J Periodontal Implant Sci.  2015 Dec;45(6):238-246. 10.5051/jpis.2015.45.6.238.

Bone formation around rhBMP-2-coated implants in rabbit sinuses with or without absorbable collagen sponge grafting

• Baek WS
• Yoon SR
• Lim HC
• Lee JS
• Choi SH
• Jung UW

• KMID: 2354942
• DOI: http://doi.org/10.5051/jpis.2015.45.6.238

Abstract

PURPOSE
The purpose of this study was to evaluate bone formation around recombinant human bone morphogenetic protein (rhBMP-2)-coated implants placed with or without absorbable collagen sponge (ACS) in rabbit maxillary sinuses.
METHODS
The Schneiderian membrane was elevated and an implant was placed in 24 sinuses in 12 rabbits. The space created beneath the elevated membrane was filled with either blood (n=6) or ACS (n=6). In the rabbits in which this space was filled with blood, rhBMP-2-coated and non-coated implants were alternately placed on different sides. The resulting groups were referred to as the BC and BN groups, respectively. The AC and AN groups were produced in ACS-grafted rabbits in the same manner. Radiographic and histomorphometric analyses were performed after eight weeks of healing.
RESULTS
In micro-computed tomography analysis, the total augmented volume and new bone volume were significantly greater in the ACS-grafted sinuses than in the blood-filled sinuses (P<0.05). The histometric analysis showed that the areas of new bone and bone-to-implant contact were significantly larger in the AC group than in the AN group (P<0.05). In contrast, none of the parameters differed significantly between the BC and BN groups.
CONCLUSIONS
The results of this pilot study indicate that the insertion of ACS after elevating the Schneiderian membrane, simultaneously with implant placement, can significantly increase the volume of the augmentation. However, in the present study, the rhBMP-2 coating exhibited limited effectiveness in enhancing the quantity and quality of regenerated bone.

Keyword

Bone morphogenetic protein 2; Collagen; Dental implants; Histology; Maxillary sinus floor augmentation; Microcomputed tomography

MeSH Terms

Bone Morphogenetic Protein 2
Bone Morphogenetic Proteins
Collagen*
Dental Implants
Humans
Maxillary Sinus
Membranes
Nasal Mucosa
Osteogenesis*
Pilot Projects
Porifera*
Rabbits
Sinus Floor Augmentation
Transplants*
X-Ray Microtomography
Bone Morphogenetic Protein 2
Bone Morphogenetic Proteins
Collagen
Dental Implants

Figure

• 

  Figure 1 Custom-made mini-implants and micrographs of their surfaces with and without a recombinant human bone morphogenetic protein (rhBMP)-2 coating. Custom-made mini-implants and micrographs of their surfaces with and without a recombinant human bone morphogenetic protein (rhBMP)-2 coating. (A) Schematic of the mini-implant (length, 6.0 mm; diameter, 3.0 mm), which had a sandblasted, large grain, acid-etched surface and included a 1.5-mm threaded portion in the coronal area for fixation and a 4.5-mm cylindrical portion that was coated with rhBMP-2. (B) Scanning electron microscopy (SEM) scan of the uncoated surface in the threaded area. (C) SEM scan of the rhBMP-2-coated surface in the cylindrical area.

• 

  Figure 2 Parameters for the linear and areal measurements. The rectangle with the blue border indicates the area of interest (AOI). The subarea bordered by a dotted line indicates the total augmented area (TA). The orange dotted line dividing the AOI indicates the Schneiderian membrane. NBA, new bone area; PH, protruding height; NBH, new bone height; CBT, cortical bone thickness; EH, exposed height.

• 

  Figure 3 Three-dimensionally reconstructed images of representative micro-computed tomography (micro-CT) views. Newly formed bone appears red, the mini-implant fixture appears green, and the nasal bone appears brown, with the internal surface of the implant facing upwards. (A, B) The newly formed bone had a pyramidal shape in the BN and BC groups. (C, D) The newly formed bone had a trapezoidal shape in the AN and AC groups. (A) The BN group, (B) the BC group, (C) the AN group, (D) the AC group. BC, blood-filled and coated implant; BN, blood-filled and non-coated implant; AC, absorbable collagen sponge and coated implant; AN, absorbable collagen sponge and non-coated implant. ACS, absorbable collagen sponge; L, lateral; M, medial; A, anterior; P, posterior.

• 

  Figure 4 Mean values of the total augmented volume (TV) and newly formed bone volume (NBV) beneath the elevated Schneiderian membrane in micro-computed tomography analysis (n=6, respectively). (A) TV, (B) NBV, (C) new bone density (NDV). *, significant difference, P<0.05.

• 

  Figure 5 Histologic images of representative sites after eight weeks of healing in the blood-filled group. (A): BN group. Bone formation in a pyramidal shape was observed. The red arrowhead indicates the outer boundary of the cortical bone layer, the yellow arrowhead indicates the inner boundary of the cortical bone layer, the blue arrowhead indicates the apical margin of new bone height (NBH), and the white horizontal line indicates the most apical line meeting the fixture. (B) The coronal part adjacent to the top area of the implant. (C) The apical part around the end of the newly formed bone. A well-maintained Schneiderian membrane was observed. (D) The BC group. (E) The coronal part adjacent to the top area of the implant. (F) The apical part around the end of the newly formed bone. NB, new bone.

• 

  Figure 6 Histologic images of representative sites after eight weeks of healing in the ACS-grafted group. (A) The AN group. (B) The coronal part adjacent to the top area of the implant. (C) The apical part around the end of the newly formed bone. A well-maintained Schneiderian membrane was observed. Detached newly formed bone was seen on the apical margin of the new bone height (NBH). Newly formed bone had a relatively low density. (D) The AC group. (E) The coronal part adjacent to the top area of the implant. (F) The apical part around the end of the newly formed bone. A high bone-to-implant contact ratio (BIC) was observed. NB, new bone.

• 

  Figure 7 Mean values of bone-to-implant contact (BIC), total augmented area (TA), newly formed bone area (NBA) and fibrovascular tissue area (FVA) in the area of interest in the histometric analysis (n=6, respectively). (A) BIC, (B) TA, (C) NBA, (D) FVA. *, significant difference, P<0.05

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