Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
Clin Oral Implants Res. 2010 Feb;21(2):201-8. doi: 10.1111/j.1600-0501.2009.01821.x. Epub 2009 Dec 4.
In this study, we evaluated the quality and quantity of bone formation in maxillary sinus floor elevation procedure using a new fully synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60% hydroxyapatite and 40% of beta-tricalcium phosphate (Straumann Bone Ceramic).
A unilateral maxillary sinus floor elevation procedure was performed in six patients using 100% BCP. Biopsy retrieval for histological and histomorphometric analysis was carried out before implant placement after a 6-month healing period.
In this study, the maxillary sinus floor elevation procedure with the use of BCP showed uneventful healing. Radiological evaluation after 6 months showed maintenance of vertical height gained immediately after surgery. Primary stability was achieved with all Straumann SLA dental implants of 4.1 mm diameter and 10 or 12 mm length. The implants appeared to be osseointegrated well after a 3-month healing period. Histological investigation showed no signs of inflammation. Cranial from the native alveolar bone, newly formed mineralized tissue was observed. Also, osteoid islands as well as connective tissue were seen around the BCP particles, cranial from the front of newly formed mineralized tissue. Close bone-to-substitute contact was observed. Histomorphometric analysis showed an average bone volume/total volume (BV/TV) of 27.3% [standard deviation (SD) 4.9], bone surface/total volume (BS/TV) 4.5 mm(2)/mm(3) (SD 1.1), trabecula-thickness (TbTh) 132.1 mum (SD 38.4), osteoid-volume/bone volume (OV/BV) 7.5% (SD 4.3), osteoid surface/bone surface (OS/BS) 41.3% (SD 28.5), osteoid thickness (O.Th) 13.3 mum (SD 4.7) and number of osteoclasts/total area (N.Oc/Tar) 4.4 1/mm (SD 5.7).
Although a small number of patients were treated, this study provides radiological and histological evidence in humans confirming the suitability of this new BCP for vertical augmentation of the atrophied maxilla by means of a maxillary sinus floor elevation procedure allowing subsequent dental implant placement after a 6-month healing period. The newly formed bone had a trabecular structure and was in intimate contact with the substitute material, outlining the osteoconductive properties of the BCP material. Bone maturation was evident by the presence of lamellar bone.
本研究采用一种新型全合成双相磷酸钙（BCP），由 60%羟基磷灰石和 40%β-磷酸三钙（Straumann Bone Ceramic）组成，评估上颌窦底提升术中骨形成的质量和数量。
在 6 名患者中单侧上颌窦底提升术，100%BCP 应用。在 6 个月愈合期后植入前，进行活检以进行组织学和组织形态计量学分析。
本研究中，BCP 上颌窦底提升术愈合顺利。6 个月后的放射学评估显示，术后即刻获得的垂直高度得到维持。所有直径为 4.1mm、长度为 10 或 12mm 的 Straumann SLA 牙科植入物均实现了初始稳定性。植入物在 3 个月的愈合期后似乎已很好地骨整合。组织学研究未发现炎症迹象。在新形成的矿化组织前方，观察到源自天然牙槽骨的颅侧有新形成的矿化组织。此外，在 BCP 颗粒前方，在新形成的矿化组织前方，观察到类骨质岛和结缔组织。观察到紧密的骨-替代物接触。组织形态计量学分析显示，平均骨体积/总体积（BV/TV）为 27.3%[标准偏差（SD）为 4.9]，骨表面/总体积（BS/TV）为 4.5mm²/mm³（SD 为 1.1），小梁厚度（TbTh）为 132.1μm（SD 为 38.4），类骨质体积/骨体积（OV/BV）为 7.5%（SD 为 4.3），类骨质表面/骨表面（OS/BS）为 41.3%（SD 为 28.5），类骨质厚度（O.Th）为 13.3μm（SD 为 4.7），破骨细胞总数/总面积（N.Oc/Tar）为 4.4 1/mm²（SD 为 5.7）。
尽管仅治疗了少数患者，但本研究在人类中提供了影像学和组织学证据，证实了这种新型 BCP 适合通过上颌窦底提升术垂直增加萎缩的上颌骨，从而允许在 6 个月的愈合期后进行随后的牙科植入物放置。新形成的骨具有小梁结构，与替代材料紧密接触，概述了 BCP 材料的骨传导特性。通过板层骨的存在证实了骨成熟。
