Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Chulalongkorn University, Bangkok, Thailand.
Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
Clin Implant Dent Relat Res. 2022 Jun;24(3):361-371. doi: 10.1111/cid.13083. Epub 2022 Mar 23.
The effect of different deproteinized bovine bone mineral (DBBM) particle sizes on bone healing in maxillary sinus floor augmentation remains unclear. This study compared the newly formed tissue and angiogenesis-related bone healing after sinus floor augmentation using large or small DBBM particles.
Overall 32 patients were randomly divided into two groups using either large (1-2 mm) or small (0.25-1 mm) DBBM particles for sinus floor augmentation. After 6 months, the mineralized tissue volume was calculated using micro-computed tomography (micro-CT) analysis. The newly formed tissue composition was histomorphometrically analyzed. Angiogenesis was also examined by means of vascular endothelial growth factor (VEGF) expression. Implant failure and marginal bone loss were measured at a 1-year follow-up. Statistical analysis was performed using independent samples t-test.
Micro-CT analysis demonstrated that grafting with large particles resulted in higher bone volume (6.99 ± 2.72 mm , p = 0.002) and Bone Volume/Tissue Volume (0.25 ± 0.1, p = 0.03) compared with small particles (3.76 ± 1.83 mm and 0.14 ± 0.13, respectively). Small particles showed higher non-mineralized tissue volume (26.31 mm ) compared with large particle group (17.4 ± 5.34 mm ) with p = 0.001. The histological data revealed significantly higher area of newly formed bone (32.15% ± 14.04% for the large particle and 15.99% ± 14.12% for the small particle groups, p = 0.004). Likewise, non-mineralized tissue was significantly greater in the small particle group (66.48% ± 20.97%) compared with the large particle group (44.36%, p = 0.016). Moreover, use of large particles resulted in a significantly higher VEGF staining intensity score and VEFG positive cells. No implant failure was recorded in both groups, while no difference was found in terms of marginal bone loss at the 1-year follow-up.
Sinus floor augmentation using large DBBM particles resulted in more angiogenesis expression, higher bone volume, and new bone formation at 6 months after sinus augmentation. However, clinical outcomes with regards to implant placement were similar in both groups.
不同脱蛋白牛骨矿物质（DBBM）颗粒大小对上颌窦底提升后骨愈合的影响尚不清楚。本研究比较了大、小 DBBM 颗粒在上颌窦底提升后新形成组织和与血管生成相关的骨愈合情况。
将 32 名患者总体随机分为两组，分别使用大（1-2mm）或小（0.25-1mm）DBBM 颗粒进行窦底提升。6 个月后，采用微计算机断层扫描（micro-CT）分析计算矿化组织体积。通过组织形态计量学分析新形成组织的组成。通过血管内皮生长因子（VEGF）的表达来检测血管生成。在 1 年随访时测量种植体失败和边缘骨丢失情况。采用独立样本 t 检验进行统计学分析。
micro-CT 分析表明，与小颗粒（6.99±2.72mm，p=0.002）相比，大颗粒组的骨体积（6.99±2.72mm）和骨体积/组织体积（0.25±0.1）更高（0.25±0.1）。与大颗粒组（17.4±5.34mm）相比，小颗粒组的非矿化组织体积（26.31mm）更高（26.31mm），差异有统计学意义（p=0.001）。组织学数据显示，大颗粒组新骨形成面积显著高于小颗粒组（32.15%±14.04%和 15.99%±14.12%，p=0.004）。同样，小颗粒组的非矿化组织也明显高于大颗粒组（66.48%±20.97%和 44.36%，p=0.016）。此外，大颗粒组的 VEGF 染色强度评分和 VEGF 阳性细胞明显更高。两组均未发生种植体失败，1 年随访时边缘骨丢失无差异。
在上颌窦底提升中使用大 DBBM 颗粒可在窦底提升后 6 个月时产生更高的血管生成表达、更高的骨体积和更多的新骨形成。然而，两组在种植体植入方面的临床结果相似。
