Single-Stage Lateral Sinus Floor Elevation Using Different Grafts: A Systematic Review of Controlled Clinical Trials.

PURPOSE: To assess histologic and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, and compare different types of grafts. MATERIALS AND METHODS: This systematic review (SR) was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual investigations, were searched to identify clinical trials reporting specific requirements. The present study needed human histologic and imaging data of bone formation around implants inserted into the maxillary sinus simultaneously with elevation and augmentation procedures. Study selection, risk of bias (Rob 2.0 or ROBINS-I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. RESULTS: Of the 1,101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility, and 5 were included (4 randomized and 1 controlled clinical trial). As a result, 130 grafted sinuses with 179 placed implants in 103 patients were analyzed. The patients were aged between 24 and 79 years and followed up between 6 and 15 months. The heterogeneity between studies did not allow the data to be combined for meta-analysis. All graft materials proved to be viable options for the intervention. The use of biphasic calcium phosphate was related to higher bone-to-implant contact. CONCLUSIONS: All of the assessed grafts are viable options for the addressed intervention. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical implant site under the sinus membrane. Longer chair time and donor site morbidity should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior bone-to-implant contact compared to deproteinized bovine bone.

Demineralized Human Dentin Matrix as an Osteoinductor in the Dental Socket: An Experimental Study in Wistar Rats.

PURPOSE: This study evaluated the bone-forming potential of the demineralized human dentin matrix by performing histologic and morphometric analyses. The immunolabeling of osteopontin, a determinant protein for bone repair, was also evaluated. MATERIALS AND METHODS: Wistar rats were selected and submitted to the extraction of the right and left second molars. Tooth sockets were separated into two groups: the control group (right), which was filled with the blood clot, and the experimental group (left), which was filled with demineralized human dentin matrix. Animals were sacrificed at 5, 10, and 21 days. Histologic and histoquantitative analyses (analyses of variance [ANOVA] and Tukey's test) were performed, as well as immunostaining for osteopontin as an osteogenesis indicator. RESULTS: After 5 days, demineralized human dentin matrix was incorporated by new trabeculae. After 10 days, connective tissue organization and new trabeculae were observed in the experimental group, and intense staining for osteopontin close to demineralized human dentin matrix was observed in the experimental group. After 21 days, the experimental group was showing mature trabeculae. A statistical difference was observed (P < .05). There was a higher number of trabeculae in the experimental groups in all periods of analysis. The presence of osteopontin was observed more intensely at 10 days close to demineralized human dentin matrix. CONCLUSION: This study indicates that demineralized human dentin matrix implanted in tooth sockets induces the acceleration of osteogenesis.