Natural hydroxyapatite-based nanobiocomposites and their biomaterials-to-cell interaction for bone tissue engineering.

Hydroxyapatite (HA) is an extensively used biomaterial for dental and orthopaedic applications because of its biocompatibility and biomimetic nature. HA is extensively used as a bone-graft substitute. HA bone graft substitutes of bovine or synthetic origins have been extensively studied. However, caprine-based HA has not been explored. In this study, we aimed to determine the utilization of goat bone-derived HA for commercial applications. HA from caprine bone and teeth was isolated using thermal calcination. The developed HA can be used as a bone graft substitute. Chemical characterization of the isolated HA was carried out using Fourier transform infrared spectroscopy, X-Ray Diffraction, Raman spectroscopy, scanning electron microscopy, and transmission electron microscopy. The biocompatibility and apatite formation of isolated HA were assessed using MG-63 cells, MC3T3-E1, L929 cells, MSCs, adipose derived stem cells, human dermal tissue derived fibroblast cells and osteoblast-like cell line, The studies demonstrate that HA support cell adhesion and osteogenic properties. To improve sheep, lamp, or caprine bone-derived HA, several other composites have been developed with MgO2, ZrO2, ZnO2, and other polymeric substances. 3D printed technology was used to develop a bioink using sheep-derived HA and printed the composite scaffold as a bone graft substitute. Furthermore, the biomedical applications of sheep-derived HA been studied in terms of their antimicrobial activity, bone-forming ability, and wound healing applications. Sheep-, goat-, and caprine-derived HA are still underutilized and require further research to develop commercial possibilities and sustainable raw materials for HA-based bone graft substitutes.

Local Antibiotic Delivery Ceramic Bone Substitutes for the Treatment of Infected Bone Cavities and Bone Regeneration: A Systematic Review on What We Have Learned from Animal Models.

AIMS: the focus of this study is to evaluate if the combination of an antibiotic with a ceramic biomaterial is effective in treating osteomyelitis in an infected animal model and to define which model and protocol are best suited for in vivo experiments of local bone infection treatment. METHODS: a systematic review was carried out based on PRISMA statement guidelines. A PubMed search was conducted to find original papers on animal models of bone infections using local antibiotic delivery systems with the characteristics of bone substitutes. Articles without a control group, differing from the experimental group only by the addition of antibiotics to the bone substitute, were excluded. RESULTS: a total of 1185 records were retrieved, and after a three-step selection, 34 papers were included. Six manuscripts studied the effect of antibiotic-loaded biomaterials on bone infection prevention. Five articles studied infection in the presence of foreign bodies. In all but one, the combination of an antibiotic with bioceramic bone substitutes tended to prevent or cure bone infection while promoting biomaterial osteointegration. CONCLUSIONS: this systematic review shows that the combination of antibiotics with bioceramic bone substitutes may be appropriate to treat bone infection when applied locally. The variability of the animal models, time to develop an infection, antibiotic used, way of carrying and releasing antibiotics, type of ceramic material, and endpoints limits the conclusions on the ideal therapy, enhancing the need for consistent models and guidelines to develop an adequate combination of material and antimicrobial agent leading to an effective human application.

An Audit of the effect of Bone Morphogenetic Protein-2 Treatment in patients with non-union of long bone fractures.

OBJECTIVE: To evaluate the outcomes, clinical and radiological application of Bone Morphogenetic Protein-2 alone versus Bone Morphogenetic Protein-2 with autograft in long bone non-unions. METHODS: A prospective review of patients was done with fracture non-union admitted to Aga Khan University Hospital, Karachi, from January 2016 to January 2019. The patients were divided into two groups; those exposed to Bone Morphogenetic Protein-2 alone in group 1, and those exposed to Bone Morphogenetic Protein-2 plus autologous graft in group 2. RESULTS: Background characteristics of both the groups were analysed. Patients were followed up at 6, 12 and 24 weeks through their medical records. The primary outcome was postoperative union at 6, 12 and 24. Union was defined by having the clinical union as well as the radiological union at the same time of assessment. Of the 80 patients enrolled, 13(16.25%) were excluded, and 5(6.25%) were lost to follow-up. The final sample had 62(77.5%) patients; 35(56.5%) in group 1, and 27(43.5%) in group 2. Union at 6 weeks was observed in 13(21%) patients; 8(62%) in group 1, and 5(38%) in group 2. Union at 12 weeks was observed in 38(61%) patients; 20(53%) in group 1, and 18(47%) in group 2. CONCLUSIONS: Results showed that using the adjuvant treatment alone was not worse than using it along with bone autologous graft.

Bovine-derived xenograft is a viable bone graft substitute in multilevel, instrumented, spinal fusion.

Objective: To evaluate radiological outcomes following the use of xenogeneic bone graft substitute (BGS) in patients undergoing multisegmental spinal fusion. Summery of Background Data: Data exists for single level and short segment fusions, there presently is a paucity of data on fusion rate after bone augmentation with BGS in multisegmental posterior spinal fusion (PSF). The leading concern is pseudarthrosis, which often leads to a loss of correction after PSF. Therefore, the bone graft is an essential aspect of PSF. Methods: We retrospectively analysed the radiological data of a consecutive cohort of patients who had been treated for adolescent idiopathic scoliosis (AIS) via multisegmental spinal fusion, in whom a bovine derived BGS had been used and had a complete dataset of 24 months follow-up. The Cobb angle of the main curve was measured pre-operatively and then at 6, 12 and 24 months post-operatively. Loosening of the screws was recorded at the same post-operative time points. Results: After applying inclusion and exclusion criteria, 28 patients were included. We found no significant change of the cobb angle from the main curve as well as the cobb angle from the thoracic kyphosis during the 24 months of follow up. No patient showed a lack of bony fusion. There was 1 revision surgery, which was due to trauma. Conclusion: In this cohort, all patients showed successful bone fusion during a 24-month follow-up. Additionally, there was no change in the Cobb angle during the 2-year post-operative period. Our data indicates that the use of bovine-derived BGS supports bone fusion after multisegmental posterior instrumented fusion of the spine.

Effectiveness of Calcium Sulfate and Hydroxyapatite Composite in Collapse Prevention in Osteonecrosis of Femoral Head.

Introduction Calcium-sulfate-hydroxyapatite bioceramics have been widely used as void fillers in bone. However, their effectiveness as void fillers in core decompression for osteonecrosis of the femoral head (ONFH) in preventing femoral head collapse prevention has limited evidence. The current study investigates the effectiveness of calcium-sulfate-hydroxyapatite bioceramics as a void filler in the core decompression procedure for ONFH. Methods We retrospectively reviewed the clinical and radiological records of ONFH patients that underwent core-decompression using either autologous iliac crest cancellous bone graft or calcium-sulfate-hydroxyapatite bioceramic paste as void fillers with at least one-year follow-up. The primary outcome of this study was the radiological progression of collapse in the last available standard anteroposterior (AP) radiographs of the hip. The collapse progression was compared between the two groups based on void fillers. Results This study included patient records with 44 hip joints that underwent core decompression. There were five female and 33 male patients. The mean age was 29.1±6.3 years. The mean follow-up duration was 21.4±3.4 months. No significant differences in collapse progression were observed between the two groups based on void fillers. Conclusion The use of calcium-sulfate-hydroxyapatite as a void filler in core decompress for ONFH is not superior to the autologous cancellous bone in terms of collapse prevention and mechanical support. Further modifications in the core decompression techniques and well-planned prospective studies would help establish sound recommendations.

Anterior Shoulder Instability Part II-Latarjet, Remplissage, and Glenoid Bone-Grafting-An International Consensus Statement.

PURPOSE: The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability. METHODS: A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS: The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation. CONCLUSION: Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage. LEVEL OF EVIDENCE: Level V, expert opinion.

Effectiveness of treating segmental bone defects with a synergistic co-delivery approach with platelet-rich fibrin and tricalcium phosphate.

Several studies have applied tricalcium phosphate (TCP) or autografts in bone tissue engineering to enhance the clinical regeneration of bone. Unfortunately, there are several drawbacks related to the use of autografts, including a risk of infection, blood loss, limited quantities, and donor-site morbidities. Platelet-rich fibrin (PRF) is a natural extracellular matrix (ECM) biomaterial that possesses bioactive factors, which can generally be used in regenerative medicine. The goal of the present investigation was to develop osteoconductive TCP incorporated with bioactive PRF for bio-synergistic bone regeneration and examine the potential biological mechanisms and applications. Our in vitro results showed that PRF plus TCP had excellent biosafety and was favorable for initiating osteoblast cell attachment, slow release of bioactive factors, cell proliferation, cell migration, and ECM formation that potentially impacted bone repair. In a rabbit femoral segmental bone defect model, regeneration of bone was considerably augmented in defects locally implanted by PRF plus TCP according to radiographic and histologic examinations. Notably, the outcomes of this investigation suggest that the combination of PRF and TCP possesses novel synergistic and bio-inspired functions that facilitate bone regeneration.

Bio-Inspired Design of a Porous Resorbable Scaffold for Bone Reconstruction: A Preliminary Study.

The study and imitation of the biological and mechanical systems present in nature and living beings always have been sources of inspiration for improving existent technologies and establishing new ones. Pursuing this line of thought, we consider an artificial graft typical in the bone reconstruction surgery with the same microstructure of the bone living tissue and examine the interaction between these two phases, namely bone and the graft material. Specifically, a visco-poroelastic second gradient model is adopted for the bone-graft composite system to describe it at a macroscopic level of observation. The second gradient formulation is employed to consider possibly size effects and as a macroscopic source of interstitial fluid flow, which is usually regarded as a key factor in bone remodeling. With the help of the proposed formulation and via a simple example, we show that the model can be used as a graft design tool. As a matter of fact, an optimization of the characteristics of the implant can be carried out by numerical investigations. In this paper, we observe that the size of the graft considerably influences the interaction between bone tissue and artificial bio-resorbable material and the possibility that the bone tissue might substitute more or less partially the foreign graft for better bone healing.

Effects of ex vivo ionizing radiation on collagen structure and whole-bone mechanical properties of mouse vertebrae.

Bone can become brittle when exposed to ionizing radiation across a wide range of clinically relevant doses that span from radiotherapy (accumulative 50 Gy) to sterilization (~35,000 Gy). While irradiation-induced embrittlement has been attributed to changes in the collagen molecular structure, the relative role of collagen fragmentation versus non-enzymatic collagen crosslinking remains unclear. To better understand the effects of radiation on the bone material without cellular activity, we conducted an ex vivo x-ray radiation experiment on excised mouse lumbar vertebrae. Spinal tissue from twenty-week old, female, C57BL/6J mice were randomly assigned to a single x-ray radiation dose of either 0 (control), 50, 1000, 17,000, or 35,000 Gy. Measurements were made for collagen fragmentation, non-enzymatic collagen crosslinking, and both monotonic and cyclic-loading compressive mechanical properties. We found that the group differences for mechanical properties were more consistent with those for collagen fragmentation than for non-enzymatic collagen crosslinking. Monotonic strength at 17,000 and 35,000 Gy was lower than that of the control by 50% and 73% respectively, (p < 0.001) but at 50 and 1000 Gy was not different than the control. Consistent with those trends, collagen fragmentation only occurred at 17,000 and 35,000 Gy. By contrast, non-enzymatic collagen crosslinking was greater than control for all radiation doses (p < 0.001). All results were consistent both for monotonic and cyclic loading conditions. We conclude that the reductions in bone compressive monotonic strength and fatigue life due to ex vivo ionizing radiation are more likely caused by fragmentation of the collagen backbone than any increases in non-enzymatic collagen crosslinks.

Honeycomb blocks composed of carbonate apatite, ß-tricalcium phosphate, and hydroxyapatite for bone regeneration: effects of composition on biological responses.

Synthetic scaffolds exhibiting bone repair ability equal to that of autogenous bone are required in the fields of orthopedics and dentistry. A suitable synthetic bone graft substitute should induce osteogenic differentiation of mesenchymal stem cells, osteogenesis, and angiogenesis. In this study, three types of honeycomb blocks (HCBs), composed of hydroxyapatite (HAp), ß-tricalcium phosphate (TCP), and carbonate apatite (CO3Ap), were fabricated, and the effects of HCB composition on bone formation and maturation were investigated. The HC structure was selected to promote cell penetration and tissue ingrowth. HAp and ß-TCP HCBs were fabricated by extrusion molding followed by sintering. The CO3Ap HCBs were fabricated by extrusion molding followed by sintering and dissolution-precipitation reactions. These HCBs had similar macroporous structures: all harbored uniformly distributed macropores (∼160 â€‹µm) that were regularly arrayed and penetrated the blocks unidirectionally. Moreover, the volumes of macropores were nearly equal (∼0.15 â€‹cm3/g). The compressive strengths of CO3Ap, HAp, and ß-TCP HCBs were 22.8 â€‹± â€‹3.5, 34.2 â€‹± â€‹3.3, and 24.4 â€‹± â€‹2.4 â€‹MPa, respectively. Owing to the honeycomb-type macroporous structure, the compressive strengths of these HCBs were higher than those of commercial scaffolds with intricate three-dimensional or unidirectional macroporous structure. Notably, bone maturation was markedly faster in CO3Ap HCB grafting than in ß-TCP and HAp HCB grafting, and the mature bone area percentages for CO3Ap HCBs at postsurgery weeks 4 and 12 were 14.3- and 4.3-fold higher and 7.5- and 1.4-fold higher than those for HAp and ß-TCP HCBs, respectively. The differences in bone maturation and formation were probably caused by the disparity in concentrations of calcium ions surrounding the HCBs, which were dictated by the inherent material resorption behavior and mechanism; generally, CO3Ap is resorbed only by osteoclastic resorption, HAp is not resorbed, and ß-TCP is rapidly dissolved even in the absence of osteoclasts. Besides the composition, the microporous structure of HC struts, inevitably generated during the formation of HCBs of various compositions, may contribute to the differences in bone maturation and formation.

Clinico-Radiological Efficacy of Posterior Instrumentation, Decompression, and Transpedicular Bone Grafting in Osteoporotic Burst Fracture Associated with Neurological Deficit.

OBJECTIVE: The aim of this study is to evaluate clinico-radiological outcomes of posterior surgery (decompression + instrumentation + transpedicular bone graft) in osteoporotic burst fracture associated with neurological deficit [OFND]. MATERIALS AND METHODS: Forty patients with neurological deficit due to delayed osteoporotic vertebral collapse managed by posterior surgery (decompression + instrumentation + transpedicular bone graft) with minimum 2 years follow-up were included in the study. Approval from the Institutional Review Board was taken. Demographic data (age, sex, mode of injury, and the severity of osteoporosis); clinical parameters (Visual Analog Score [VAS], Oswestry Disability Index [ODI], Frankel grade), radiological parameters (local kyphosis), and surgical variables (blood loss, surgery duration, and intraoperative events) were recorded. Neurological worsening/improvement, complications, and implant failures were noted. RESULTS: Significant improvement was noted in VAS (preoperative 8.20 ± 0.65/postoperative 4.1 ± 0.64) and ODI (preoperative 76.54 ± 6.96/postoperative 30.5 ± 6.56). Complete neurological recovery was noted in 37 patients (Frankel Grade E), three patients remained nonambulatory (Frankel Grade C). Significant improvement was noted in local kyphosis angle (preoperative = 21.80 ± 2.70; postoperative 11.40 ± 1.80), with 10% loss of correction (2.5 ± 0.90) at final follow-up. Symptomatic implant failure was noted in two patients and proximal junctional failure in one patient requiring an extension of fixation. CONCLUSIONS: OFND can be managed with a single posterior-only surgery with significant improvement in neurology and functional scores of patients. Aggressive kyphosis correction is often not required and optimal correction of kyphosis is noticed due to prone-positioning alone. Transpedicular grafting is safe and simple alternative to cement augmentation or anterior surgery for collapsed vertebrae.

Linking the Transcriptional Landscape of Bone Induction to Biomaterial Design Parameters.

New engineering possibilities allow biomaterials to serve as active orchestrators of the molecular and cellular events of tissue regeneration. Here, the molecular control of tissue regeneration for calcium phosphate (CaP)-based materials is established by defining the parameters critical for tissue induction and those are linked to the molecular circuitry controlling cell physiology. The material properties (microporosity, ion composition, protein adsorption) of a set of synthesized osteoinductive and noninductive CaP ceramics are parameterized and these properties are correlated to a transcriptomics profile of osteogenic cells grown on the materials in vitro. Using these data, a genetic network controlling biomaterial-induced bone formation is built. By isolating the complex material properties into single-parameter test conditions, it is verified that a subset of these genes is indeed controlled by surface topography and ions released from the ceramics, respectively. The gene network points to a decisive role for extracellular matrix deposition in osteoinduction by genes such as tenascin C and hyaluronic acid synthase 2, which are controlled by calcium and phosphate ions as well as surface topography. This work provides insight into the biomaterial composition and material engineering aspects of bone void filling and can be used as a strategy to explore the interface between biomaterials and tissue regeneration.

Effectiveness of CT for the detection of glenoid bone graft resorption following reverse shoulder arthroplasty.

INTRODUCTION: Glenoid bone grafting is often used in cases of reverse shoulder arthroplasty (RSA) with glenoid deficiency. Additionally, bony increased-offset RSA (BIO-RSA) uses a cylindrical bonegraft harvested from the humeral head and is positioned beneath the glenoid baseplate to increase lateralization. Postoperative computed tomography (CT) has been used to detect glenoid bonegraft resorption, which is typically identified by a gap between the bonegraft and baseplate; however, CT images are often degraded by implant metal artifact. The purpose of this CT imaging study was to determine if a simulated bonegraft resorption gap is detectable following RSA with glenoid bone grafting. HYPOTHESIS: CT is unable to detect bone graft resorption following reverse shoulder arthroplasty conducted with bone grafting beneath the glenoid baseplate. MATERIALS AND METHODS: RSA with glenoid bone grafting was performed on four cadaver shoulders. Glenoid bonegraft resorption gaps were simulated by fixing the implant at six different gap widths (0, 1, 2, 4, 6 and 8mm). Clinical CT scans were acquired for each gap resulting in 6 scans per specimen. Two experienced observers (blinded) analyzed DICOM images in the axial and coronal directions, and measured gap widths using Mimics(®) software. Each observer had access to approximately 200 images per condition per specimen. RESULTS: The sensitivity of CT imaging to positively identify bonegraft resorption was 38%, with an accuracy of 46%. Inter-observer agreement was 92%. Observers tended to visualize no-gap for most conditions. Resorption gap width measurements were consistently underestimated. DISCUSSION: Metal artifact prevented identification of simulated bonegraft resorption gaps and observers most often determined that there was bonegraft-to-implant "healing" on CT, when in fact a gap was clinically present. This study illustrates the need for more effective imaging techniques to determine if bonegraft resorption has occurred following RSA.

Enxertos ósseos autógenos intrabucais em implantodontia: estudo retrospectivo / Intraoral autogenous bone grafts in implantology: a retrospective study

Após as extrações dentárias, o osso alveolar sofre um processo fisiológico de reabsorção que, muitas vezes, dificulta a instalação de implantes osseointegrados, porém procedimentos reconstrutivos visam viabilizar a instalação correta dos implantes. O objetivo deste estudo foi avaliar os enxertos ósseos autógenos removidos de áreas intrabucais e sua eficácia em relação à osseointegração na área enxertada. Tratou-se de um estudo observacional descritivo retrospectivo, baseado nos dados coletados nos prontuários. Dos sítios doadores avaliados, 54,17% eram do ramo da mandíbula e 43,75% da região mentoniana. Observou-se que, dos 98 implantes instalados, 97,96% obtiveram sucesso e ainda permaneciam em função. Com relação ao objetivo do enxerto, 56,25% foram destinados ao tipo Inlay, enquanto 43,75% foram do tipo Onlay. Complicações pós-operatórias foram observadas em 22,91% dos casos, sendo a parestesia a mais frequente, 95% dos pacientes relataram estar satisfeitos com a reabilitação sobre implantes e 97,50% se sujeitariam a um novo procedimento cirúrgico envolvendo reconstrução óssea se necessário. O estudo mostrou um elevado índice de sucesso dos implantes em áreas enxertadas, caracterizando essas reconstruções como um fator de baixo risco para osseointegração... (AU)

Alveolar bone undergoes a physiological resorption process after tooth extraction, creating difficulties for the insertion of dental implants, but reconstructive procedures enable the correct installation of implants. This study aims to evaluate autogenous bone grafts harvested from intraoral donor sites in order to assess their effectiveness in relation to implant osseointegration. This was a retrospective observational descriptive study based on data collected from medical records. The donor sites evaluated were the mandibular ramus (54.17%) and the chin region (43.75%). It was observed that of 98 implants inserted, 97.96% were successful and continued to function. Inlay grafts were used in 56.25% of cases and onlay ones in 43.75%. Postoperative complications were observed in 22.91% of cases, the most frequent of which was paresthesia. Ninety-five percent of patients reported they were satisfied with their rehabilitation over implants and 97.50% would be willing to undergo a similar surgical procedure involving bone reconstruction if necessary. The study showed a high success rate of implants in the graft areas, thereby characterizing such reconstructions as a low-risk factor for osseointegration... (AU)

Avaliação do comportamento de quatro biomateriais associados a enxertos ósseos autógenos nos procedimentos cirúrgicos de elevação de seio maxilar. Estudo histomorfométrico em humanos / Evaluation of the behavior of 4 different biomaterials associated with autogenous bone graft in the sinus procedures. A histomorphometric study in humans

O objetivo deste trabalho foi estudar, histológica e histométricamente, o comportamento de enxertos ósseos e biomateriais, utilizados para aumento de altura óssea em cavidade sinusal de humanos. Para tanto, foram selecionados 20 pacientes e divididos em quatro grupos que após obtenção do material de enxerto da região de sínfise mentoniana, receberam o seguinte tratamento: Grupo GI, após elevação do assoalho da cavidade sinusal receberam associação de osso autógeno e osso desmineralizado, seco e congelado (DemboneÒ), Grupo GII, receberam após elevação do assoalho da cavidade sinusal associação de osso autógeno e hidroxiapatita (OsteogenÒ), Grupo GIII, receberam associação do osso autógeno e polímero vegetal osteointegrável (Poliquilâ), após elevação da cavidade sinusal e Grupo GIV, após elevação do assoalho do seio maxilar receberam associação do osso autógeno cimento de fosfato de cálcio (Bone Source®). Os pacientes de cada condição experimental permaneceram, durante o período de 10 meses, sem receber carga mastigatória na região citada e após esse período, os pacientes receberam implantes osseointegrados, sendo nesse momento coletado material para exame histológico e histométrico. Os resultados mostraram que houve ganho de massa óssea em todos os grupos, onde o osso novo formado, mostrou características habituais da região. Além disso as substâncias utilizadas apresentaram compatibilidade biológica, pois foram integradas total ou parcialmente aos tecidos ao longo do processo de regeneração óssea. Os resultados histométricos mostraram um índice médio de formação óssea de 60,86% para o Grupo GI, 54,29% para o grupo GII, 38,50% para o grupo GIII e 44,35% para o grupo GIV, verificando-se diferenças entre os grupos de tratamento, no entanto não se pode apontar superioridade de um dos materiais

The aim of this study was to evaluate, by histological and histometric analysis, the behavior of the association of autogenous bone graft with biomaterials used in sinus lift procedures. Out of 20 patients were used in this study, and they were equally distributed among 4 different groups: GI: Autogenous bone graft with DFDBA (Dembone®); GII: Autogenous bone graft with hidroxilapatite (Osteogen)®; GIII: Autogenous bone graft with castor oil polimer (Poliquil®); and GIV: Autogenous bone graft calcium phosphate cement (Bone Source ®).After the subantral augmentation was performed the autogenous bone graft was collected from the chin and associated with the biomaterial, according to the group the patient was previously located, and subantral cavity was filled. The groups were allowed to repair without load during 10 months. After this period biopsies were taken, during implant placement sugery for analysis. The results showed an improvement in bone area in all groups; The biomaterials were total or partial absorved thought out the bone regeneration process. The results of histomorfometrical analysis were GI 60,86%, GII 54,29% ; GIII 38,50% and GIV 44,35%, in although there were differences among the groups none of the materials showed a better result when compared to another one