Maxillary Sinus Floor Elevation Surgery With BioOss Mixed With Enamel Matrix Derivative: A Human Randomized Controlled Clinical and Histologic Study
Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.
Preoperative views of patient 3 before total maxillary extraction and placement of a removable total denture. (a) Preoperative panoramic scan showing maxillary molar regions before teeth extraction. (b) Preoperative clinical view after removing teeth 2, 3, 12, 13, 14, and 15.
Figure 2. Cone beam computerized tomography of patient 3 scans shows the atrophic maxillary sinuses requiring the bilateral sinus floor elevation procedure. (a) View of the upper left side (tooth 14 extraction site). (b) View of the upper right side (tooth 3 extraction site). Figure 3. Six months after bilateral sinus lift procedures in patient 3, cone beam computerized tomography scans shows the augmentation of the vertical bone height. (a) View of the upper right side (tooth 3 extraction site). (b) View of the upper left side (tooth 14 extraction site).
Final restoration view in patient 3 showing fixed implant-supported prostheses in place and healed gingiva.
Histologic images of test and control groups. (a) Overview histologic slice of bone core within the trephine taken from a test site (+enamel matrix derivative) showing graft material remnants (black arrows) and the presence of a frank and mature new bone formation. Magnification, ×4. (b) Higher magnification of view a showing the new bone formation (*) around and in close contact to the deproteinized bovine bone mineral (DBBM) particles. Magnification, ×10. (c) Overview histologic slice of bone core within the trephine taken from a control site (DBBM alone) showing significantly less new bone formation compared with the test group. Magnification, ×4. (d) Higher magnification of view c showing the new bone formation (*) around and in close contact to the DBBM particles. Magnification, ×10.
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