Freeze-dried homogeneous and heterogeneous bone for sinus augmentation in sheep. Part I: histological findings

Freeze-dried bone has been reported to possess an osteogenetic potential, i.e. to be osteo-inductive or osteoconductive depending on the grafted site. In this animal study homogeneous demineralized freeze-dried bone from the sheep (s-DFDB) and heterogeneous human demineralized freeze-dried bone (h-DFDB) used for single-stage sinus elevation were examined for their potential to improve bone-to-implant bonding. In 72 sinuses of 36 adult female mountain sheep Schneider's membrane was elevated from the local bone through an extra-oral approach and two cylindrical plasma-flame sprayed titanium implants were inserted in the lateral wall of each sinus. At the same time 18 sinuses were reinforced with s-DFDB, another 18 with h-DFDB and yet another 18 with autogenous cancellous bone from the iliac crest. In 18 animals the subantral space remained ungrafted. At each follow-up date, i.e. at 12, 16 and 26 weeks, 12 animals were re-examined and one randomly selected implant from each sinus was analyzed histologically and histomorphometrically. With both s-DFDB and h-DFDB extensive fragmentation and disintegration were seen side by side with sporadic areas of remineralization. These were mainly located in the vicinity of the local host bone and coalesced over time to be ultimately replaced and consolidated by woven bone. But most of the h-DFDB/s-DFDB particles continued to be embedded in abundant collagenous connective tissue and were surrounded by mononucleated and multinucleated giant cells, ultimately causing extensive resorption. The mean bone-to-implant contact length was 16.4% of the implant surface for s-DFDB, 16.9% for h-DFDB, 32.8% for autogenous bone and 22.2% in ungrafted controls. In the autogenous bone group the mean bone-to-implant contact length progressively increased with increasing contact time. In the control group, by contrast, the mean bone-to-implant contact length initially increased in the first two follow-up periods, but dropped again at 26 weeks. Both in the h-DFDB and the s-DFDB group the percent bone contact area was lower at 16 weeks than at 12 weeks but increased again by 26 weeks. In apical implant sections, s-DFDB produced significantly less bone-to-implant contact than autogenous cancellous bone from the iliac crest. In basal implant sections, both DFDB-grafted groups did significantly less well than the two control groups. The results of this experimental study showed that DFDB homografts and heterografts cannot be recommended alone instead of cancellous autografts from the iliac crest for augmenting the maxillary sinus in single-stage sinus elevations. Longer follow-up times than in the present study may perhaps show better results at the bone-implant interface.