Maxillary Sinus Augmentation with Decellularized Bovine Compact Particles: A Radiological, Clinical, and Histologic Report of 4 Cases

Abstract

Background. One of the most problematic regions for endosseous implants is the posterior maxilla, not only having poor bone density, but also lacking adequate vertical height as a result of sinus pneumatization. The purpose of the present study was a radiologic, histological, and histomorphometrical evaluation, in humans, of specimens retrieved from sinuses augmented with decellularized bovine compact particles, after a healing period of 6 months. Methods. Four patients, with atrophic resorbed maxillas, underwent a sinus lift augmentation with decellularized bovine compact bone from bovine femur. The size of the particles used was 0.25-1 mm. A total of four grafts and 5 biopsies were retrieved and processed to obtain thin ground sections with the Precise 1 Automated System. Results. The mean volume after graft elevation calculated for each of the 4 patients was 2106 mm³ in the immediate postoperative period (5-7 days), ranging from 1408.8 to 2946.4 mm³. In the late postoperative period (6 months) it was 2053 mm³, ranging from 1339.9 to 2808.9 mm³. Histomorphometry showed that newly formed bone was 36 ± 1.6% and marrow spaces were 34 ± 1.6%, while the residual graft material was 35 ± 1.4%. Conclusion. In conclusion, based on the outcome of the present study, Re-Bone® can be used with success in sinus augmentation procedures and 6 months are considered an adequate time for maturation before implant placement.

Figure 1

CBCT of an edentulous patient with bilateral severely atrophic maxilla.

Figure 2

Sinus lifting procedure. The maxillary sinus lateral wall is exposed and a bone window is removed.

Figure 3

Sinus filled with cortical bovine bone.

Figure 4

A membrane is placed over the antrostomy.

Figure 5

Postoperative CBCT scan panoramic view at 6 months after maxillary sinus lifting.

Figure 6

The lateral wall is completely closed by new hard tissues.

Figure 7

(a-b) Bone core biopsy carried out with a small trephine. (c) Newly formed trabecular bone (T) is present, with wide marrow (M) spaces and biomaterials (B). Toluidine blue 10x.

Figure 8

At higher magnification previous image: a few lamellar bones are visible (LB). Toluidine blue 50x.

Figure 9

No gaps are present at the bone-particles interface, and newly formed bone is always in close contact with the particles. The biomaterial (B) seems to be totally incorporated in the trabecular bone (T). Toluidine blue 100x.