Porcine bone used in sinus augmentation procedures: a 5-year retrospective clinical evaluation.
ABSTRACT Rehabilitation of the edentulous posterior maxilla with dental implants often represents a clinical challenge because of the insufficient bone volume resulting from pneumatization of the maxillary sinus and crestal bone resorption. The aim of this study was a retrospective clinical evaluation of maxillary sinus augmentation using porcine bone.
One hundred twenty-one healthy patients with a noncontributory medical history were included in this study. All patients underwent sinus augmentation procedures with porcine bone. After a 4- to 6-month healing period, sandblasted and acid-etched implants were inserted.
All grafted sinuses healed without major complications, except for 2 that showed no regeneration at the time of implant placement. A total of 21 implants were lost, 8 after the second-stage surgery and 13 in the 5 years' follow-up after loading. The cumulative survival rate was 92% after a mean loading time of 5 years. Only minor peri-implant marginal bone resorption was found.
Within the limitations of this study, porcine bone can be used with success in sinus augmentation procedures, and rougher-surfaced implants are probably preferable.
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ABSTRACT: The purpose of the present study was the histologic and ultrastructural evaluation of a biomaterial composed of cortical pig bone in the form of granules. After maxillary sinus augmentation using this biomaterial, 10 specimens were retrieved after 5 months in 10 patients using this biomaterial. The specimens were processed to be observed under light microscopy (LM) and transmission electron microscopy (TEM). Histomorphometric measurements were presented by means +/- standard deviations. LM showed that most of the particles were surrounded by newly formed bone. In some areas, the osteoid matrix was present; however, mainly compact bone was present at the interface. There was no evidence of an acute inflammatory infiltrate. The newly formed bone was 36% +/- 2.8% and marrow spaces were 38% +/- 1.6%, whereas residual grafted material was 31% +/- 1.6%. Under TEM, all phases of bone formation (osteoid matrix, woven, and lamellar bone) were observed in proximity with the biomaterial particles. The bone-biomaterial interface showed a close contact between the porcine bone particles and the surrounding bone that had mainly features of mature bone with numerous osteocytes. A lamina limitans was sometimes present at this interface. According to our knowledge, this is the first study presenting data on TEM of a porcine bone-derived biomaterial used in sinus augmentation procedures in humans. Our findings show that this is a biocompatible biomaterial that can be used for maxillary sinus augmentation procedures without interfering with the normal reparative bone processes.Journal of Periodontology 01/2007; 77(12):1984-90. · 2.40 Impact Factor
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ABSTRACT: The reconstruction of edentulous patients with adequate bone volume and density by using dental implants has become a viable treatment option with high predictability. However, initial stabilization is difficult to achieve in the posterior maxillary regions where cortical bone is thin or absent due to severely resorbed alveolar ridges. Maxillary sinus lift procedures applied with various grafting materials enable clinicians to place implant-supported prostheses even in cases with increased pneumatization of the maxillary sinus. The purpose of this study was to evaluate histologically and clinically different grafting materials used in maxillary sinus floor augmentation. Deproteinized bovine bone granules (DBBG), demineralized freeze-dried bone powder (DFBP), and porous hydroxyapatite (PHA) were used as grafting materials. A total of 19 implants in 8 patients were placed into grafted sites. In 3 patients, a 2-stage approach was used wherein implants were inserted after a 6-month healing period following a sinus lift procedure. Specimens were taken with a trephine drill, and the site of the specimen was enlarged to accept an implant. For the remaining cases, a 1-stage approach, which included sinus lifting and implant placement, was used and bone biopsies were taken during the uncovering stage. After 6 months of healing, fixed prosthetic restorations were fabricated. The healing period progressed without any complications, and all implants were loaded. The mean functioning time was 12 months, varying from 9 to 24 months. The results indicate that DFBP resorbs earlier than PHA and DBBG in sinus lift procedures.Journal of Periodontology 11/2001; 72(10):1436-42. · 2.40 Impact Factor
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ABSTRACT: Based on a systematic review of the literature from 1986 to 2002, this study sought to determine the survival rate of root-form dental implants placed in the grafted maxillary sinus. Secondary goals were to determine the effects of graft material, implant surface characteristics, and simultaneous versus delayed placement on survival rate. A search of the main electronic databases was performed in addition to a hand search of the most relevant journals. All relevant articles were screened according to specific inclusion criteria. Selected papers were reviewed for data extraction. The search yielded 252 articles applicable to sinus grafts associated with implant treatment. Of these, 39 met the inclusion criteria for qualitative data analysis. Only 3 of the articles were randomized controlled trials. The overall implant survival rate for the 39 included studies was 91.49%. The database included 6,913 implants placed in 2,046 subjects with loaded follow-up time ranging from 12 to 75 months. Implant survival was 87.70% with grafts of 100% autogenous bone, 94.88% when combining autogenous bone with various bone substitutes, and 95.98% with bone grafts consisting of bone substitutes alone. The survival rate for implants having smooth and rough surfaces was 85.64% and 95.98%, respectively. Simultaneous and delayed procedures displayed similar survival rates of 92.17% and 92.93%, respectively. When implants are placed in grafted maxillary sinuses, the performance of rough implants is superior to that of smooth implants. Bone-substitute materials are as effective as autogenous bone when used alone or in combination with autogenous bone. Studies using a split-mouth design with one variable are needed to further validate the findings.The International journal of periodontics & restorative dentistry 01/2005; 24(6):565-77. · 1.08 Impact Factor