Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
Patient (N)
Gender/age
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient (N)
Gender/age)
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient
Gender/age
Implant site
T0
T1
Increase
...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH. Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations. J Biomed Mater Res. 1999;48:393–402.
Schulten EAJM, Prins HJ, Overman JR, Helder MN, ten Bruggenkate CM, Klein-Nulend JA. Novel approach revealing the effect of collagenous membrane on osteoconduction in ...
Schopper C, Ziya-Ghazvini F, Goriwoda W, Moser D, Wanschitz F, Spassova E, Lagogiannis G, Auterith A, Ewers R. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation—a long-term histological study. J Biomed Mater Res B Appl Biomater. 2005;74:458–67.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Strauma...
Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg. 1996;25:268–71.
Vermeeren JIJF, Wismeijer D, van Waas MAJ. One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants: a 5-year follow-up. Int J Oral Maxillofac Surg. 1996;2:112–5.
Nkenke E, Stel...
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30:207–29.
Del Fabbro M, Rosano G, Taschieri S. Implant survival rates after maxillary sinus augmentation. Eur J Oral Sci. 2008;116:497–506.
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12 months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (μm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9 months after MSFE and five patients underwent dental implant surgery 12 months after MSFE. In the 9-month group (three men and two women), the average age was 56.6 years (range 40 to 64 years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3 years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
Patient (N)
Gender/age
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient (N)
Gender/age)
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient
Gender/age
Implant site
T0
T1
Increase
...
Patient
Gender/age
Implant site
T0
T1
Increase
...
Bouwman, W.F., Bravenboer, N., Frenken, J.W.F.H. et al. The use of a biphasic calcium phosphate in a maxillary sinus floor elevation procedure: a clinical, radiological, histological, and histomorphometric evaluation with 9- and 12-month healing times.
Int J Implant Dent 3, 34 (2017). https://doi.org/10.1186/s40729-017-0099-x
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Received: 22 May 2017
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH. Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations. J Biomed Mater Res. 1999;48:393–402.
Schulten EAJM, Prins HJ, Overman JR, Helder MN, ten Bruggenkate CM, Klein-Nulend JA. Novel approach revealing the effect of collagenous membrane on osteoconduction in ...
Schopper C, Ziya-Ghazvini F, Goriwoda W, Moser D, Wanschitz F, Spassova E, Lagogiannis G, Auterith A, Ewers R. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation—a long-term histological study. J Biomed Mater Res B Appl Biomater. 2005;74:458–67.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Strauma...
Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg. 1996;25:268–71.
Vermeeren JIJF, Wismeijer D, van Waas MAJ. One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants: a 5-year follow-up. Int J Oral Maxillofac Surg. 1996;2:112–5.
Nkenke E, Stel...
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30:207–29.
Del Fabbro M, Rosano G, Taschieri S. Implant survival rates after maxillary sinus augmentation. Eur J Oral Sci. 2008;116:497–506.
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12 months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (μm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9 months after MSFE and five patients underwent dental implant surgery 12 months after MSFE. In the 9-month group (three men and two women), the average age was 56.6 years (range 40 to 64 years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3 years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...