Does the association of blood-derived growth factors to nanostructured carbonated hydroxyapatite contributes to the maxillary sinus floor elevation? A randomized clinical trial.

OBJECTIVE: The combination of calcium phosphate with blood-derived growth factors (BDGF) has been widely used in bone regeneration procedures although its benefits are still unclear. The purpose of this study was to evaluate whether or not BDGF improves the efficacy of a modified carbonated calcium phosphate biomaterial in sinus floor augmentation. MATERIAL AND METHODS: Ten patients underwent 20 sinus floor augmentation procedures using nanostructured carbonated hydroxyapatite (cHA) microspheres alone or associated with BDGF in a randomized controlled clinical trial. The in vitro release of growth factors was assessed by an elution assay. Bone grafts were randomly implanted in the right and left maxillary sinuses of each participant, associated either with a 0.9% saline solution or BDGF. Bone gain was evaluated through cone beam tomography after 180 days. RESULTS: Nine women and one man composed the sample. The blood-derived concentrates were able to release high levels of growth factors and cytokines. A significant clinical advantage was observed in the use of the BDGF after fibrin polymerization around the biomaterial microspheres, optimizing the surgical procedures, thereby reducing the time and displacement, and improving the adaptation of the biomaterial in the maxillary sinus. No synergistic effect was observed in bone formation when cHA was associated with BDGF (p > 0.05). CONCLUSION: Equivalent new bone formation was observed for cHA in the presence or absence of the BDGF concentrate in bilateral sinus floor elevation after 6 months. Blood-derived growth factors did not improve bone repair when associated with calcium phosphate in sinus lift procedures.

Avaliação clínica de compósito constituidos por fosfato de cálcio nanoestruturado e biopolímero associado à células osteoprogenitoras como alternativa à biocerâmica para a uso na rede SUS na reneração óssea / Clinical evaluation of composite constitude by nanostructured calcium phosphate and biopolymer associated with osteoprogenitor celss as an alternative to bioceramics for use in the S*S network in bone regeneration

Os biomateriais nanoestruturados têm se destacado como elementos estratégicos para a medicina regenerativa devido à sua grande área específica, a sua característica de atuar como veículo portador e libera dor de fatores de crescimento, células e pela sua mobilidade no plasma, no meio extra e intra-celular. Nos últimos anos, a equipe executora deste estudo, constituída por pesquisadores do CBPF, UFF, UFRJ e INMETRO têm concentrado seus esforços no desenvolvimento de novos fosfatos de cálcio na forma nanoestruturada e com substituições iônicas para uso clí nico. Estas características potencializam a bioabsorção do material e sua eficiência na regeneração tecidual, bem como seu uso como nanocarreador de biomoléculas (proteínas, peptídeos, fatores de crescimento e fármacos). Neste estudo foi produzido e avaliado clinicamente um novo biomaterial para a regeneração óssea, seguindo o princípio de “quality by desing”, visando aumentar sua eficiência em procedimentos clínicos específicos tais como o tratamento do edentulismo...