Effects of implant placement timing and type of soft-tissue grafting on histological and histomorphometric outcomes in a preclinical canine model.

AIM: To determine the effects of implant timing and type of soft-tissue grafting on histological and histomorphometric outcomes in a preclinical model. MATERIALS AND METHODS: Four implant placement protocols were randomly applied at the mesial root sites of the third and fourth mandibular premolars in 10 mongrel dogs: immediate placement (group IP), early placement (group EP), delayed placement with/without alveolar ridge preservation (groups ARP and DP, respectively). A connective-tissue graft (CTG) or porcine-derived volume-stable collagen matrix (VCMX) was applied to enhance the ridge profile (simultaneously with implant placement in group IP and staged for others), resulting in five sites for each combination. All dogs were sacrificed 3 months after soft-tissue grafting. Histological and histomorphometric analyses were performed, and the data were analysed descriptively. RESULTS: CTG and VCMX were difficult to differentiate from the augmented area. The median total tissue thickness on the buccal aspect of the implant was largest in group IP/CTG (between 2.78 and 3.87 mm). The soft-tissue thickness was generally favourable with CTG at all implant placement timings. Within the DP groups, CTG yielded statistically significantly larger total and soft-tissue thickness than VCMX (p < .05). Among the groups with VCMX, group EP/VCMX showed the largest soft-tissue thickness at apical levels to the implant shoulder. CONCLUSIONS: CTG generally led to greater tissue thickness than VCMX.

Keratinized tissue augmentation using collagen-based soft tissue substitute with/without epidermal growth factor on buccally positioned implants: a pilot preclinical study.

OBJECTIVES: To investigate the effect of epithelial growth factor (EGF) with collagen matrix (CM) on the gain of KT for buccally positioned implants in dogs. MATERIALS AND METHODS: In five dogs, four implants were placed buccally with the whole part of KT excision on the buccal side (two implants per each hemi-mandible). After one month, KT augmentation was performed: 1) free gingival grafts (FGG), 2) collagen matrix (CM) only, 3) CM soaked with 1 µg/g of EGF, and 4) CM soaked with 10 µg/g of EGF (n = 5 in each group). The experimental animals were sacrificed three months post-KT augmentation. Clinical, histologic, and histomorphometric analyses were performed. RESULTS: The clinical KT zone was the highest in group FGG (5.16 ± 1.63 mm). Histologically, all groups presented buccal bony dehiscence. Regarding newly formed KT, no specific difference was found among the groups, but robust rete pegs formation in some specimens in group FGG. Histomorphometric KT height (4.66 ± 1.81 mm) and length (5.56 ± 2.25 mm) were the highest in group FGG, whereas similar increases were noted in the rest. The buccal soft tissue thickness at the coronal part of the implant did not exceed 2 mm in all groups. CONCLUSION: All groups presented increased KT zone, but FGG treatment was more favored. The addition of EGF to CM appeared not to enhance KT formation. CLINICAL RELEVANCE: FGG treatment was more favorable to re-establish the KT zone than other treatment modalities.

Dimensional ridge changes in conjunction with four implant timing protocols and two types of soft tissue grafts: A pilot pre-clinical study.

AIM: To determine the effect of (1) implant placement timing and (2) the type of soft tissue graft in terms of ridge profile changes. MATERIALS AND METHODS: Four implant treatment modalities were applied in the mesial root areas of the third and fourth mandibular premolars of 10 mongrel dogs alongside connective-tissue graft (CTG) and volume-stable cross-linked collagen matrix (VCMX): immediate, early, and delayed placement (DP), and DP following alveolar ridge preservation (ARP). All dogs were sacrificed 3 months after soft tissue augmentation. Standard Tessellation Language files from designated time points were analysed. RESULTS: Compared with the pre-extraction situation, the median width of the ridge demontstrated a linear increase only in group ARP/CTG (0.07 mm at the 2-mm level), whereas all other groups showed a reduction (between -1.87 and -0.09 mm, p > .05). Groups ARP/CTG (0.17 mm) and DP/CTG (0.05 mm) exhibited a profilometric tissue gain in a set region of interest (p > .05). The net effect of CTG and VCMX ranged from 0.14 to 0.79 mm. CONCLUSIONS: Dimensional ridge changes varied between treatment protocols. ARP with CTG led to the smallest difference in ridge profile between the pre-extraction and the study end time point. Both CTG and VCMX enhanced the ridge contour.

Effectiveness of hydraulic pressure-assisted sinus augmentation in a rabbit sinus model: a preclinical study.

OBJECTIVES: To investigate the effectiveness of hydraulic pressure-assisted sinus augmentation (SA) in a rabbit sinus model in terms of radiographical and histological healing. MATERIALS AND METHODS: Bilateral SA was performed in 12 rabbits. Each sinus was randomly assigned to either a hydraulic pressure-assisted SA (test) or a conventional SA (control) group. Healing periods of 2 and 4 weeks were applied (n = 6 for each week). Healing pattern including newly formed bone (NB) and residual bone substitute material (RM) was analyzed with microcomputed tomographically, histologically, and histomorphometrically. RESULTS: No sinus membrane perforation was detected in either group. In the microcomputed tomographic analysis, the test group exhibited higher apico-coronal spread of RM compared to the control group (p < 0.05). Particularly, the test group exhibited several masses of NB out of the cluster of RM. Histologically, the test group showed an elongated shape of the augmented space, whereas the control group generally presented a dome shape. Histomorphometrically, the total augmented area and the area of NB (1.32 ± 0.56 vs. 0.84 ± 0.40 mm2 at 2 weeks, 2.24 ± 1.09 vs. 2.22 ± 0.85 mm2 at 4 weeks) were not significantly different between the test and the control groups at both healing periods (p > 0.05). CONCLUSION: Hydraulic pressure-assisted SA led to new bone formation in the distant areas from the bony access hole, but similar histological healing pattern to conventional SA. CLINICAL RELEVANCE: Hydraulic pressure-assisted SA is a promising option for treating pneumatized posterior maxilla.

Late implant placement following ridge preservation versus early implant placement: A pilot randomized clinical trial for periodontally compromised non-molar extraction sites.

AIM: To compare late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites with respect to soft tissue levels, aesthetics, and patient-reported outcomes. MATERIALS AND METHODS: Sixteen patients were randomly allocated to groups LP/ARP (n = 9) or EP (n = 7). Group LP/ARP received ARP using deproteinized bovine bone mineral containing 10% collagen and a native bilayer collagen membrane, and group EP received only extraction. Implant placement was performed 4-8 weeks post-extraction in group EP and 4 months post-alveolar ridge preservation in group LP/ARP. The soft tissue levels, pink/white esthetic scores, and periodontal parameters were evaluated at 1 year post-loading. Patient's discomfort level was evaluated in terms of extraction/ARP and implant placement. RESULTS: No implant failure or biologic complications occurred. There was no statistically significant difference in the median change of the midfacial mucosal margin (0.03 for group LP/ARP, -0.19 mm for group EP) and the mesial/distal papilla (0.62/0.25 mm for group LP/ARP, 0.29/-0.5 mm for group EP), pink/white esthetic scores, periodontal parameters, and patient's discomfort between the two groups. CONCLUSION: Both implant placement protocols led to comparable outcomes in soft tissue levels, periodontal parameters, and patient's discomfort level.

An immediate peri-implantitis induction model to study regenerative peri-implantitis treatments.

OBJECTIVES: The aim of this study was to evaluate the validity of the immediate peri-implantitis model to test regenerative therapies in peri-implantitis defects. MATERIAL AND METHODS: In an immediate peri-implantitis model in beagles, the mandibular third premolars were extracted, and dental implants were immediately placed in the distal extraction sockets. Without a healing period, experimental peri-implantitis was induced by ligature placement for 3 months. In the conventional peri-implantitis model, dental implants were placed in the healed mandibular fourth premolar region and were submerged for osseointegration. After 3 months of healing, peri-implantitis induction was performed for another 3 months. After peri-implantitis defects were formed in both models, regenerative therapy was performed in both models. RESULTS: After 3 months in the immediate model and 9 months in the conventional model, similarly shaped horizontal bone defects (wide and craterlike) were observed. However, buccal bone defects were deeply formed in the immediate model compared with the conventional model (6.02 ± 1.20 and 4.34 ± 0.86 mm, respectively; P = 0.009), but the amounts of bone regeneration were not significantly different between the models (P = 0.107). On the lingual side, re-osseointegration was significantly greater in the conventional model than in the immediate model (0.72 ± 0.50 and 1.77 ± 0.87 mm, respectively; P = 0.009), although lingual bone defects were not significantly different between the models (P = 0.248). CONCLUSIONS: Although the immediate peri-implantitis model is challenging for regeneration, it may be able to replace the conventional model to study regenerative peri-implantitis treatment due to its short experimental time and similar defect configuration.

Gummy Smile Correction Using Lingual Orthodontics and Augmented Corticotomy in Extremely Thin Alveolar Housing.

BACKGROUND: Tooth movement out of anatomic limitations was assisted by augmented corticotomy using deproteinized bovine bone mineral. METHODS: Lip protrusion can be reduced by premolar extraction followed by retraction of the anterior teeth. Surgical intervention is appropriate when the alveolar bone housing of the anterior region is insufficient for the tooth movement. In this patient, corticotomy in upper palatal area and anterior segmented osteotomy in the mandible were performed. Anatomic limitation to the retraction was expanded by xenograft. An antero-posterior lingual appliance was used to bodily retract the upper anterior teeth. The gummy smile was resolved by intrusion of upper entire arch using 2 mid-palatal temporary skeletal anchorage devices. RESULTS: New bone formation was observed on palatal side of upper anterior teeth. The teeth were moved into augmented area without fenestration or vitality loss. Lip protrusion was resolved, and the gummy smile was effectively improved. CONCLUSIONS: Orthodontic tooth movement beyond the limitation of the alveolar bone housing can be achieved with surgical assistance, which can be performed under local anesthesia. Without orthognathic surgery, the gummy smile can be reduced using an antero-posterior lingual retractor with mid-palatal skeletal anchorage.

Validity of Collagen Plugs for Ridge Preservation in a Canine Model.

PURPOSE: The purpose of the present study was to evaluate healing outcomes after collagen plug insertion in extraction-related defects. MATERIALS AND METHODS: The third and fourth mandibular premolars in canines were extracted, and the septal bone was removed. The following treatments were performed for the defects: porcine atelo-collagen plug, bovine atelo-collagen plug, and no intervention (control). The experimental animals were killed after 6, 12, or 24 weeks (n = 4, respectively). Histologic and histomorphometric analyses were performed. RESULTS: Clinical healing was uneventful, and no difference was detected among the 3 groups. Histologically, similar healing patterns were observed in all groups. Gingival healing was complete at 6 weeks, but discontinuity in the buccal crestal bone was observed. At 12 weeks, various degrees of buccal bone depression and increase in bone marrow were observed. At 24 weeks, no further healing was observed. Histomorphometrically, the ridge width at 1, 3 and 5 mm levels below the crest and the ridge dimensions 1, 3, and 5 mm above the level were not statistically different among groups or healing periods. CONCLUSION: The healing following the use of collagen plug in the extraction socket may correspond to the natural healing after extraction.

Surface properties correlated with the human gingival fibroblasts attachment on various materials for implant abutments: a multiple regression analysis.

OBJECTIVES: To reveal the suitable surface condition of an implant abutment for fibroblast attachment, the correlation between the surface characteristics of various materials and the human gingival fibroblast (HGF-1) attachment to the surfaces were analyzed. METHODS: Six kinds of surfaces comprised of machined titanium alloy (SM), machined Co-Cr-Mo alloy (CCM), titanium nitride coated titanium alloy (TiN), anodized titanium alloy (AO), composite resin coating on titanium alloy (R) and zirconia (Zr) were used. The measured surface parameters were Sa, Sq, Sz, Sdr, Sdq, Sal, Str and water contact angle (WCA). The HGF-1 cell attachment was investigated and the correlations were analyzed using a multiple regression analysis. RESULTS: The HGF-1 cell attachment was greater in the SM, TiN and Zr groups than the other groups and smallest in the CCM group (p = 0.0096). From the multiple regression analysis, the HGF-1 cell attachment was significantly correlated with Sdr, Sdq and WCA. When the R group was excluded, only WCA showed significant correlation with the fibroblast attachment. CONCLUSIONS: Within the limitations of this study, the cell attachment of human gingival fibroblasts was correlated with WCA, developed interfacial area ratio and surface slope. When the surfaces with Sa values of ∼ 0.2 µm or less were concerned, only WCA showed a correlation in a third order manner.

Time-dependent periimplant bone reaction of acidic monomer-treated injection molded zirconia implants in rabbit tibiae.

PURPOSE: The aim of this study was to evaluate and compare the osseointegration of zirconia implants in rabbit tibiae with and without 10-methacryloyloxydecyl dihydrogen phosphate (MDP) treatment. MATERIALS AND METHODS: Twenty-eight rabbits received a total of 112 external hex-type implants made by the powder injection molding technique with and without MDP treatment before installation in the tibiae. The contact angles on the zirconia implants and zirconia discs before and after MDP application were evaluated. Removal torque (RT) and bone-implant contact (BIC) ratios were measured. RESULTS: The MDP treatment markedly enhanced the hydrophilicity and seemed to alter the topography and chemical composition of the implant and disc surface. As the healing time increases, the BIC and RT were increased in both groups. The MDP-treated implants exhibited higher BIC values than the control implants after 2 and 4 weeks of healing. The RT was higher in MDP-treated implants after 2 weeks of healing but not after 4 weeks of healing. CONCLUSION: The 10-MDP treatments made the surface more hydrophilic and enhanced the osseointegration of the implants in the early healing phase.

Decontamination methods using a dental water jet and dental floss for microthreaded implant fixtures in regenerative periimplantitis treatment.

OBJECTIVE: This study evaluated decontamination methods using a dental water jet and dental floss on microthreaded implants for regenerative periimplantitis therapy. MATERIALS AND METHODS: In 6 beagle dogs, experimental periimplantitis was induced, and decontamination procedures, including manual saline irrigation (control group), saline irrigation using a dental water jet (group 1) and saline irrigation using a dental water jet with dental flossing (group 2), were performed. After in situ decontamination procedures, some of the implant fixtures (n = 4 per group) were retrieved for analysis by SEM, whereas other fixtures (n = 4 per group) underwent regenerative therapy. After 3 months of healing, the animals were killed. RESULTS: The SEM examination indicated that decontamination of the implant surfaces was the most effective in group 2, with no changes in implant surface morphology. The histological examination also revealed that group 2 achieved significantly greater amounts of newly formed bone (6.75 ± 2.19 mm; P = 0.018), reosseointegration (1.88 ± 1.79 mm; P = 0.038), and vertical bone fill (26.69 ± 18.42%; P = 0.039). CONCLUSION: Decontamination using a dental water jet and dental floss on microthreaded implants showed positive mechanical debridement effects and positive bone regeneration effects.

Primary flap closure in alveolar ridge preservation for periodontally damaged extraction socket: A randomized clinical trial.

INTRODUCTION: The effect of primary wound closure (PC) on alveolar ridge preservation (ARP) in periodontally damaged sockets has yet to be fully discovered. METHODS: Periodontally damaged sockets were allocated to one of the following groups: (1) ARP with PC (group PC), and (2) ARP without PC (group secondary wound closure [SC]). Following tooth extraction and flap elevation, granule-type xenogeneic bone substitute material and a collagen barrier were applied. Ridge change was evaluated using cone-beam computed tomographic (CBCT) scans immediately after ARP and at 4 months. Core biopsy specimens were examined histomorphometrically. RESULTS: A total of 28 patients were included in the analysis (13 in group PC, 15 in group SC). Histomorphometrically, the percentage of newly formed bone was 26.2 ± 17.7% and 24.6 ± 18.4% in groups PC and SC, respectively (independent t-test, degree of freedom [df] = 25, p > 0.05). Horizontal ridge changes on CBCT were -4.9 ± 3.1 mm and - 4.2 ± 2.5 mm in groups PC and SC at the 1 mm level below the ridge crest, respectively (independent t-test, df = 26, p > 0.05). Approximately half of the sites required additional bone augmentation at implant placement. CONCLUSIONS: ARP with/without PC yielded similar new bone formation and radiographic ridge change. This clinical trial was not registered prior to participant recruitment and randomization (https://cris.nih.go.kr/cris/search/detailSearch.do/19718).

Soft tissue outcomes following alveolar ridge preservation with/without primary flap closure for periodontally damaged extraction socket: A randomized clinical trial.

INTRODUCTION: The changes in soft tissue profile following alveolar ridge preservation (ARP) with/without primary flap closure (PC) in periodontally damaged sockets have yet to be discovered. METHODS: For periodontally damaged non-molar extraction sockets, ARP with PC (group PC)/without PC (group SC) was performed using granule-type xenogeneic bone substitute material and a collagen barrier. Intraoral scans were performed at the time of ARP and 4 months thereafter. Superimposition of STL files was performed to examine tissue change on the soft tissue level. The level of mucogingival junction (MGJ) was also evaluated. RESULTS: A total of 28 patient (13 in group PC, 15 in group SC) completed the study. Soft tissue profile change was evaluated only when the measurement level was located on the non-mobile tissue. Group PC tended to shrink less on the long axis of the extraction socket than group SC (-4.3 ± 3.1 mm vs. -5.9 ± 4.4 mm at the 1 mm below the pre-extraction gingival margin, p > 0.05). Profilometric analysis (on the region of interest) also have a tendency of less tissue profile change in group PC than group SC (-1.0 ± 0.8 mm vs. -1.3 ± 0.5 mm, p > 0.05). The MGJ level change was not statistically significantly different between the groups (p > 0.05) even though the MGJ level was located more apically at 4 months in group SC compared with group PC. CONCLUSIONS: Alveolar ridge preservation with PC tended to yield less soft tissue shrinkage than ARP without PC.

The effect of non-resorbable membrane on buccal bone healing at an immediate implant site: an experimental study in dogs.

OBJECTIVE: For successful implant treatment in the esthetic area, stable hard tissue and soft tissue are very important. At the buccal side without buccal bone defects, prophylactic guided bone regeneration (GBR) with bone substitute was frequently used for achieving thick buccal bone. The aim of this study was to evaluate the effect of GBR using a non-resorbable membrane in an immediate implant site without bone defects. MATERIAL AND METHODS: Immediate implants were placed into the mandibles of four mongrel dogs. In the experimental group (TM group), a non-resorbable membrane was placed and fixed onto the buccal bone plate around the implant. In the control group, the implants were placed without membrane coverage. After 12 weeks, the dogs were sacrificed and histological specimens were prepared. The vertical distances from the smooth-rough surface interface (SRI) to the gingiva, the first-bone contact, and the bone crest were measured on the buccal and lingual sides. The horizontal thicknesses of the gingiva and bone at 0, 1, 2, and 3 mm below the SRI were measured. RESULTS: In the TM group, first-bone contact on the buccal side was more coronally positioned approximately 0.8 mm than the control group (P=0.041). The buccal bone thickness of the TM group was well preserved and there was no difference between the buccal and lingual sides. Comparing the control group, implants of the TM group had 1 mm thicker buccal bone (P=0.0051 at bone 1 mm level, P=0.002 at bone 2 mm level). In the control group, buccal bone loss was observed and buccal bone was about 1 mm thinner than the lingual bone (P<0.05). CONCLUSIONS: GBR with a non-resorbable membrane and no bone graft substitute could help to preserve buccal bone thickness on the immediate implant site without defects.

A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites.

Information regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4-8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04-0.35 mm in group LP/ARP, 0.04-0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

Relationships between cognitive function and frailty in older Korean adults: The moderating effect of the number of teeth.

BACKGROUND: Cognitive function and physical frailty are known to be closely related. Among older adults with dementia, those who wear dentures have a higher mortality rate than those who do not wear them. This suggests the possibility that oral health may affect the cognitive-frailty relationship. This study aims to investigate whether the number of teeth present, acts as a moderating variable in the cognitive function-frailty relationship. METHODS: Data were obtained from the cross-sectional baseline study of the Korean Frailty Aging Cohort Study (2016-2017). Cognitive function was assessed using the Mini-Mental State Examination. Frailty score was based on the Cardiovascular Health Study Index. Oral condition was evaluated by the number of teeth present and analyzed using categories of 0-9 teeth, 10-19 teeth, and ≥20. The moderation effect was analyzed using the ordinary least squares (OLS) regression. RESULTS: Data on 2,310 older adults (1,110 men; mean age 75.9 ± 3.9 years) was analyzed. Adjusting for age, sex, income, education, alcohol drinking, body mass index, and number of comorbidities, cognitive function and frailty showed a negative association (B=-.030, p = .011). In the 10-19 teeth category, compared to the 0-9 teeth category, a negative association with frailty was found (B=-.152, p = .026). A significant interaction effect between the number of teeth and cognitive function was detected (p = .007). CONCLUSION: The number of teeth may modify the degree of the association between cognitive function and frailty. For effective frailty management of older persons, cognitive function management and oral management should be considered and performed together.

Factors influencing the outcome of root-resection therapy in molars: a 10-year retrospective study.

BACKGROUND: Root resection is one treatment option for preserving molars with furcation involvement. This study evaluated the prognosis of root-resection therapy retrospectively and examined the factors influencing the survival rate of resected molars. METHODS: Root-resection therapy was performed on 691 molars in 579 patients. The associated factors were examined from 342 of 402 molars that had been followed up for >1 year. Survival analysis was used to statistically analyze the factors. RESULTS: Over the past 10 years, 102 of 342 cases (29.8%) failed. The factors were classified into four groups and analyzed to determine their influence on the survival rate of the resected molars. Regarding the resection-related factors, the molars resected because of periodontal problems had a higher survival rate than those resected because of non-periodontal problems (tooth fracture, dental caries, and endodontic problems; P = 0.0097). Patient- and tooth-related factors had no effect on the survival rates. Among the site-related factors, only the amount of bone support of the remaining roots at the time of surgery had a significant effect on the survival rate in the group of molars with periodontal problems (P = 0.0269). CONCLUSIONS: Root resection to treat periodontal problems had a better prognosis than for non-periodontal problems. To achieve a good result, it was important that the remaining roots had >50% bone support. This guideline may help to improve the predictability of root-resection therapy.

Cone-beam computed tomographic analysis of the alveolar ridge profile and virtual implant placement for the anterior maxilla.

PURPOSE: To analyze the ridge profile of the anterior maxilla using cone-beam computed tomography and to assess the clinical significance of the ridge profile by performing virtual implant placement. METHODS: Thirty-two cone-beam computed tomography scans of anterior maxillae were included. For each tooth, a vertical line was made along the longitudinal axis, and 3 horizontal lines at 1-, 3-, and 5-mm levels below the labial bone crest were drawn perpendicularly to the vertical reference. At these levels, the thickness of the alveolar ridge (RT), and the labial (LT) and palatal bone plate (PT) were measured. Then, virtual implant placement using standard and tapered implants was performed. A generalized linear mixed model was used for statistical analysis. RESULTS: The teeth were located labially based on the proportion of LT and PT with respect to RT. At the 1-mm level, the value of LT was between 1.0±0.4 mm for central incisors and 1.3±0.6 mm for canines. A large number of teeth had area(s) with less than 1-mm-thick labial bone between the 1- and 5-mm levels below the crest. The mean PT was generally thicker than the LT in all tooth types. The greatest mean value of labial concavity was observed for canines, compared to other tooth types. Men had a greater RT than did women, but had a comparable LT. Less apical fenestration was observed when tapered implants were used. CONCLUSIONS: Most teeth in the anterior maxilla had a thin labial bone plate, with no significant difference between sexes. Tapered implants may be advantageous for the anterior maxilla.

Bone reaction to bovine hydroxyapatite for maxillary sinus floor augmentation: histologic results in humans.

This study was designed to examine the sequential progress of healing, at two different time intervals, following delayed sinus augmentation using bovine hydroxyapatite (BHA) as the sole grafting material. Fourteen pairs of bone biopsies were taken from 10 patients after 6 and 12 months of healing, respectively. The biopsy specimens were examined histologically and histomorphometrically. The bone that was formed following sinus augmentation with BHA increased and matured over time up to 12 months after grafting; meanwhile, no overt signs of resorption of BHA were visible within the study period.