men) with a mean age of 62 years (range 48-69 years) with severe atrophy of the posterior maxilla were included in this study. Thirty maxillary sinuses with <5 mm subantral alveolar bone were augmented with a mixture of 80% DPBB and 20% autogenous bone. Eleven years (mean 11.5 years) after augmentation, biopsies were taken from the grafted areas of the 11 patients who volunteered to participate in this new surgical intervention. The following histomorphometrical measurements were performed in these specimens: total bone area in percentage, total area of the DPBB, total area of marrow space, the degree of DPBB-bone contact (percentage of the total surface length for each particle), the length of all DPBB particles and the area of all DPBB particles. The length and the area of the particles were compared with samples harvested from the same patients at 6 months (nine samples) and pristine particles from the manufacturer.

RESULTS: The biopsies consisted of 44.7+/-16.9% lamellar bone, 38+/-16.9% marrow space and 17.3+/-13.2% DPBB. The degree of DPBB to bone contact was 61.5+/-34%. There were no statistically significant differences between the length and area of the particles after 11 years compared with those measured after 6 months in the same patients or to pristine particles from the manufacturer.

CONCLUSION: DPBB particles were found to be well integrated in lamellar bone, after sinus floor augmentation in humans, showing no significant changes in particle size after 11 years. To cite this article: Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone.

Place, publisher, year, edition, pages
John Wiley & Sons, 2010. Vol. 21, no 9, p. 961-70
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-27147DOI: 10.1111/j.1600-0501.2010.01939.xPubMedID: 20497443OAI: oai:DiVA.org:mau-27147DiVA, id: diva2:1488754
Available from: 2020-11-03 Created: 2020-11-03 Last updated: 2020-11-03Bibliographically approved
In thesis
1. On tissue reactions to and resorption of bone substitutes
Open this publication in new window or tab >>On tissue reactions to and resorption of bone substitutes
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The increasing need for bone grafting procedures inimplant dentistry and the introduction of a variety of bone substitutesrequire a deeper understanding of the biological response and shortandlong-term behaviour of these materials to choose the adequategraft and surgical procedure for the intended clinical application.Aims: The overall aim was to clinically and histologically studythe short- and long-term tissue reactions to and resorption of bonesubstitutes after bone augmentation.Material and methods: In paper I, dentin blocks with different demineralizationtimes were placed subperiostally in 40 rat skulls. Aftera healing period of 4 weeks the rats were sacrificed and the healingof the dentin blocks were evaluated. In paper II, eleven patients weretreated with bilateral sinus floor augmentation using biphasic calciumphosphate (BCP) on one side and deproteinized bovine bone (DPBB)on the contralateral side, acting as control. After 3 years, biopsieswere retrieved from the grafted area for histological evaluation andhistomorphometry and 62 dental implants, placed 8 months aftergraft healing, were clinically evaluated. In paper III and IV, fourteen(22 sinuses) of the included 20 patients (30 sinuses) treated withsinus floor augmentation with a mixture of 80% DPBB and 20%autogenous bone (AB) from the chin were followed throughout the10 years study period. These patients had 53 implants placed ingrafted sites and 15 implants placed in non-grafted bone. Clinicaland radiographic examinations were performed. Biopsies wereretrieved from the grafted sinuses after 11 years of graft healing for16histological evaluation and histomorphometry. The particle sizeswere compared with samples retrieved after 6 months from the samepatients and pristine particles from the manufacturer. In paper V, 13patients (14 jaws) were treated with lateral ridge augmentation using2 different mixtures of DPBB:AB (90:10 and 60:40) in a randomizedand controlled trial, designed as a split mouth study. The width andvolume changes were evaluated after 7.5 months by means of conebeam computed tomography. After 8 months of graft healing, at thetime of implant placement, biopsies were retrieved for histologicalevaluation and histomorphometry.Results: Resorption increased with increasing degree of demineralizationof dentin blocks while bone formation increased with increasingdegree of demineralization, in the latter case provided inflammationwas compensated for (paper I). After 3 years of healing the BCPparticles showed different levels of dissolution, in contrast to DPBBparticles that showed no signs of resorption. The overall implantsurvival rate was 96.8% and the success rate for implants placed inBCP and DPBB was 91.7% and 95.7% respectively (paper II). Thecumulative survival rate of the implants after 10 years was 86% andthe marginal bone loss was 1.6 mm. There was only a reduction ingraft height between 3 months and 2 years but no further reductionup to 10 years (paper III). There was no difference between the sizeof DPBB particles after 11 years compared to those measured after6 months or to particles from the manufacturer (paper IV). Thegain in width of the alveolar crest was 3.5 mm and 2.9 mm and thereduction of the grafts were 37% and 47% for the 60:40 mixtureand 90:10 mixture respectively (significant differences). There wereno histomorphometrical differences between the groups (paper V).Conclusions: Partial demineralization may provide a method foroptimizing the integration of dentin onlays. A similar degree of boneformation and bone-to-graft contact for BCP and DBB was found 3years after maxillary sinus augmentation with similar success ratesfor implants placed in both grafting materials. At 10 years follow-upafter sinus floor augmentation with 80:20 (DPBB:AB) graft, theremaining implants presented good clinical and radiological resultsand there seems to be no further graft resorption after 2 years of17graft healing. DPBB particles were found to be well integrated inlamellar bone, showing no apparent signs of resorption after 11 yearsin humans. Despite a small difference in width changes after lateralridge augmentation, the amount of AB added to DPBB did not seemto have a major impact on the graft healing and graft reduction, thusmaking it possible to install implants in all grafted sites.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2013. p. 122
Series
Doctoral Dissertation in Odontology
Keywords
bone graft, bone substitutes, sinus floor augmentation, lateral ridge augmentation
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7677 (URN)15114 (Local ID)978-91-7104-393-1 (ISBN)15114 (Archive number)15114 (OAI)
Note

Note: The papers are not included in the fulltext online.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-06Bibliographically approved

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