The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study

Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

摘要
研究目的：本研究旨在评估5种不同骨替代材料用于上颌窦骨增量术后的新生骨、结缔组织形成情况及残留生物材料状态。本研究通过骨钙素免疫标记（osteocalcin immunolabeling）技术，验证新生骨的钙化程度及患者接受牙科种植体的可行性。

研究方法：本研究纳入40例行上颌窦骨增量术的患者，将其分为5组：第1组共8个上颌窦，采用自体骨移植（autogenous bone graft, AB）植骨；第2组共8个上颌窦，采用生物活性玻璃（bioactive glass, BG）植骨；第3组共8个上颌窦，采用1:1比例混合的生物活性玻璃与自体骨移植材料（BG + AB）植骨；第4组共8个上颌窦，采用Bio-Oss（BO）植骨；第5组共8个上颌窦，采用1:1比例混合的Bio-Oss与自体骨移植材料（BO + AB）植骨。

研究结果：自体骨移植组中，原骨区域骨形成率为37.8%，中间区域为38.1%，根尖区域为44.5%。生物活性玻璃组原骨区域骨形成率为43.6%，中间区域为37%，根尖区域为49.3%。1:1混合生物活性玻璃与自体骨组原骨区域骨形成率为39.0%，中间区域为34.8%，根尖区域为36.8%。Bio-Oss组原骨区域骨形成率为33.4%，中间区域为32.5%，根尖区域为34.3%。1:1混合Bio-Oss与自体骨组原骨区域骨形成率为32.8%，中间区域为36.1%，根尖区域为27.8%。骨钙素免疫标记结果显示，所有组别均呈现强阳性染色，证实了新生骨的钙化情况。

研究结论：本研究结果表明，术后6个月骨愈合完成后，所有受试组均可在上颌窦重建区域形成合格的板层骨，因此可满足牙科种植体植入的适应证要求。