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Antonin Simunek
Michal Cierny
Dana Kopecka
Ales Kohout
Josef Bukac
Dagmar Vahalova
The sinus lift with phycogenic bone
substitute
A histomorphometric study
Authors’ affiliations:
Antonin Simunek, Dana Kopecka, Dagmar
Vahalova, Department of Stomatology, Faculty of
Medicine in Hradec Kralove, Charles University in
Prague, Hradec Kralove, Czech Republic
Michal Cierny, Private practice, Zürich,
Switzerland
Ales Kohout, Fingerland Department of Pathology,
Faculty Hospital, Hradec Kralove, Czech Republic
Josef Bukac, Department of Medical Biophysics,
Faculty of Medicine in Hradec Kralove, Charles
University in Prague, Hradec Kralove, Czech
Republic
Key words: Algipore, apatite, dental implants, histomorphometry, osseointegration,
Correspondence to:
Antonin Simunek
Department of Stomatology
Teaching Hospital
500 05 Hradec Kralove
Czech Republic
Tel.: þ 420 495 833 446
Fax: þ 420 495 832 024
e-mail: simunek_antonin@email.cz
placed. The patients were followed for 12–23 months. In intervals of 6, 9, 12, or 15 months
sinus lift
Abstract
Objectives: The aim of this histomorphometric prospective study was to ascertain the
efficacy of phycogenic bone substitute in an augmented sinus. The process of graft healing,
bone remodeling, and biomaterial replacement was examined.
Material and methods: The phycogenic material (fluorohydroxyapatite) made from
calcium-encrusted sea algae was used for the sinus lifts. Twenty-four procedures were
carried out (one-stage and two-stage equally) and 45 titanium stepped-screw implants were
after the sinus lift, 24 graft specimens were taken with a trephine bur. These specimens
were examined histomorphometrically.
Results: The grafting material was gradually resorbed and replaced by newly formed bone.
Between the sixth and 15th month after the sinus lift, the percentage of newly formed
bone grew linearly (from 15.5 9.6% to 40.8 15.3%) and the percentage of bone
substitute decreased linearly (from 34.5 8.6% to 13 9.6%). After 15 months, the
density of trabeculae in grafted bone corresponded to cancellous bone of good quality;
however, the bone substitute was not completely resorbed during this period. No
significant difference between the quality of the newly formed bone in the cases of the
one- and two-stage sinus lifts was found.
Conclusion: Sinus lift carried out with phycogenic bone substitute was shown to be an
effective method with limited invasiveness and a high survival rate of implants (97.8%).
Date:
Accepted 25 April 2004
To cite this article:
Simunek A, Cierny M, Kopecka D, Kohout A, Bukac J,
Vahalova D. The sinus lift with phycogenic bone
substitute. A histomorphometric study.
Clin. Oral Impl. Res. 16, 2005; 342–348
doi: 10.1111/j.1600-0501.2005.01097.x
Copyright r Blackwell Munksgaard 2005
342
Dental implants have achieved a high level
of reliability and a considerable rate of
success (Adell et al. 1990). However, not
all areas of the jaw afford implants equally
favorable anatomical conditions. The best
results are observed in the voluminous,
highly mineralized bone of the interforaminal region of the mandible (Adell et al.
1990). In contrast, the least favorable region is the posterior maxilla, where the
bone is largely cancellous with a low level
of mineralization (McCarthy et al. 2003).
Its height is usually limited by the ex-
tended maxillary sinus. This anatomical
handicap can be overcome with a sinus
lift (Jensen et al. 1998).
Sinus lift was introduced by Boyne in the
1960s and Tatum popularized the operation
(Jensen 1999). Early studies advocated the
use of autogenous bone to ensure graft
survival and bone formation in the augmented space (Xu et al. 2003). However,
its use is restricted by the limited amount
of graft material that can be harvested
intraorally and the need for general anesthesia for bone harvesting from extraoral
Simunek et al . Sinus lift with phycogenic bone substitute
sites (Jakse et al. 2003; Mangano et al.
2003). Donor-site morbidity, bone resorption, and increased hospital costs led to a
search for alternative graft materials, such
as alloplasts (hydroxyapatite, b-tricalciumphosphate, bioactive glass), xenografts
(bovine hydroxyapatite, coralline hydroxyapatite), or allografts (freeze-dried demineralized bone) (Valentini & Abensur 2003;
Xu et al. 2003; Ewers et al. 2004). The
mineralized tissue volume of grafted sinuses has been reported as being relatively
greater than that of native cancellous bone
in the edentulous posterior maxilla, with
mineralized tissue volume of the latter
ranging from 17.1% to 26.7% (Jensen
1999; Fanuscu et al. 2003).
Biomaterials that are used for the reconstruction of bone are non-viable foreign
bodies, which only provide scaffolding for
the formation of new bone (Schopper et al.
2003). Appositional bone growth around
biomaterials can be considered as a result
of a host response. Thus, it is desirable that
biomaterials provide stability until bone
formation has been largely completed and
thereafter become gradually replaced by
vital bone during bone remodeling (Schopper et al. 2003).
The aim of this study was to ascertain
the efficacy of phycogenic bone substitute
in an augmented sinus, as the properties of
this material in connection with sinus
grafting have not been documented in detail till now. The process of graft healing,
bone remodeling, and biomaterial replacement was examined with the help of
histomorphometric methods.
Material and methods
Patient selection
The study was carried out on a group of 24
patients (12 men and 12 women, mean age
47.4 years, range 18–61 years) with a
defect of dentition in the posterior maxilla.
All the patients had a residual sinus floor of
less than 6 mm in height and at least 5 mm
in width. There were no patients with
unsatisfactory oral hygiene, diabetes mellitus or other serious general diseases, coagulopathy, acute maxillary sinusitis, or
those who smoked more than 15 cigarettes
a day. The study was officially approved by
the Helsinki committee, and patients were
informed about their participation in the
study according to the Helsinki declaration
of 1994.
Treatment procedure
From April 2001 to June 2002, 24 sinus
grafting operations were performed, 12
with simultaneous implant placement
(the preoperative height of alveolar bone
was at least 3 mm) and 12 with subsequent
implant placement (the preoperative bone
height did not reach 3 mm). In the case of
the one-stage procedure, the initial healing
period was 9 months. In the case of the
two-stage procedure, the healing time between sinus lift and implant placement
was 6 months. Implants were loaded after
a subsequent 9 months. The sinus lift was
carried out using the window technique
(Artzi et al. 2001). Amoxicillin potentialized by clavulanat (500 mg orally three
times per day) was prescribed for 6 days;
the first dose was administered 2 h before
surgery. In the case of the two-stage procedure, dental implants were placed in the
second stage, after a prophylactic oral dose
of 2.5 g amoxicillin 2 h before surgery.
Tiaprofen acid 300 mg was prescribed three
times daily for pain relief only if needed.
All the surgical procedures were carried out
in the University Hospital (Hradec Kralove, Czech Republic) under local anesthesia in a fully sterile hospital setting.
The phycogenic material Algipore was
used for the sinus lift. Algipore (DENTSPLY Friadent, Mannheim, Germany) is
made from calcium-encrusted sea algae
Corallina officialis (Bieniek 1990; Schumann 1997; Schopper et al. 2003) (Fig. 1).
Biomaterial processing involves pyrolytical
segmentation of the native algae and hydrothermal transformation of the calcium
carbonate (CaCO3) into fluorohydroxyapatite (Ca5(PO4)3OHxF1 x) (Schopper et al.
2003). During this production, the organic
components are completely removed. The
particles of the biomaterial contain a pore
system with the mean diameter of pores
being 10 mm. Every pore is limited by one
layer of small fluorohydroxyapatite crystallites with a size of 25–35 nm (Schopper
et al. 2003). The specific pore volume
averages 0.93 cm3/g (Schopper et al.
2003). The specific surface area reaches
32–50 m2/g, which is caused by its 65%
porosity (Kasperk et al. 1988). Approximately one 2-ml package of Algipore with
Fig. 1. One-stage sinus lift with phycogenic bone
substitute.
grain size 1–2 mm mixed with 0.5 ml of
venous blood was used in each procedure.
Forty-five Frialit-2 implants (DENTSPLY Friadent) in the form of stepped screws
with deep profile surface (DPS) gridblasting and etching were placed in 24
augmented sinuses. Each patient received
from one to three implants (mean 1.9)
with diameters of 3.8, 4.5, or 5.5 mm, and
lengths of 13 or 15 mm. Their stability
was established by Periotest (Siemens
AG, Bensheim, Germany) during the second-stage surgery. Marginal bone loss was
measured to the precision of 0.2 mm using
the long-cone paralleling technique of intraoral radiography carried out during the
second-stage surgery and after 1-year loading. The implants were followed to April
2003; i.e., 12–23 months (mean 16.4
months) after insertion.
Harvesting of the specimens,
histomorphometry
The quality of the newly formed bone was
evaluated on the basis of histomorphometric analysis of biopsy specimens taken
under local anesthesia using a 2 mm internal diameter trephine bur. The trephine
bur was introduced through a short mucosal incision under copious cool saline irrigation. It was directed horizontally from
the oral vestibule to the centre of the graft
at least 3 mm above the supposed bottom
of the alveolar recess. If implants were
present, the bur passed in at least 1 mm
away from the implant. A biopsy specimen
was obtained 6, 9, 12, or 15 months after
343 |
Clin. Oral Impl. Res. 16, 2005 / 342–348
grafting, one from each of the augmented
sinuses. As there were 24 procedures, six
biopsy specimens were harvested at each
time interval, three from both one- and
two-stage operations. Cylindrical specimens were fixed in Burkhardt’s solution,
dehydrated in increasing concentrations of
ethanol, and embedded in methylmetacrylate, without decalcification. After morphological examination, area values for
bone and biomaterial were obtained. Five
subsequent 4-mm-thick sections were cut
with microtome (Jung, Heidelberg, Germany) from each specimen. Three sections
were stained with Giemsa stain and used
for histomorphometric evaluation. The
other two sections were stained with Gömöri and Ladewig stains, respectively, in
order to evaluate qualitative features of the
bone tissue. The quantity of bone and bone
substitute was histomorphometrically
evaluated after digitalization of the light
microscopic picture using the software
LUCIA M, version 3.0 (Laboratory Imaging, Prague, Czech Republic). The percentage of the components of the harvested
tissue (i.e., hard bone tissue, residual bone
substitute, and fibrous tissue) was investigated with respect to the healing period.
The linearity of the dependence was tested
(Draper & Smith 1996) to find out if a
linear regression model is applicable.
Results
All implants were stable at the secondstage surgery; the mean Periotest value
was 2.9 1.5. The mean marginal
bone loss at the second-stage surgery and
after 1-year loading was 0.41 0.33 and
0.92 0.42 mm, respectively. At the end
of the observation period, 44 implants were
loaded without progressive resorption of
marginal bone and without undesirable
clinical symptoms. One implant from a
49-year-old healthy woman failed 4.5
months after loading. The success rate of
the implant placements was 97.8%.
One specimen was taken incorrectly,
missing the grafted area. This is why only
23 specimens were processed. Microscopically, the specimens showed trabeculae of
lamellar cancellous bone, fibrous tissue,
and particles of resorbing bone substitute
with foci of new bone and osteoid formation on its surface (Figs 2–5). The original
host bone was represented by broad regular
trabeculae of lamellar bone. Small irregular
deposits of primitive woven bone and osteoid closely apposed or growing into the
Fig. 2. Ingrowth of osteoid (blue; arrow) into the porous structure of the
phycogenic bone substitute (asterisk). 12 months, Giemsa staining, original
magnification 400.
Fig. 4. A trabecula of mineralized bone (blue) and osteoid (red) on the surface of
phycogenic bone substitute (asterisk). Note ingrowth of the osteoid into porous
structure of substitute material (arrow). 9 months, Ladewig staining, original
magnification 400).
Fig. 3. Mature lamellar bone on the surface of phycogenic bone substitute
(asterisks). 15 months, Gömöri staining, original magnification 400.
Fig. 5. Broad trabeculae of bone with a remnant of unresorbed phycogenic bone
substitute (arrow). 6 months, Giemsa staining, original magnification 200).
344 |
porous substitute material were regarded as
newly formed bone. These areas unequivocally prove the osseoconductive property
of the substitute material. Deposits of the
new bone on the surface of the substitute
material sometimes showed a lamellar pattern similar to ‘creeping apposition’ seen
on the surface of necrotic trabeculae in
bone infarction. Neither inflammatory infiltrate nor foreign body reaction was present. The percentage of bone, the residual
bone substitute, and fibrous tissue in
biopsy specimens is shown in Fig. 6.
The percentage of bone and bone substitute in relation to the healing period is
presented in Tables 1–3 and in Fig. 7. The
regression analysis in which the independent variable is time was used. The use of
the simple linear regression model has been
justified by the test of linearity. This test
indicates that such a model is the right one.
The percentage of bone grows linearly with
respect to time.
The percentage of bone substitute decreases with the healing time. But, according to a one-sample t-test, even after 15
months it is different from zero. Even
though the decrease may be described as
linear, the low coefficient of determination
(0.27) does not allow for any predictions as
to when the resorption of bone substitute
will be completed.
Statistical comparison showed no significant differences between the one- and
two-stage sinus lift.
Fig. 6. Percentage of bone, phycogenic bone substitute, and fibrous tissue in biopsy specimens. O, one-stage
procedure; T, two-stage procedure.
Table 1. Percentage of bone and of phycogenic bone substitute (meanSD) in relation to
the healing period: one- and two-stage procedure
Time (months)
Number of specimens
Bone (%)
Bone substitute (%)
6
6
15.5 9.6
34.5 8.6
9
6
28.2 16.8
22.6 16.4
12
5
34.3 6.9
22.2 16.7
15
6
40.8 15.3
13 9.6
the healing period: one-stage procedure
Time (months)
Number of specimens
Bone (%)
Bone substitute (%)
6
3
20.1 8.6
36.7 12.3
9
3
31.7 16.3
24.6 25.1
12
3
34.8 9.1
21.7 18.2
15
3
51.5 14.1
8.7 6.5
the healing period: two-stage procedure
Time (months)
Number of specimens
Bone (%)
Bone substitute (%)
6
3
10.9 9.5
32.2 4.5
9
3
25 20.2
20.5 5.8
12
2
33.5 5.2
22.9 21.1
15
3
30.2 7
17.3 11.5
Discussion
The usefulness of sinus lift depends on the
grafting material (Wheeler et al. 1996).
Autogenous bone has been documented as
the gold standard (Boyne & James 1980). If
the non-autogenous material is used, the
operation required for harvesting of the
autogenous bone is eliminated. The bone
substitute has to be resorbed and completely replaced with newly formed bone. The
process of restructuring can be evaluated
histomorphometrically. A number of studies have appeared concerning bovine
(Valentini et al. 1998; Landi et al. 2000;
Yildirim et al. 2000; Artzi et al. 2001;
Hallman et al. 2001; Szabó et al. 2001) or
synthetic hydroxyapatite (Artzi et al.
2001), b-tricalciumphosphate (Szabó et al.
2001; Zerbo et al. 2001), freeze-dried
Fig. 7. Percentage of bone and of phycogenic bone substitute in relation to the healing period.
345 |
demineralized bone (Landi et al. 2000), or
bioactive glass (Schepers et al. 1998; Tadjoedin et al. 2000; Cordioli et al. 2001).
Even though results in these publications
were highly variable, it has been proven
that the percentage of bone in the grafting
material during the healing period grows
and the percentage of unresorbed foreign
residue is reduced (Landi et al. 2000). After
6 months, 5.4–44.1% of bone and 7.7–
34.5% of bone substitute (Landi et al.
2000; Tadjoedin et al. 2000; Yildirim
et al. 2000; Szabó et al. 2001), and after
12 months, 28–43.7% of bone and 24.6–
28% of bone substitute were registered
(Valentini et al. 1998; Landi et al. 2000;
Artzi et al. 2001). After 16 months, the
bone formed 45% of the mass, while bone
substitute was completely resorbed in several cases (Tadjoedin et al. 2000).
The general properties of the phycogenic
bone substitute Algipore have been researched by a number of authors. They
state that the granules are vascularized in
the tissue after only a few weeks and are
then gradually resorbed and replaced with
new bone through remodeling. This process is aided by the osseoconductivity of
the material (Kasperk et al. 1988; Feifel
et al. 1995; Schopper et al. 1999). The
doubts about the ability of bone growth
into biomaterial with pore sizes smaller
than 40 mm (Klawitter et al. 1976) were
not verified. The suitability of the Algipore
for sinus grafting was investigated by
Schopper et al. (2003). Their investigation
demonstrated that the use of this biomaterial can trigger appositional bone formation in the maxillary sinuses of severely
atrophic human maxillae even without
additional bone harvesting. The results
also showed that a pore size of 10 mm is
capable of accepting bone growth into the
bone substitute particles. The average
amount of bone that had formed after a
mean healing time of 7 months was 23%.
(Schopper et al. 2003). This is in agreement
with our investigation (15.5 9.6% and
28.2 16.8% after 6 and 9 months, respectively).
A horizontal approach for obtaining
bone samples was preferred over the conventional vertical approach, because the
implants were not always inserted
simultaneously. However, this method is
associated with a higher risk of missing the
grafted area. In all cases, the sections were
346 |
stained with Giemsa, Gömöri, and Ladewig stains. The Giemsa stain was used for
undecalcified methylmetacrylate sections
as a routine staining method because it
gives better results and shows more cytological details than the hematoxylin and
eosin stain. In addition, sections stained
with Giemsa stain excellently show the
structure of the porous substitute material
and are suitable for histomorphometric
evaluation. The Gömöri stain shows the
pattern of collagen fibers in bone trabeculae
and it enables distinguishing the lamellar
and the woven bone, respectively. The
Ladewig stain is necessary to distinguish
the mineralized bone matrix (blue) and the
unmineralized osteoid (red). This staining
method shows ingrowth of osteoid into the
structure of porous substitute material and
the osteoid seams in the mineralized bony
trabeculae.
In this study, the percentage of bone
substitute after 6 months was 34.5%, gradually decreasing over the entire 15-month
period of observation. The last measurement, taken 15 months after the sinus lift,
reached a mean value of 13%. As Fig. 6
shows, an almost complete resorption of
bone substitute in three specimens in a
9-month period or later was recorded. Statistical analysis of the results, however,
leads to the conclusion that even after 15
months the bone substitute is not fully
resorbed and that it is impossible to ascertain when this is going to happen. The
impossibility of predicting this is most
likely caused by major interindividual differences and a non-standard method of
harvesting with the trephine bur. Haessler
et al. (1999) estimate the complete resorption time of Algipore during sinus lift to be
5 years.
With increasing healing time, the percentage of newly formed bone grew linearly. After 15 months of healing, the
percentage of trabeculae was 40.8%, which
corresponds to cancellous bone of good
quality (Trisi & Rao 1999). This points to
a good long-term prognosis for the implant.
In the case of the one-stage procedure,
the newly formed bone was loaded from
the ninth month on, and in the case of the
two-stage lift, only from the fifteenth
month on after the augmentation. It can
be assumed that due to functional loading,
the newly formed bone from the one-stage
surgery will be of better quality than the
bone from the two-stage surgery. This
hypothesis, however, has been rejected
statistically.
Long-term survival of implants in sinus
grafting was studied by Tong et al. (1998).
Using meta-analysis, they evaluated 1149
implants placed 6 months to 5 years previously. The maximum number of failures
was documented during the first 6 months.
Implantation into grafted bone had a success
rate 87–98%, which was higher than that of
the implants placed in the native, lowquality bone of the posterior maxilla. Others
have published similar findings (Wheeler
1997; Lorenzoni et al. 2000; Raghoebar et
al. 2001). The results of the present study, a
97.7% overall survival rate after 12–23
months, support these findings.
Conclusions
Sinus lift carried out with phycogenic bone
substitute and stepped screw dental implants is considered a highly satisfactory
method, which has a limited invasiveness
and high success rate of implants (97.8%,
12–23 months following implant placement). Phycogenic bone substitute is gradually resorbed and replaced by newly
formed bone. During the time period of
6–15 months, the percentage of newly
formed bone grows linearly and the percentage of phycogenic material decreases
linearly. After 15 months, the density of
trabeculae in grafted bone corresponds to
cancellous bone of good quality. Phycogenic bone substitute is not completely
resorbed after 15 months. No significant
difference between the quality of newly
formed bone in the cases of the one-stage
and the two-stage sinus lifts has been
found.
Acknowledgements:
This study was
carried out with the assistance of
DENTSPLY Friadent GmbH, Mannheim,
Germany (No. 062 59 189 408).
Résumé
Le but de cette étude prospective histomorphométrique a été d’analyser l’efficacité d’un substitut
osseux phycogénique lors de l’épaississement sinusal. Les processus de guérison osseuse, de remodelage osseux et du remplacement du biomatériel ont
été examinés. Le matériel phycogénique (fluorohydroxyapatite) fabriqué à partir d’algues maritimes
incrustées de calcium a été utilisé pour ces épaississements sinusaux. Trente-quatre processus ont été
effectués (en une ou deux étapes) et 45 implants vis
en titane ont été placés. Les patients ont été suivis
durant 12 à 23 mois. Dans les intervalles des 6, 9,12
ou 15 mois après l’opération, 24 spécimens de
greffons ont été prélevés à l’aide d’un trépan. Ces
spécimens ont été examinés histomorphométriquement. Le matériel greffé était graduellement résorbé
et remplacé par de l’os néoformé. Entre le sixième et
le quinzième mois, le pourcentage d’os néoformé
augmentait linéairement de 16 10% à
41 15%, et le pourcentage de substitut osseux
diminuait également linéairement de 35 9% à
13 10%. Après quinze mois, la densité des trabécules dans l’os greffé correspondaient à de l’os
spongieux de bonne qualité; cependant le subsitut
osseux n’était pas complètement résorbé durant
cette période. Aucune différence significative de
qualité de l’os néoformé n’a été visible dans les cas
opérés en une étape ou deux. L’épaississement
sinusal effectué avec un substitut osseux phycogénique s’est avéré être une méthode efficace avec peu
d’invasion et un taux de survie important des implants (97,8%).
Zusammenfassung
Ziel: Das Ziel dieser histomorphometrischen Langzeitstudie war, die Nützlichkeit eines phycogenen
Knochenersatzmaterials im damit aufgebauten Sinus zu bestätigen. Man untersuchte die Einheilung
des Transplantates, die Knochenremodellation und
den Abbau des Biomaterials.
Material und Methode: Man verwendete für die
Sinusbodenelevation ein phycogenes Material
(Fluorohydroxyapatite), das aus verkalkten Meeralgen gewonnen worden war. Man führte 24 Operationen durch (je 12 Operationen einphasig und 12
Operationen zweiphasig) und setzte 45 abgestufte
Titanschraubenimplantate ein. Die Nachuntersuchungen fanden 12–23 Monate lang statt. In Intervallen von 6, 9, 12 oder 15 Monaten nach der
Sinusbodenelevation entnahm man den 24 Trans-
plantaten mit einem Trepanbohrer Biopsien. Diese
Präparate untersuchte man histomorphometrisch.
Resultate: Das Transplantationsmaterial wurde
schrittweise resorbiert und mit neugebildetem Knochen ersetzt. Zwischen dem sechsten und fünfzehnten Monat nach der Sinusbodenelevation wuchs
einerseits der Prozentsatz von neu gebildetem
Knochen linear an (von 15.5 9.6% auf
40.8 15.3%) und der Prozentsatz des Knochenersatzmaterials nahm andererseits linear ab (von
34.5 8.6% auf 13 9.6%). Nach 15 Monaten
entsprach die Dichte der Knochenbälkchen im augmentierten Knochen einem spongiösen Knochen
von guter Qualität; das Knochenersatzmaterial war
aber in dieser Zeitspanne noch nicht vollständig
resorbiert worden. Zudem fand man keine statistisch signifikanten Unterschiede zwischen der Knochenqualität des neugebildeten Knochens bei einer
einphasigen und bei einer zweiphasigen Sinusbodenelevation.
Zusammenfassung: Die mit Hilfe eines phycogenen Knochenersatzmaterials durchgeführte Sinusbodenelevation erwies sich als effiziente Methode
mit geringer Invasivität und hoher Überlebensrate
für die Implantate (97.8%).
Entre el sexto y el decimoquinto mes tras la elevación
del seno, el porcentaje de hueso neoformado creció
linealmente (desde 15.5 9.6% hasta 40.8 15.3%) y el porcentaje de sustituto óseo decreció
linealmente (desde 34.5 8.6% hasta 13 9.6%).
Tras 15 meses, la densidad de las trabéculas en el
hueso injertado correspondı́an a las de hueso esponjoso de buena calidad; de todos modos el sustituto
óseo no fue completamente reabsorbido durante este
periodo. No se encontraron diferencias significativas
entre la calidad del hueso neoformado en los casos de
una sola fase y los de dos fases de elevación del seno.
Conclusión: La elevación del seno llevada a cabo
con sustituto óseo ficogénico demostró ser un método efectivo con invasividad limitada y un alto
ı́ndice de supervivencia de los implantes (97.8%).
Resumen
Objetivos: La intención de este estudio histomorfométrico prospectivo fue determinar la eficacia de
sustituto óseo ficogénico en el seno aumentado. Se
examinó el proceso de cicatrización, remodelado
óseo y reemplazo del biomaterial.
Material y Métodos: El material ficogénico
(fluorohydroxyapatita) hecho de algas marinas incrustadas con calcio se uso para la elevación del seno.
Se llevaron a cabo veinticuatro procedimientos (una
fase y dos fases igualmente) y se colocaron 45
implantes roscados. Los pacientes se siguieron durante 12–23 meses. En intervalos de 6, 9, 12 o 15
meses tras la elevación del seno se tomaron 24
biopsias con un trépano. Los especimenes se examinaron histomorfometricamente.
Resultados: El material de injerto se reabsorbió gradualmente y se reemplazó por un hueso neoformado.
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