Performance of β-tricalcium phosphate granules and putty, bone grafting materials after bilateral sinus floor augmentation in humans

Abstract

Sinus floor augmentation (SFA) using bone grafting materials, and in particular calcium phosphates (CaP), is a well-established pre-implantology procedure. The use of CaP simplifies SFA procedures. β-tricalcium phosphate (β-TCP) is amply used for SFA. This study evaluated the clinical and osteogenic performance of β-TCP granules (TCP-G) and a β-TCP putty (TCP-P) bone graft material. TCP-P consisted of TCP-G in a hyaluronic acid (HyA) carrier. Bone formation, volume stability and osteogenic marker expression after bilateral SFA in patients was assessed. Eight patients were selected for a split-mouth design. Biopsies obtained six months after SFA, were processed for immunohistochemical analysis of collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Histomorphometric analysis determined bone, grafting material and marrow space percentages. Cone-beam computed tomography was used to calculate the graft volume and its stability. Both materials allowed excellent bone regeneration and volume stability. TCP-P displayed better surgical handling properties, greater bone formation, higher expression of Col I, ALP, OC and BSP; as well as significantly lower grafting volume reduction values. HyA had no adverse effect on TCP-P performance. Due to its clinical and osteogenic performance, TCP-P can be regarded as excellent bone grafting material for SFA.

Keywords: Granules; Putty; Sinus floor augmentation; Split-mouth design; β-TCP bone graft.