title: Anorganic bovine bone (ABB) vs. autologous bone (AB) plus ABB in maxillary sinus grafting. A prospective non-randomized clinical and histomorphometrical trial.
abstract: OBJECTIVE
  This investigation focused on histological characteristics and 5-year implant survival after sinus floor augmentation with anorganic bovine bone (ABB, Bio-Oss) and ABB plus autologous bone (AB) with a ratio of 1/1.
  
  
  METHODS
  Nineteen consecutive patients with bony atrophy of the posterior edentulous maxilla and a vertical bone height ≤4 mm were prospectively included in this study. In the first surgical stage, the maxillary sinus was non-randomized either augmented with ABB alone (n = 12) or a 1/1 mixture of ABB and AB (n = 7). After a mean healing period of 167 days, biopsies were harvested in the region of the grafted sinus with a trephine burr and implants were placed simultaneously, ABB n = 18 and ABB + AB n = 12. The samples were microradiographically and histomorphometrically analyzed judging the newly formed bone (bone volume, BV), residual bone substitute material volume (BSMV), and intertrabecular volume (soft tissue volume, ITV) in the region of the augmented maxillary sinus. Implant survival was retrospectively evaluated from patient's records.
  
  
  RESULTS
  No significant difference in residual bone substitute material (BSMV) in the ABB group (31.21 ± 7.74%) and the group with the mixture of ABB and AB (28.41 ± 8.43%) was histomorphologically determined. Concerning the de novo bone formation, also both groups showed statistically insignificant outcomes; ABB 26.02 ± 5.23% and ABB + AB 27.50 ± 6.31%. In all cases, implants were installed in the augmented sites with sufficient primary stability. After a mean time in function of 5 years and 2 months, implant survival was 93.75% in the ABB and 92.86% in the ABB + AB group with no statistically significant differences.
  
  
  CONCLUSIONS
  The usage of ABB plus AB to a 1/1 ratio leads to an amount of newly formed bone comparable with the solitary use of ABB after grafting of the maxillary sinus. Considering that ABB is a non-resorbable bone substitute, it can be hypothesized that this leads to stable bone over time and long-term implant success. Importantly, in the sole use of ABB, bone grafting and therefore donor site morbidities can be avoided.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Schmitt
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Tobias
authors.identifier: http://orcid.org/0000-0002-3763-3122
authors.initials: T
authors.lastname: Moest
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Rainer
authors.identifier: http://orcid.org/0000-0003-0199-9437
authors.initials: R
authors.lastname: Lutz
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Neukam
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Karl Andreas
authors.initials: KA
authors.lastname: Schlegel
mesh_terms: D000328:Adult; D000818:Animals; D016025:Bone Transplantation / Q000379:methods*; D002417:Cattle; D005260:Female; D005416:Flavivirus; D005500:Follow-Up Studies; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D059546:Sinus Floor Augmentation / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*; D014183:Transplantation, Heterologous / Q000379:methods*; D016896:Treatment Outcome; D014780:Viruses
keywords: AB; ABB; Bio-Oss; anorganic bovine bone; augmentation; autologous bone; bone graft; bone regeneration; bone substitute material; dental implants; sinus floor elevation