MAXILLARY SINUS AUGMENTATION WITH A SYNTHETIC CELL-BINDING PEPTIDE: HISTOLOGICAL AND HISTOMORPHOMETRICAL RESULTS IN HUMANS

MAXILLARY SINUS AUGMENTATION WITH A SYNTHETIC CELL-BINDING PEPTIDE: HISTOLOGICAL AND HISTOMORPHOMETRICAL RESULTS IN HUMANS
November 6, 2004
By Marco Degidi, MD, DDS, Maurizio Piattelli, MD, DDS, Antonio Scarano, DDS, Giovanna Iezzi, DDS, Adriano Piattelli, MD, DDS
Journal of Oral Implantology
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Abstract
Bone substitutes should be used when sufficient amounts of autologous bone cannot be harvested from intraoral donor sites. P-15 is a highly conserved linear peptide with a 15 amino acid sequence identical to the sequence contained in the residues 766 to 780 of the alpha-chain of type I collagen. PepGen P-15 (Dentsply Friadent, Mannheim, Germany) is a combination of the mineral component of bovine bone (Osteograf/N 300) with P-15. Bio-Oss (Geistlich, Mannheim, Germany) is a deproteinized sterilized bovine bone with 75% to 80% porosity and a crystal size of approximately 10 ¨µm in the form of cortical granules. The purpose of the present histological and histomorphometrical study was to compare maxillary sinus augmentation procedures in humans performed with PepGen P-15 with procedures associated with Bio-Oss and autologous bone. Seven patients participated in this study (3 men and 4 women; ages between 48 and 69 years, mean of 58 years) and were categorized into 3 groups. In group 1, a mixture of 50% autologous bone from an intraoral source and 50% Bio-Oss was used. In group 2, the graft materials used were 50% Bio-Oss and 50% PepGen P-15. In group 3, 50% autologous bone and 50% PepGen P-15 were used. Group 1 histomorphometry showed that the percentage of newly formed bone was 38.7% ¨± 3.2%, marrow spaces represented 45.6% ¨± 5%, and residual graft particles constituted the remaining 14.4% ¨± 2.1%. Group 2 histomorphometry showed that newly formed bone represented 36.7% ¨± 3.3%, marrow spaces represented 39.7% ¨± 3.4%, and residual graft particles represented 19.6% ¨± 2.1%. In group 3, newly formed bone represented 32.2% ¨± 3.2%, marrow spaces represented 38% ¨± 2.5%, and residual graft particles represented 28.8% ¨± 1.1%. Nonstatistically significant differences were found in the percentage of newly formed bone in the different groups (P = .360). Statistically significant differences were found in the percentage of residual graft materials among the different groups (group 1 vs groups 2 and 3) (P = .0001). These data demonstrate that the use of bone-replacement materials, without the addition of autologous bone, could be an alternative in sinus augmentation procedures. Such treatment would increase patient satisfaction, decrease surgical complications, and save the clinician substantial operating time.
INTRODUCTION
Insufficient bone volume in the posterior portions of the maxilla can create problems for dental implant installation, and the reduced bone quantity and quality may affect the outcome of implant treatment in this area.1 The purpose of the augmentation procedures is to provide a sufficient volume of bone for mechanical support and integration of implants.2 The maxillary sinus augmentation was first presented by Tatum in 1976.3,4 Several different materials have been used for sinus grafting, but it is still not clear which graft materials are clinically most suitable for bone regeneration.5 Autologous grafts are considered the golden standard in terms of osteogenic potential, but they present some disadvantages, such as a limited availability of material from the intraoral donor site, a tendency to be partially resorbed, and that the extraoral site requires general anesthesia with an additional surgery at the donor site and is often associated with morbidity (limping, anesthesia, paresthesia, residual defects) at the donor site.1,6ÇƒÏ15 There is a prolonged operation time, which, in turn, leads to higher expenses for the surgery.1 These facts have led to a quest for a bone substitute that could be used in bone-regeneration techniques. These bone substitutes should be used when sufficient amounts of autologous bone cannot be harvested from intraoral donor sites.7 Moreover, because autologous bone grafts often undergo a significant resorption (up to 50%),7,16 the addition of a material that does not resorb or resorbs very slowly could help stabilize the graft. A further obvious advantage would be to use the bone substitutes alone because no donor site for harvesting of autologous bone is needed.2,5 Several types of mixture of graft materials have been proposed and reported in the literature; however, the ideal ratio of these mixtures is still unknown.1