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. 2022 Mar;33(3):322-332.
doi: 10.1111/clr.13891. Epub 2022 Jan 12.

Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study

Claudio Stacchi  1 , Antonio Rapani  1 , Teresa Lombardi  2 , Fabio Bernardello  3 , Vanessa Nicolin  1 , Federico Berton  1
Affiliations

Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study

Claudio Stacchi et al. Clin Oral Implants Res. 2022 Mar.

Abstract

Objective: The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH).

Material and methods: Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis.

Results: Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (β coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (β coefficient =-.038, p = .825).

Conclusions: The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.

Keywords: bone regeneration; bone substitutes; guided tissue regeneration; maxillary sinus; sinus floor elevation.

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Conflict of interest statement

The authors do not have any financial interests, either directly or indirectly, in the products or information listed in this paper.

Figures

FIGURE 1
FIGURE 1
Histomorphometric analysis was performed only on the newly formed tissue: the part of the biopsy including pristine crestal bone was separated from the augmentation area with a manually drawn line (von Kossa stain; 30× magnification)
FIGURE 2
FIGURE 2
Histological microphotography showing residual graft particles (RXG and RSG) bridged by newly formed mineralized tissue (NFMT) after 6 months of healing. Osteocytes (*) are present within NFMT, suggesting the presence of woven bone in active remodelling phase. RXG, residual xenograft; RSG, residual synthetic graft; NFNMT, newly formed nonmineralized tissue (von Kossa stain; 400× magnification)
FIGURE 3
FIGURE 3
Linear regression line describing the strong negative correlation between new bone formation and sinus width. NFMT, newly formed mineralized tissue; SW, sinus width
FIGURE 4
FIGURE 4
Linear regression line describing the absence of correlation between new bone formation and residual bone height. NFMT, newly formed mineralized tissue; RBH, residual bone height
See this image and copyright information in PMC

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