title: On the Early Mechanisms of Bone Formation after Maxillary Sinus Membrane Elevation: An Experimental Histological and Immunohistochemical Study.
abstract: BACKGROUND
  Previous studies have shown predictable bone formation in the maxillary sinus after membrane elevation. However, how and where the bone is formed is not well understood.
  
  
  OBJECTIVE
  The aim of the study was to histologically and immunohistochemically study the early bone formation events in primates after membrane elevation in the maxillary sinus.
  
  
  METHODS
  Nine adult male tufted capuchin primates (Cebus apella) were included in the study. Eight animals were subjected to bilateral maxillary sinus membrane elevation using a lateral replaceable bone window technique. One oxidized dental implant was placed into the maxillary sinus cavity on both sides. In four animals, one sinus was left without any additional treatment, whereas the contralateral sinus was filled with autologous bone grafts from the tibia. In two animals, the implants were inserted under the elevated sinus membrane on both sides. In two animals, the sinus membrane was totally removed. The animals were euthanized after 10 or 45 days. One nonoperated animal representing pristine tissue conditions served as control. The maxillary sinuses with implants were retrieved and further processed for light microscopic ground sections or decalcified sections for immune-histochemical analyses.
  
  
  RESULTS
  Bone formation started from the bottom of the sinus floor, sprouting into the granulation tissue along the implant surface under the elevated membrane irrespective of time and surgical technique. Bone formation was not seen in direct conjunction with the sinus membrane. A distinct expression of osteopontin was observed in the serous glands of the lamina propria close to the implant within all groups.
  
  
  CONCLUSIONS
  Bone formation after sinus membrane elevation with or without additional bone grafts starts at the sinus floor and sprouts into the elevated space along the implant surface. The sinus membrane does not seem to present osteoinductive potential in sinus membrane elevation procedures in this study.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Oral and Maxillofacial Surgery, Umeå University, Umeå, Sweden.
authors.forename: Måns
authors.initials: M
authors.lastname: Jungner
authors.affiliation: Department of Oral and Maxillofacial Surgery, Umeå University, Umeå, Sweden.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cricchio
authors.affiliation: Department of Oral & Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Salata
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Sennerby
authors.affiliation: Department of Oral and Maxillofacial Surgery, Umeå University, Umeå, Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Lundqvist
authors.affiliation: Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Malou
authors.initials: M
authors.lastname: Hultcrantz
authors.affiliation: Department of Oral and Maxillofacial Surgery, Umeå University, Umeå, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lundgren
mesh_terms: D000818:Animals; D016025:Bone Transplantation; D002428:Cebus; D015921:Dental Implants; D007150:Immunohistochemistry; D008297:Male; D023421:Models, Animal; D010012:Osteogenesis / Q000502:physiology*; D059546:Sinus Floor Augmentation / Q000379:methods*; D013977:Tibia / Q000637:transplantation
chemical_list: D015921:Dental Implants
keywords: CD68; bone formation; dental implants; macrophages; osteocalcin; osteopontin; sinus membrane elevation