September 15, 2014
Study shows significant difference in height of grafted sinus in subjects treated with two doses of MCBA +rhBMP-2/ACS compared to subjects treated with MCBA alone (control group) three weeks after grafting, with similar heights between the groups after 6 to 9 months postoperative healing. There was no significant difference in volume or shrinkage between the groups. The bone density increase over time in both treatment groups was similar and statistically higher than in the control group. However, the density in the control group was still significantly greater than in either test group.
Researchers from the New York University College of Dentistry (NYUCD) and the Bluestone Center for Clinical Research have published “Radiographic Comparison of Different Concentrations of Recombinant Human Bone Morphogenetic Protein with Allogenic Bone Compared with the Use of 100% Mineralized Cancellous Bone Allograft in Maxillary Sinus Grafting” in The International Journal of Periodontics & Restorative Dentistry.
The rehabilitation of edentulous posterior maxilla with dental implants can be challenging due to insufficient bone volume. The vertical dimension of the alveolar bone can be increased by using the maxillary sinus augmentation procedure, although it is not clear which bone grafting material is most effective for this technique. Assessment of augmented areas can be performed using histomorphometric analysis, dental radiographs, panoramic radiographs, and computed tomography (CT) scans. Although the amount of bone resorption can be measured as height and width reductions in two-dimensional radiographs, these measurements only represent one axis of the three-dimensional graft. Using CT scans in conjunction with CT data software, it is possible to determine both the absolute amount of bone volume reduction and bone density. The purpose of this study was to radiographically evaluate through CT scans bone height, volume, and density after the grafting of maxillary sinuses using MCBA alone, or MCBA plus two different doses of rhBMP-2/ACS. The secondary objective was to evaluate the combined analysis of percentage of vital bone and bone height, volume, and density 6-9 months after grafting.
Eighteen subjects who required bilateral subantral sinus grafting (resulting in a total of 36 maxillary sinus augmentation sites) were enrolled in and completed the study, and were randomized to receive one of the following study treatments in each sinus: MCBA only (control), MCBA + 5.6 mL rhBMP-2/ACS (T1), or MCBA + 2.8 mL rhBMP-2/ACS (T2). CT scans were analyzed using a computer software system at two different time points: 3 weeks after sinus grafting surgery, and 6-9 months after sinus grafting surgery. The investigators found that while there was a significant difference in bone volume between T1 and control, and T1 and T2, 6-9 months after grafting, the overall decrease in bone volume at this time point was substantial and not significantly different between the groups. At both time points, there was a significant difference in bone density between all three groups. The investigators found a strong association between height and volume in all groups (although it was not significant in the control group), and an association between volume and new vital bone in the control group alone. No statistically significant relationships between height and bone density or between volume and bone density were observed for any group. The investigators recommend further studies involving a larger number of subjects to verify these results.
The article was authored by Stuart J. Froum, DDS, clinical professor and director of clinical research in the Department of Periodontology and Implant Dentistry, NYUCD. Other authors include Ismael Khouly, DDS, MS, PhD, clinical assistant professor of oral and maxillofacial surgery and clinical research coordinator at the Bluestone Center for Clinical Research; Patricia Corby, DDS, MS, Associate Director, Bluestone Center for Clinical Research; Stephen Wallace, DDS; Sang-Choo Cho, DDS; Edwin Rosenberg, DMD; Scott Froum, DDS; Patrick Mascarenhas, DDS; and Dennis Tarnow, DDS.
About the Bluestone Center for Clinical Research: The Bluestone Center for Clinical Research, in conjunction with the NYU Oral Cancer Center, is an academic research organization located at the NYU College of Dentistry. Bluestone’s mission is to take a creative scientific approach to transform world health. Bluestone is dedicated to conducting research in oral cancer, cancer symptomology, pharmaceuticals, medical devices, emerging biotechnology, periodontics, implants, and oral health products.
About New York University College of Dentistry: New York University College of Dentistry (NYUCD) is the third oldest and the largest dental school in the US, educating more than 8 percent of all dentists. NYUCD has a significant global reach and provides a level of national and international diversity among its students that is unmatched by any other dental school.