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Maxillary Sinus Lift with Beta-Tricalcium Phosphate (β-TCP) in Edentulous Patients: A Nanotomographic and Raman Study

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Abstract

Sinus lift elevation restores bone mass at the maxilla in edentulate patients before the placement of dental implants. It consists of opening the lateral side of the sinus and grafting beta-tricalcium phosphate granules (β-TCP) under the olfactory membrane. Bone biopsies were obtained in five patients after 60 weeks. They were embedded undecalcified in poly(methyl methacrylate) (pMMA); blocks were analyzed by nanocomputed tomography (nanoCT); specific areas were studied by Raman microspectroscopy. Remnants of β-TCP were osseointegrated and covered with mineralized bone; osteoid tissue was also filling the inner porosity. Macrophages having engulfed numerous β-TCP grains were observed in marrow spaces. β-TCP was identified by nanoCT as osseointegrated particles and as granules in the cytoplasm of macrophages. Raman microspectroscopy permitted to compare the spectra of β-TCP and bone in different areas. The ratio of the ~820 cm−1 band of pMMA (–CH2 groups) on the ν1 phosphate band at 960 cm−1 reflected tissue hydration because water was substituted by MMA during histological processing. In bone, the ratio of the ~960 cm−1 phosphate to the amide 1 band and the ratio ν2 phosphate band by the 1240–1250 amide III band reflect the mineralization degree. Specific bands of β-TCP were found in osseointegrated β-TCP granules and in the grains phagocytized by the macrophages. The hydration degree was maximal for β-TCP phagocytized by macrophages. Raman microspectroscopy associated with nanoCT is a powerful tool in the analysis of the biomaterial degradation and osseointegration.

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Acknowledgements

The authors thank Mrs Laurence Lechat for secretarial assistance, Mrs N. Retailleau and S. Lemière for microCT and histotechnology. E. Paschalis and G. Mabilleau are thanked for helpful discussions. This work was made possible by grants from ANR, program LabCom “NextBone”. The authors thank Kasios, 18 Chemin de la Violette, 31240 L’Union—France—for providing the β-TCP granules.

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Authors and Affiliations

  1. GEROM Groupe Etudes Remodelage Osseux et bioMatériaux, NextBone, IRIS-IBS Institut de Biologie en Santé, CHU d’Angers, Université d’Angers, 49933, Angers Cedex, France

    Florence Pascaretti-Grizon, Bernard Guillaume, Lisa Terranova, Baptiste Arbez, Hélène Libouban & Daniel Chappard

  2. CFI, Collège Français d’Implantologie, 6, rue de Rome, 75005, Paris, France

    Bernard Guillaume

  3. GEROM – NextBone, IRIS-IBS Institut de Biologie en Santé, CHU d’Angers, 49933, Angers Cedex, France

    Daniel Chappard

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  1. Florence Pascaretti-Grizon
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  2. Bernard Guillaume
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  3. Lisa Terranova
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  4. Baptiste Arbez
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  5. Hélène Libouban
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  6. Daniel Chappard
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Contributions

The study was conceived by DC and BG. Surgery and patient handling were done by BG. Experimental analyses were designed by DC and performed by the acknowledged technicians. Histopathological analysis was done by DC. Raman analysis was done by FPG, SEM by BA, and nanoCT by LT and HL. The paper was written by DC and FPG, and the final manuscript was approved by all of the authors.

Corresponding author

Correspondence to Daniel Chappard.

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Conflict of interest

Florence Pascaretti-Grizon, Bernard Guillaume, Lisa Terranova, Baptiste Arbez, Hélène Libouban, and Daniel Chappard declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

An informed consent was obtained from each subject. This experimental protocol was approved by the ethical committee of the French Collège d’Implantologie and was done in accordance with the institutional guidelines of the French Ethical Committee and with the 1964 Helsinki declaration and its later amendments.

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223_2017_280_MOESM1_ESM.mp4

Supplementary material 1 Video movie of the block of the bone biopsy presented on Fig. 2A-B focusing on the interface between β-TCP granules (light grey) and bone trabeculae directly anchored on the granules (darker grey). In the marrow spaces, note the presence of numerous macrophages (in light grey) responsible of a “milky way” appearance. These phagocytic cells are revealed due to the presence of numerous β-TCP grains in their cytoplasm. (MP4 8028 kb)

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Pascaretti-Grizon, F., Guillaume, B., Terranova, L. et al. Maxillary Sinus Lift with Beta-Tricalcium Phosphate (β-TCP) in Edentulous Patients: A Nanotomographic and Raman Study. Calcif Tissue Int 101, 280–290 (2017). https://doi.org/10.1007/s00223-017-0280-5

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  • DOI: https://doi.org/10.1007/s00223-017-0280-5

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