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Comparing Two Surgical Approaches Using Cross-Linked Hyaluronic Acid-Biofunctionalized Alloplast Particulate in Sinus

Chantal Wittmers1, Anton Friedmann1, Andreas van Orten2

  • 1Department of Periodontology, Faculty of Health, School of Dentistry, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany.

Journal of Functional Biomaterials
|February 26, 2026
PubMed
Summary

Sinus floor elevation using beta-tricalcium phosphate/hydroxyapatite alloplast biofunctionalized with hyaluronic acid showed safe and beneficial outcomes. Both transcrestal and lateral approaches yielded satisfactory results, with 100% implant survival after one year.

Keywords:
bone graftingcross-linked hyaluronic aciddental implantssinus floor elevationß-TCP/HA

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Area of Science:

  • Biomaterials Science
  • Oral and Maxillofacial Surgery
  • Regenerative Medicine

Background:

  • Sinus floor elevation (SFE) is crucial for dental implant placement in atrophic maxillae.
  • Biofunctionalized bone graft materials aim to enhance bone regeneration.
  • Comparing surgical access techniques is essential for optimizing SFE outcomes.

Purpose of the Study:

  • To evaluate the efficacy of beta-tricalcium phosphate/hydroxyapatite (ß-TCP/HA) alloplast, biofunctionalized with cross-linked hyaluronic acid (xHya), for SFE.
  • To compare an innovative transcrestal sinus floor elevation (tSFE) technique with a conventional lateral window approach (lSFE).
  • To assess clinical, radiographic, and histological outcomes of SFE using these materials and techniques.

Main Methods:

  • Twenty patients with residual bone height ≤ 4 mm underwent SFE using either tSFE or lSFE.
  • Graft material: ß-TCP/HA alloplast biofunctionalized with xHya, covered by a collagen membrane.
  • Evaluation at 5 months: Cone Beam Computed Tomography (CBCT), implant placement, and bone core biopsies.
  • Follow-up: 1-year implant survival rate.

Main Results:

  • Eighteen patients qualified for implant placement; ten provided biopsies.
  • Histomorphometry showed a mean of 61.17% newly formed bone.
  • The lateral approach (lSFE) enabled placement of longer implants without augmentation in 9/10 cases, while the transcrestal approach (tSFE) required additional augmentation.
  • All implants integrated, and the 1-year survival rate was 100%.

Conclusions:

  • Biofunctionalized ß-TCP/HA alloplast with xHya is safe and effective for SFE.
  • Both surgical techniques demonstrated satisfactory clinical, radiographic, and histological results.
  • In severely atrophic conditions, the tSFE method may necessitate a combined approach with the conventional lateral technique.