Nonceramic hydroxyapatite bone derivative in sinus augmentation procedures: Clinical and histomorphometric observations in 10 consecutive cases

A synthetic, nonceramic resorbable hydroxyapatite (R-HA) was applied to augment the subantral area in 10 consecutive sinus lift procedures in humans. Implants were simultaneously placed in eight patients; in the remaining two, where residual bone height was less than 3 mm, a two-stage surgical approach was carried out. The aim of the study was to examine, clinically and histopathologically at 12 months, the healing pattern of these augmented sinuses around the implants. In the simultaneous technique, radiopaque grafted mineral surrounded the implants. In the two-stage technique, R-HA particles filled the augmented site and were confined to the subantral area. At the uncovering phase, all implants (n = 36) were stable, with no clinical bone resorption around the cervix. A 2.5-mm trephine bur was used to collect specimens from the 10 augmented sites at the lateral-deep area. Histologically, new bone formation was evident in all examined cores. R-HA particles were primarily surrounded by newly formed bone, mostly woven bone, in different stages of remodeling. However, in the deep areas of the specimen cores, lamellar bone fragments were also seen. Morphometric measurements showed that the mean bone area of the 10 sites was 28.1% at the lateral/external side and 37.8% at the deep/inward side. Under polarizing microscopy, the mean lamellar:woven bone ratio was 1:7.2 at the lateral side and 1:4.2 at the deep end. Differences were statistically significant. R-HA proved to be a suitable filler material for osseointegrated implants in sinus augmentation procedures, since it showed both biocompatible and osteoconductive properties.