Bioactive glass added to autogenous bone graft in maxillary sinus augmentation: a prospective histomorphometric, immunohistochemical, and bone graft resorption assessment

Abstract Objective The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. Material and Methods A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. Conclusions The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.

摘要 研究目的：本研究旨在对比生物活性玻璃（bioactive glass，Biogran；Biomet，美国印第安纳州华沙市）与自体骨移植（autogenous bone graft）按1:1混合，以及单纯自体骨移植，在上颌窦提升术中的骨吸收速率、组织形态计量学及免疫组织化学结果。
材料与方法：本研究共纳入9个接受上颌窦提升术的上颌窦，采用Biogran联合自体骨移植进行修复（组1），另12个上颌窦采用单纯自体骨移植修复（组2）。术后15天（T1）行锥形束计算机断层扫描（cone beam computed tomography，CBCT）以测量移植骨初始体积；术后6个月再次行CBCT扫描，评估移植骨最终体积（T2）并计算骨吸收速率。组1的骨吸收速率为37.9%±18.9%，组2为45.7%±18.5%（P=0.82）。术后6个月，在植入牙科种植体的同时获取活检样本，对样本进行组织形态计量学分析及抗酒石酸酸性磷酸酶（tartrate-resistant acid phosphatase，TRAP）免疫组织化学分析。
结果：组1的天然骨区域平均新骨形成率为36.6%±12.9%，中间区域为33.2%±13.3%，根尖区域为45.8%±13.8%；组2在天然骨、中间及根尖区域的新骨形成率分别为34.4%±14.4%、35.0%±13.9%及42.0%±16.6%。TRAP免疫染色显示两组的破骨活性均较弱，提示样本处于骨重塑阶段。
结论：两组术后6个月的移植骨体积形成与维持情况相似，表明按1:1比例混合的生物活性玻璃与自体骨可安全用作上颌窦提升术的骨替代材料。