Comparative Histological and Histomorphometric Analysis of Cerabone^® Plus and Bio-Oss^® After Human Sinus Floor Augmentation

Bio-Oss^® is the clinical benchmark xenograft for maxillary sinus floor augmentation, whereas Cerabone^® is produced by high-temperature sintering into a highly crystalline, volume-stable, but largely bioinert scaffold. Cerabone^® plus adds a hyaluronate (Hya) coating intended to "biologize" this otherwise purely osteoconductive scaffold without compromising its sintering-related volume stability. The aim of this study was to compare the histological and histomorphometrical healing pattern of cerabone plus and Bio-Oss after human sinus floor augmentation.

Twenty-three patients underwent sinus floor augmentation with Bio-Oss (n=12) or cerabone plus (n=11). Bone core biopsies were harvested at implant placement after 6 months of healing and processed for histological and histomorphometrical analysis. Relative area fractions of newly formed bone (NB), residual bone substitute material (BSM) and connective tissue (CT) were determined and compared by one-way ANOVA with Tukey's multiple comparisons test.

Both materials showed comparable osteoconductive integration, with new bone forming directly on the granule surfaces. NB, BSM and CT fractions were 26.84±8.08% vs. 19.33±4.58%, 28.55±10.32% vs. 31.82±4.45%, and 44.61±8.21% vs. 48.86±3.92% for Bio-Oss vs. cerabone plus, respectively; none differed significantly between materials (NB, p=0.398; BSM, p=0.959; CT, p=0.883). Within each material, CT was significantly higher than NB and BSM (Bio-Oss, both p<0.0001; cerabone plus, p<0.0001 and p=0.0053, respectively), while NB and BSM did not differ significantly (Bio-Oss, p=0.994; cerabone plus, p=0.079).

Cerabone plus achieved a histomorphometric tissue distribution comparable to Bio-Oss after 6 months of healing; however, without an uncoated cerabone control group, the specific contribution of the hyaluronate coating cannot be determined.