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A comparison of two techniques to augment maxillary sinuses using the lateral window approach: rigid synthetic resorbable barriers versus anorganic bovine bone. Five-month post-loading clinical and histological results of a pilot randomised controlled clinical trial.

2009; Springer Nature; Volume: 2; Issue: 4 Linguagem: Inglês

1756-2406

Pietro Felice, Antônio Scarano, Roberto Pistilli, Luigi Checchi, Maurizio Piattelli, Gerardo Pellegrino, Marco Esposito,

Periodontal Regeneration and Treatments

Purpose To compare the efficacy of two different techniques to augment maxillary sinuses using a lateral window approach: rigid synthetic resorbable barriers (Inion) versus granular anorganic bovine bone (Bio-Oss). Materials and methods Ten partially edentulous patients having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses, as measured on computed tomography (CT) scans, were randomised to receive two different 2-stage sinus lift procedures using the lateral window approach. In one side, the sinus lining was raised by placing a resorbable rigid Inion barrier without any bone substitute whereas the contralateral side was loosely packed with 100% granular Bio-Oss. After 6 months, 2 to 3 implants were inserted at each side and submerged for 4 months. Implants were loaded with provisional acrylic prostheses and replaced after 4 months, by definitive screwretained metal-ceramic prostheses. Outcome measures were: time necessary to complete the augmentation procedure, bone gain on CT scans, histomorphometry, any complication, implant and prosthetic failures, and clinician and patient preference assessed by a blinded outcome assessor. All patients were followed up to 5 months after loading. Results No patient dropped out. There was no significant difference in time to complete the augmentation procedure (19.8 minutes for Inion versus 20.5 for Bio-Oss). After 6 months, both interventions gained bone in a highly statistically significant way (14.4 mm for Inion versus 14.1 mm for Bio- Oss) with no significant differences between the procedures. Histologically, more new bone formed at Bio-Oss treated sites (36.1% versus 24.2%), the difference being highly statistically significant (P = 0.002). There were no differences in complications between groups (2 perforations of the maxillary lining at Inion treated sites versus 1 at a Bio-Oss site), however, in one of the patients where a perforation occurred at the Inion site, at implant placement, the sinus was two-thirds filled with soft tissue and the site was successfully retreated with Bio-Oss. No implant failed. The clinician preferred Bio-Oss because it was simpler to handle. There were no statistically significant differences in patient preference 1 month after surgery and 1 month after delivery of definitive prostheses: 8 patients had no preference while 2 preferred the Bio-Oss treated side. Conclusions Although bone grafting is not needed to augment atrophic maxillary sinuses since it is sufficient to keep space with a rigid barrier, bone was histologically more mature and appeared to be clinically harder when using Bio-Oss. Moreover, it was judged simpler to fill sinuses with a bone substitute than to position a rigid barrier for maintaining space.