Comparison of two anorganic bovine bone in maxillary sinus lift: a split-mouth study with clinical, radiographical, and histomorphometrical analysis

Abstract

Background: Anorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test).

Results: A split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p < 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p > 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p < 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%.

Conclusion: Both materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.

Keywords: Anorganic bovine bone; Bone grafting; Clinical trial; Dental implants; Maxillary sinus; Sinus floor elevation.

Fig. 1

Midcrestal and vertical buccal incisions were made along the residual alveolar bone. A diamond bur is used to create a window and placed deproteinized bovine bone (control or test) into the maxillary sinus

Fig. 2

The preoperative (a) and postoperative (b) images were used to evaluate the measurements of bone ridge height using a software tool of DentalSlice®

Fig. 3

Bone taken with a trephine burr for biopsy

Fig. 4

Implants placed in the grafted sinuses after 6-month healing

Fig. 5

Image representing the histological findings observed in ROI in the control sites. ROI represents the area from the junction of the native bone (i.e., the former floor of the sinus cavity) and ends until the frame delimited into the sample. The “old bone” (OB) was evidenced as a lamellar bone area, while the new formed bone area (NFB) was characterized as a parallel-fibered bone with areas of interlaced fibers. The residual graft particles (GP) were present in close contact to the new formed bone, evidencing a good osseointegration rate

Fig. 6

A part histological image highlighting the area of new bone (%NB—yellow color), residual graft particles (%RGP—orange color), and connective tissue (blue color) within a region of interest allowing then the calculation of the relative fraction (%) of each parameter

Fig. 7

Schematic image illustrating the histomorphometric linear measurements in the control (a) and test (b) groups

Fig. 8

Schematic image illustrating the evaluation about the number of patients

Fig. 9

Measurements demonstrate the radiographic findings (vertical bone height) preoperative and postoperative after MSFA. ANOVA two-way was used to compare intergroup

Fig. 10

Histomorphometrical analysis results. Difference between Bio-Oss and Lumina-Bone Porous about newly formed bone, residual graft particle, connective tissue, and total bone. The symbol above the result demonstrates statistical significance