Clinical Oral Investigations

, Volume 17, Issue 2, pp 543–551 | Cite as

The influence of bone substitute materials on the bone volume after maxillary sinus augmentation: a microcomputerized tomography study

  • Sebastian Kühl
  • Christoph Brochhausen
  • Hermann Götz
  • Andreas Filippi
  • Michael Payer
  • Bernd d’Hoedt
  • Matthias Kreisler
Original Article



This study aims to evaluate the effect of adding bone substitute materials (BSM) to particulated autogenous bone (PAB) on the volume fraction (Vf) of newly formed bone after maxillary sinus augmentation.

Materials and methods

Thirty healthy patients undergoing maxillary sinus augmentation were included. PAB (N = 10), mixtures of PAB and beta-tricalciumphosphate (PAB/β-TCP) (N = 10), as well as PAB and β-TCP and hydroxyapatite (PAB/HA/β-TCP) (N = 10) were randomly used for sinus augmentation. A sample of the graft material was maintained from each patient at time of maxillary sinus augmentation, and Vfs of the PAB and/or BSM in the samples were determined by means of microcomputerized tomography (μ-CT). Five months later, samples of the grafted areas were harvested during implantation using a trephine bur. μ-CT analysis of these samples was performed, and the Vf of bone and BSM were compared with the data obtained 5 months earlier from the original material.


The mean Vf of the bone showed a statistically significant increase (p < 0.05) in all groups after a healing period of 5 months without statistically significant difference between the groups.


With regard to the increase of bone volume, it is not relevant if PAB is used alone or combined with β-TCP or HA/β-TCP.

Clinical relevance

The amount of PAB and associated donor site morbidity may be reduced by adding BSM for maxillary sinus augmentation.


Maxillary sinus augmentation Bone Substitute materials 



The study was partly funded by a study grant of the University of Mainz (MAIFOR). We extend our gratitude to Prof. Dr. Heinz Duschner for the facilities in terms of μ-CT acquisition and Irene Mischak for the statistical analysis.

Conflict of interests

The authors declare that they have no conflict of interests.


  1. 1.
    Boyne PJ, James RA (1980) Grafting of the maxillary sinus floor with autogenous marrow and bone. Int J Oral Maxillofac Surg 38:613–661Google Scholar
  2. 2.
    Tatum OH (1986) Maxillary and sinus implant reconstruction. Dent Clin N Am 30:207–229PubMedGoogle Scholar
  3. 3.
    Huerzeler MB, Kirsch A, Ackermann KL, Quinones CR (1996) Reconstruction of the severely resorbed maxilla with dental implants in the augmented maxillary sinus: a 5-year clinical investigation. Int J Oral Maxillofac Implants 11:466–475Google Scholar
  4. 4.
    Wallace ST, Froum ST (2003) Effect of maxillary sinus augmentation on the survival of endosseous dental implants. A systematic review. Ann Periodontol 8:328–343PubMedCrossRefGoogle Scholar
  5. 5.
    Kreisler M, Moritz O, d'Hoedt B (2006) Evidence-based medicine in sinus floor elevation part 1: general aspects and the influence of the grafting material on implant prognosis. J Dent Implantol 22:299–323Google Scholar
  6. 6.
    Kreisler M, Moritz O, d'Hoedt B (2007) Evidence-based medicine in sinus floor elevation part 2: direct and indirect factors in sinus floor elevation and their influence on implant prognosis. J Dent Implantol 23:68–86Google Scholar
  7. 7.
    Froum SJ, Tarnow DP, Wallace SS, Rohrer MD, Cho SC (1998) Sinus floor elevation using bovine bone mineral (OsteoGraf/N) with and without autogenous bone: a clinical, histologic, radiographic and histomorphometric analysis—part 2 of an ongoing prospective study. Int J Periodonics Restor Dent 18:528–543Google Scholar
  8. 8.
    Hallman M, Sennerby L, Lundgren S (2002) A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone, bovine hydroxyapatite, or a 20:80 mixture. Int J Oral Maxillofac Implants 17:635–643PubMedGoogle Scholar
  9. 9.
    Schlegel KA, Fichtner G, Schultze-Mosgau S, Wiltfang J (2003) Histologic findings in sinus augmentation with autogenous bone chips versus a bovine substitute material. Int J Oral Maxillofac Implants 18:53–58PubMedGoogle Scholar
  10. 10.
    Hatano N, Shimizu Y, Ooya K (2004) A clinical long-term radiographic evaluation of graft height changes after maxillary sinus floor augmentation with a 2:1 autogenous/xenograft mixture and simultaneous placement of dental implants. Clin Oral Implants Res 15:339–345PubMedCrossRefGoogle Scholar
  11. 11.
    Guarnieri R, Grassi R, Ripari M, Pecora G (2006) Maxillary sinus augmentation using granular calcium sulfate (surgiplaster sinus): radiographic and histologic study at 2 years. Int J Periodontics Restorative Dent 26:79–85PubMedGoogle Scholar
  12. 12.
    Wanschitz F, Figl M, Wagner A, Ewers R (2006) Measurement of volume changes after sinus floor augmentation with phycogenic hydroxyapatite. Int J Oral Maxillofac Implants 21:422–438Google Scholar
  13. 13.
    Johansson LA, Isaksson S, Lindh C, Becktor JP, Sennerby L (2010) Maxillary sinus floor augmentation and simultaneous implant placement using locally harvested autogenous bone chips and bone debris: a prospective clinical study. Int J Oral Maxillofac Implants 68:837–844CrossRefGoogle Scholar
  14. 14.
    Yildirim M, Spiekermann H, Biesterfeld S, Edelhoff D (2000) Maxillary sinus augmentation using xenogenic bone substitute material Bio-Oss® in combination with venous blood. A histologic and histomorphometric study in humans. Clin Oral Implants Res 11:217–229PubMedCrossRefGoogle Scholar
  15. 15.
    Maiorana C, Sigurta D, Mirandola A, Garlini G, Santoro F (2006) Sinus elevation with alloplast or xenogenic materials and implants: an up-to-4-year clinical and radiologic follow-up. Int J Oral Maxillofac Implants 21:426–432PubMedGoogle Scholar
  16. 16.
    Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R et al (2010) Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev 3:CD008397PubMedGoogle Scholar
  17. 17.
    Froum SJ, Wallace SS, Cho SC, Elian N, Tarnow DP (2008) Histomorphometric comparison of a biphasic bone ceramic to anorganic bovine bone for sinus augmentation: 6- to 8-month postsurgical assessment of vital bone formation. A pilot study. Int J Periodontics Restorative Dent 28:273–281PubMedGoogle Scholar
  18. 18.
    Cordaro L, Bosshardt DD, Palattella P, Rao W, Serino G, Chiapasco M (2008) Maxillary sinus grafting with Bio-Oss® or Straumann® Bone Ceramic: histomorphometric results from a randomized controlled multicenter clinical trial. Clin Oral Implants Res 19:796–803PubMedCrossRefGoogle Scholar
  19. 19.
    Artzi Z, Kozlovsky A, Nemcovsky CE, Weinreb M (2005) The amount of newly formed bone in sinus grafting procedures depends on tissue depth as well as the type and residual amount of the grafted material. J Clin Periodontol 32:193–199PubMedCrossRefGoogle Scholar
  20. 20.
    Huerzeler MB, Quinones CR, Kirsch A, Schupbach P, Krausse A, Strub JC et al (1997) Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part III. Evaluation of autogenous bone combined with porous hydroxyapatite. Clin Oral Implants Res 8:401–411CrossRefGoogle Scholar
  21. 21.
    Scarano A, Degidi M, Iezzi G, Pecora G, Pattelli M, Orsini G et al (2006) Maxillary sinus augmentation with different biomaterials: a comparative histologic and histomorphometric study in man. Implant Dent 15:197–207PubMedCrossRefGoogle Scholar
  22. 22.
    Suba Z, Takacs D, Matusovits D, Barabas J, Fazekas A, Szabo G (2006) Maxillary sinus floor grafting with ß-tricalcium phosphate in humans: density and microarchitecture of the newly formed bone. Clin Oral Implants Res 17:102–108PubMedCrossRefGoogle Scholar
  23. 23.
    Burchardt H (1983) The biology of bone graft repair. Clin Orthop Relat Res 174:28–42PubMedGoogle Scholar
  24. 24.
    van den Bergh JP, ten Bruggenkate CM, Krekeler G, Tuinzing DB (1998) Sinusfloor elevation and grafting with autogenous iliac crest bone. Clin Oral Implants Res 9:429–435PubMedCrossRefGoogle Scholar
  25. 25.
    Frenken JWFH, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EAJM, Bruggenkate CM (2010) The use of Straumann® Bone Ceramic in maxillary sinus floor elevation procedure: a clinical, radiological, histological and histomorphometric evaluation with a 6-month healing period. Clin Oral Implants Res 21:201–208PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen OT, Shulman LB, Block MS, Iacono VJ (1998) Report of the Sinus Consensus Conference of 1996. Int J Oral Maxillofac Implants 13:11–45PubMedGoogle Scholar
  27. 27.
    Tong DC, Rioux K, Drangsholt M, Beirne OR (1998) A review of survival rates for implants placed in grafted maxillary sinuses using metaanalysis. Int J Oral Maxillofac Implants 13:175–182PubMedGoogle Scholar
  28. 28.
    Kühl S, Götz H, Hansen T, Kreisler M, Behneke A, Heil U et al (2010) Three-dimensional analysis of bone formation after maxillary sinus augmentation by means of microcomputed tomography: a pilot study. Int J Oral Maxillofac Implants 25:930–938PubMedGoogle Scholar
  29. 29.
    Artzi Z, Weinreb M, Carmeli G, Lev-Dor R, Dard M, Nemcovsky CE (2010) Histomorphometric assessment of bone formation in sinus augmentation utilizing a combination of autogenous and hydroxyapatite/biphasic tricalcium phosphate graft materials: at 6 and 9 month in humans. Clin Oral Implants Res 19:686–692Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sebastian Kühl
    • 1
  • Christoph Brochhausen
    • 2
  • Hermann Götz
    • 3
  • Andreas Filippi
    • 1
  • Michael Payer
    • 4
  • Bernd d’Hoedt
    • 5
  • Matthias Kreisler
    • 5
  1. 1.School of Dental Medicine, Department of Oral Surgery, Oral Radiology and Oral MedicineUniversity of BaselBaselSwitzerland
  2. 2.REPAIR-lab, Institute of PathologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
  3. 3.Institute for Applied Structure and MicroanalysisUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
  4. 4.Department of oral Surgery and Radiology, School of DentistryMedical University of Graz, AustriaGrazAustria
  5. 5.School of Dental Medicine; Department of Oral SurgeryUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany

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