Assessment of the value of anorganic bone additives in sinus floor augmentation: A review of clinical reports

Department of Oral and Maxillofacial Surgery, University Medical Centre Nijmegen, University of Nijmegen, The Netherlands.
International Journal of Oral and Maxillofacial Surgery (Impact Factor: 1.57). 03/2003; 32(1):1-6. DOI: 10.1054/ijom.2002.0346
Source: PubMed


In order to objectively assess the value of anorganic bone additives in sinus floor augmentation, a review of the English literature till May 2002 was carried out. The studies or parts of studies had to include at the least two patients, with a follow-up of at least 3 months, whilst histomorphometric data ought to be available of biopsies taken from the core of the graft. Only 12 studies fulfilled these criteria. Firm conclusions could not be drawn because there were substantial differences in histomorphometric techniques, healing periods and ratio autogenous bone anorganic additives, but it seemed that autogenous bone without anorganic additives resulted in the highest amount of bone after a 4-6 months healing period, while hydroxyapatite and bovine bone mineral, used as a bone substitute, gave the lowest amount of bone. No correlation between bone volume and time of graft healing could be found. The consequences, however, for implant placement and survival are at present, not fully understood. A plea is made for systematic prospective clinical and experimental studies to assess the various bone additives and ratios of autogenous bone to bone additives in composite grafts analysed with an adequate histomorphometric technique. Part of this study was presented at the 15th ICOMS, Durban, South Africa, 19-24 May 2001.

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    • "Xenogenic implants also play an important role in reconstructive bone surgery. These implants are made of skeletal material obtained from animals (Merkx et al., 2003), in most cases from equine, bovine or porcine bones. Animal material is processed by means of thermal treatment in order to deplete it completely of its organic components (Barakat et al., 2009). "

    Tissue Regeneration - From Basic Biology to Clinical Application, 03/2012; , ISBN: 978-953-51-0387-5
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    • "In order to present such desirable features, the biomaterials are produced associated to several materials and substances [16]. For example, the use of bone grafts together with growth factors such as PDGF, TGF-α and bone morphogenetic proteins (BMPs) is based on the association of natural or recombinant proteins to a carrier such as biological or synthetic polymers (collagen or poly-L-lactic acid, respectively), ceramics (hydr-oxyapatite , inorganic bovine bone) and other materials [17]. "
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    ABSTRACT: Presently, several different graft materials are employed in regenerative or corrective bone surgery. However current misconceptions about these biomaterials, their use and risks may compromise their correct application and develop-ment. To unveil these misconceptions, this work briefly reviewed concepts about bone remodeling, grafts classification and manufacturing processes, with a special focus on calcium phosphate materials as an example of a current em-ployed biomaterial. Thus a search on the last decade was performed in Medline, LILACS, Scielo and other scientific electronic libraries using as keywords biomaterials, bone remodeling, regeneration, biocompatible materials, hy-droxyapatite and therapeutic risks. Our search showed not only an accelerated biotechnological development that brought significant advances to biomaterials use on bone remodeling treatments but also several therapeutic risks that should not be ignored. The biomaterials specificity and limitations to clinical application point to the current need for developing safer products with better interactions with the biological microenvironments.
    Journal of Biomaterials and Nanobiotechnology 01/2011; 2(03):318-328. DOI:10.4236/jbnb.2011.23039
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    • "Here, we propose a modification of this classical approach, consisting in removing the lateral wall of the maxillary sinus with bone shavers and using it as a particulate bone graft. Because of the fact that xenografts are osteoconductive rather than osteoinductive , a longer healing time is required in order to achieve a similar amount of vital bone as that reported with autogenous bone grafts, (Merkx et al. 2003; John & Wenz 2004). Autogenous bone chips revascularize in approximately 3–4 months (Stricker et al. 2003), which implies that the healing time is shortened when compared with that which a boneonly substitute graft needs. "
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    ABSTRACT: The aim of this study was to determine the clinical efficacy of a mixture of autologous bone harvested from the lateral wall of the maxilla using bone shavers and bovine-derived hydroxyapatite (HA) placed as a graft to elevate the maxillary sinus floor. The histological picture of tissue found in the sinus, the survival rate and the success of the implants were all evaluated. A total of 90 titanium implants were placed in 34 patients. In all of them, the lateral maxillary wall was harvested as a particulate bone graft, subsequently mixed with bovine-derived HA and packed in the sinus cavity. The lateral access window was then covered with a bioresorbable porcine-derived collagen membrane. In 32 sinuses, a two-stage surgery was performed, while in the remaining 10 cases a one-stage surgery was carried out. In the two-stage approach, 14 randomly selected biopsies were obtained at the time of implant insertion after a healing period of 9 months. The histological specimens were histologically and histomorphometrically evaluated. One implant was lost, leading to a survival rate of 98.9%. The new bone consisted of lamellae of living bone contained osteocytes and in close contact with bovine bone particles that were partly infiltrated by newly formed bone. Bovine bone particle resorption could not be found. The histomorphometric analysis showed the following averages: 29% of newly formed bone and 21% of anorganic bovine bone. The marrow spaces made up the remaining 50% of the specimens. Sinus lift graft with autologous bone harvested from the maxillary lateral wall combined with demineralized bovine bone leads to a predictable outcome regarding the amount of bone formation in sinus floor augmentation.
    Clinical Oral Implants Research 04/2010; 21(4):430-8. DOI:10.1111/j.1600-0501.2009.01877.x · 3.89 Impact Factor
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