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Histomorphometric analysis of regenerated bone in sinus lift by deproteinized bovine bone particles
EAO Online Library. DANIELE D. Oct 9, 2018; 232491; P- PB- 38
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Sinus grafting is a predictable surgical procedure for the rehabilitation of the edentulous posterior maxilla. Several biomaterials have been proposed to achieve new bone formation. Although autologous bone grafts still represent the gold standard in bone augmentation procedures, heterologous bone substitutes are successfully used to overcome the limited availability of autologous tissue, reduce morbidity, operating time and cost.The aim of this study is to histologically evaluate the bone tissue response to a new heterologous bone graft material (creos xenogain) at four different follow-up times (7, 11, 13, 15 months), to better understand the quality of newly formed bone during the regeneration process.Sinus floor elevation with deproteinized bovine bone particles was performed using a lateral approach. A resorbable non-cross-linked collagen membrane (creos xenoprotect) was placed to prevent the migration of undesired soft tissues into the bone augmentation site. After the approval by ethics committee, a biopsy was taken from each patient 7, 11, 13 and 15 months after surgery. A trephine bur was used to harvest cylindric bone cores with same dimensions (2 mm diameter, 6 mm height). Biopsies were dehydrated in ascending grades of ethanol and embedded in Technovit 7200 VLC. 60 micron thick ground sections were prepared according to the Donath and Breuner technique, stained with RBS and counterstained with acid fuchsin. Histological and histomorphometric analysis were performed using light microscopy. A semi-automated method was selected to measure the surfaces of newly formed bone, residual graft particles and connective tissue. Average percentages were calculated from collected data.Good healing responses were obtained for during an average follow-up period of 17,4 months. The resorbable collagen membrane wasn’t exposed at any location. Implants placed into the regenerated bone exhibited success and survival rates of 100%. Overviews of bone cores revealed well-structured augmented areas with graft particles embedded in compact bone. Light micrographs showed intimate and gapless bone-to-graft contact. Graft particles surfaces served as conducting track for the newly formed bone, which interconnected the apatite particles. The rate of new bone formation was 33,3% (measured values ranged between 39,9% and 28,3%). An average 34,9% of xenogenic biomaterial was measured. 11 months after sinus surgery the percentage of graft particles was still 38,4%, indicating that resorption processes occurred slowly. Graft particles acted as spacer for the newly forming bone. Connective tissue occupied an average 31,8% of measured fields and was composed mainly by bone marrow.The histologically observed integration of deproteinized bovine bone particles (creos xenogain) and the good clinical results support bovine apatite as valid bone substitute where sinus floor elevation precedes implant insertion. Bovine apatite acts as spacer and conducting structure for the new bone formation. Mesenchymal stem cells, osteoblasts and capillaries are able to enter the macropores of the xenograft particles, promoting the healing process.
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