Greffes sinusiennes massives par phosphate tricalcique. Résultats à long terme

doi:10.1016/j.stomax.2008.10.006

Revue de Stomatologie et de Chirurgie Maxillo-faciale

Volume 110, Issue 2, April 2009, Pages 69-75

https://doi.org/10.1016/j.stomax.2008.10.006 Get rights and content

Résumé

Introduction

L’utilisation de substituts osseux dans les greffes sinusiennes massives à visée pré-implantaire est controversée. Nous avons évalué la fiabilité à long terme du phosphate tricalcique sous forme β (βTCP, Cerasorb^®, Curasan, Kleinostheim, Allemagne) dans cette indication.

Matériel et méthode

Vingt patients (33 sinus) présentant une atrophie osseuse sévère (classes 4 à 6 selon Cawood) ont eu un comblement sinusien par βTCP. Ils ont été suivis prospectivement entre janvier 2002 et mai 2008. La voie d’abord latérale était classique (sous anesthésie locale chez huit patients). Le sinus a été comblé par 6 cm³ de βTCP en moyenne. Des facteurs de croissance autologues de type PRP et PRF ont été associés selon la technique décrite par Dohan et Weibrich. Cent vingt-trois implants ont été mis en place entre le quatrième et le huitième mois postopératoire (implants Nobel Biocare MK III et MK IV–longueur moyenne 12,44 mm) selon une technique enfouie suivie d’une mise en charge entre le quatrième et le sixième mois. La surveillance comportait des examens cliniques et des orthopantomogrammes réguliers à la recherche de complications sinusiennes et/ou implantaires. Les radiographies ont également servi à la mesure de la résorption du biomatériau.

Résultats

Le recul postopératoire moyen a été de 4,5 ans pour les greffes sinusiennes et de quatre ans pour les implants. Pour les greffes sinusiennes, un cas d’infection locale a été noté au 15^e jour postopératoire (3 %). Le taux de succès implantaire a été de 97,6 % (deux absences d’ostéo-intégration et une perte après mise en charge). Le taux de succès prothétique a été de 100 %. La résorption moyenne du matériau a été de 20,3 % et le gain moyen de hauteur a été de 16,9 mm.

Discussion

L’utilisation de βTCP, sans apport osseux, associés aux facteurs de croissance (PRP ou PRF) dans les greffes sinusiennes entraîne peu de complications. Le taux de succès implantaire est équivalent à celui obtenu par greffe d’os autologue. La résorption du matériau est comparable à celle de l’os autologue.

Summary

Introduction

The use of bone substitutes in massive sinus-lift pre-implant procedures remains controversial. The aim of our study was to evaluate the long-term reliability of pure-phase β-tricalcium phosphate (βTCP, Cerasorb^©, Curasan, Kleinostheim, Germany) used in this particular indication.

Material and method

Twenty patients (33 sinus) presenting with severe sinus floor atrophy (class 4 to 6 according to Cawood) and having undergone a sinus lift procedure by mean of βTCP were followed in a prospective study between january 2002 and may 2008. The surgical approach was classical (under local anesthesia in eight patients) and the sinuses were filled with βTCP (6 cm³ on average per sinus) and autologous growth factors (platelet rich plasma PRP and platelet rich fibrin PRF, according to the technique described by Dohan and Weibrich). One hundred and twenty-three dental implants were inserted in the grafted sinuses between the fourth and the eighth postoperative month (Nobel Biocare MK III and MK IV–mean length: 12.44 mm) using a 2-step buried technique and loaded between the fourth and the sixth month. Follow-up included regular clinical examination and panoramic X-rays to screen for possible sinus and implant complications. The control X-rays also allowed measuring the biomaterial resorption rate.

Results

The mean postoperative follow-up was 4.5 years for the sinus lift procedures and 4 years for the implants. We noted one case of local infection at the 15th postoperative day (3%). The implant success rate was 97.6% (lack of osteo-integration for two implants in the same patient, one failure after loading). The prosthetic success rate was 100%. The mean resorption rate of the material was 20.3% and the mean gain of height was 16.9 mm.

Discussion

The use of βTCP associated to growth factors (PRP ou PRF) without bone graft, in massive sinus-lift procedures induces few complications. The implant success rate is comparable to the one obtained by using autologous bone grafts. The resorption rate of the material is comparable to that of autologous bone.

Section snippets

Intoduction

Le matériau de comblement de référence dans les greffes sinusiennes à visée pré-implantaire est l’os autologue 1, 2. Compte tenu de la morbidité aux sites donneurs 3, 4 et du recours fréquent à une anésthésie générale, de plus en plus d’équipes utilisent des substituts osseux. Les résultats rapportés sont excellents, mais ces substituts osseux sont souvent associés à des fragments d’os autologue 5, 6 ; ils sont limités à de faibles volumes [7] et ils ne sont évalués qu’à court ou moyen terme.

Matériel et méthode

Vingt patients ont été suivis dans une étude prospective de janvier 2002 à mai 2008 (sex-ratio : 2 hommes/1 femme, âge moyen : 52 ans, extrêmes : 38–67). Ils ont bénéficié, après consentement éclairé, de greffes sinusiennes massives par βTCP. Treize patients ont été opérés des deux sinus, soit 33 sinus au total.

Tous les patients présentaient une atrophie osseuse sévère (stades 4 à 6 selon la classification de Cawood et Howell [8]). La hauteur d’os résiduelle était en moyenne de 3,3 mm (0–4,5 mm). Les

Résultats

Le recul moyen a été de 4,5 ans (2,5–6,5 ans) pour les greffes sinusiennes et de quatre ans (2–6 ans) pour les implants dentaires.

Pour les greffes sinusiennes, un cas d’infection partielle du matériau a été noté au 15^e jour postopératoire (3 %). Cette complication s’est manifestée par des douleurs et par une fistule vestibulaire. Après antibiothérapie et expulsion du matériel infecté, l’évolution a été favorable, n’empêchant pas la mise en place des implants au sixième mois postopératoire.

Le taux

Discussion

L’utilisation de βTCP, sans apport osseux, et associé au PRP et au PRF, dans les greffes sinusiennes massives, entraîne peu de complications. Le gain de hauteur sous-sinusienne est stable. Le taux de succès implantaire et prothétique est équivalent à ceux des autres procédés.

L’os autologue reste le matériau de référence dans cette indication avec un taux de complications sinusiennes (infections, rejets…) de l’ordre de 10 % 7, 11, 12. L’utilisation de βTCP est au moins aussi sûre (3 % de

Remerciements

Nous remercions le laboratoire Curasan (Kleinostheim, Allemagne) pour la mise à disposition gracieuse du biomatériau nécessaire à l’étude. Aucun soutien financier n’a été obtenu et les conclusions de cette étude restent totalement libres de tout conflit d’intérêt.

Références (23)

S. Reinert et al.
Stability of bone grafting and placement of implants in the severely atrophic maxilla
Br J Oral Maxillofac Surg
(2003)
S. Aboul-Hosn et al.
Prélèvement osseux tibial pour comblement osseux maxillaire en implantologie
Rev Stomatol Chir Maxillofac
(2006)
J.I. Cawood et al.
A classification of the edentulous jaws
Int J Oral Maxillofac Surg
(1988)
S. Reinert et al.
Stability of bone grafting and placement of implants in the severely atrophic maxilla
Br J Oral Maxillofac Surg
(2003)
M. Thorwarth et al.
Stability of autogenous bone grafts after sinus lift procedures: a comparative study between anterior and posterior aspects of the iliac crest and an intraoral donor site
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2005)
M.N. Baccar et al.
Stabilité du greffon et des implants après greffe osseuse du sinus maxillaire. Étude rétrospective de 44 cas
Rev Stomatol Chir Maxillofac
(2005)
R. Ewers
Maxilla sinus grafting with marine algae derived bone forming material: a clinical report of long-term results
J Oral Maxillofac Surg
(2005)
D. Goga et al.
Greffe sinusienne d’origine iliaque à visée pré-implantaire. Étude rétrospective des complications rencontrées à partir de 100 cas
Rev Stomatol Chir Maxillofac
(2000)
G.M. Raghoebar et al.
Morbidity of mandibular bone harvesting: a comparative study
Int J Oral Maxillofac Implants
(2007)
T. Turunen et al.
Bioactive glass granules as a bone adjunctive material in maxillary sinus floor augmentation
Clin Oral Implants Res
(2004)

P. Galindo-Moreno et al.

Evaluation of sinus floor elevation using a composite bone graft mixture

Clin Oral Implants Res

(2007)

Cited by (17)

Use of a biphasic bone substitute dispersed within a collagen matrix as a filling material in sinus floor elevations. A retrospective monocentric study
2019, Journal of Stomatology, Oral and Maxillofacial Surgery
Citation Excerpt :
Among synthetic biomaterials, β-TCP gave good results in some studies, but it seems to be resorbed as much as autologeous bone. Its association with HA seems to lead to greater new bone formation compared to xenografts [16,19]. The association with a collagen, matrix allows for cohesivity, provides a better ease of use and hemostatic properties when used dry [12].
7.20 Dental graft materials
2017, Comprehensive Biomaterials II
Due to the significant increase in dental implants placements and in alveolar ridge augmentation procedures over the last two decades, there has been an ever increasing demand for adequate bone grafting materials. Consequently, numerous bone grafting materials have been investigated. This includes calcium phosphate-based grafting materials such as synthetic as well as corallline or bovine-derived hydroxyapatites, tricalcium phosphate ceramics, biphasic hydroxyapatite tricalcium phosphates, calcium carbonates, bioactive glasses and glass ceramics, and demineralized freeze-dried bone allografts. More recently injectable and mouldable cements, putty like materials as well as scaffolds for craniofacial bone tissue engineering have been developed. Furthermore the combination of grafting materials with growth factors has been explored. However, compared to the bone substitute materials which are currently clinically available, there is a significant need for bone substitute materials which degrade more rapidly, but still stimulate osteogenesis at the same time. This has initiated an ever increasing search for bioactive rapidly resorbable bone grafting materials, which exhibit good bone bonding behavior by stimulating enhanced bone formation at the interface in combination with a high degradation rate. A silica containing calcium alkali othophophate material, which meets these requirements, has been shown to render excellent bone regeneration results in the maxillary sinus floor 6 months after sinus floor augmentation in humans in a first clinical study. Furthermore, current research efforts include the optimization of resorbable bone grafting cements as well as of scaffolds and concepts for various tissue engineering approaches.
Retrospective evaluation of 211 patients with maxillofacial reconstruction using parietal bone graft for implants insertion
2016, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
The infection rate during the sinus lift procedure led us to prefer autologous bone graft to biomaterial for the first procedure. Indeed, biomaterials, remaining foreign structures for a long time before resorption, have poor resistance against infections, especially for large grafting procedures (Hallman et al., 2002; Schimming and Schmelzeisen, 2004; Meyer et al., 2009). Systematically, we recommend prophylactic antibiotic treatment after the maxillary sinus grafting procedure, for a minimum of 3 weeks.
For a century, autologous bone grafts have been used in maxillofacial reconstruction. The ideal bone harvest site and grafting procedure remains a point of contention in regards to obtaining optimal long-term results with sufficient bone quantity and density without serious complications. More recently, confronted with growing patient requests and biomaterials development, maxillofacial surgeons and dentists have been considering these issues as they relate to pre-implant surgery. This study sought to evaluate implant success rate and complications following pre-implant surgery with parietal bone grafting.
A retrospective study was carried out on patients who underwent maxillofacial reconstruction of different sites (symphysis, mandibular corpus, maxillary sinus and premaxilla) for the purpose of implant insertion.
311 procedures in 211 patients were included. The implant osseointegration rate was around 95%. Clinical follow-up ranged from 10 months to 11 years. A secondary procedure was performed in 6.1% of cases and we noted no serious complications at the harvest site.
With good revascularization and osseointegration of the graft, the use of parietal bone leads to an implant success rate similar to that seen in the literature. Moreover, the use of this material results in few infections and low bone resorption provided there is strict immobilization of the graft and no tension on the soft tissue sutures.
Parietal bone grafts technique possess the required qualities for the success of implant surgery, offering results at least as interesting as others using autogenous bone and with no serious complications on donor site.
Use of autogenous bone and beta-tricalcium phosphate in maxillary sinus lifting: A prospective, randomized, volumetric computed tomography study
2015, International Journal of Oral and Maxillofacial Surgery
The correction of bone defects can be performed using autogenous or alloplastic materials, such as beta-tricalcium phosphate (β-TCP). This study compared the changes in bone volume (CBV) after maxillary sinus lifting using autogenous bone (n = 12), autogenous bone associated with β-TCP 1:1 (ChronOS; DePuy Synthes, Paoli, CA, USA) (n = 9), and β-TCP alone (n = 11) as grafting material, by means of cone beam computed tomography (CBCT). CBV was evaluated by comparing CBCT scans obtained in the immediate postoperative period (5–7 days) and at 6 months postoperative in each group using OsiriX software (OsiriX Foundation, Geneva, Switzerland). The results showed an average resorption of 45.7 ± 18.6% for the autogenous bone group, 43.8 ± 18.4% for the autogenous bone + β-TCP group, and 38.3 ± 16.6% for the β-TCP group. All bone substitute materials tested in this study presented satisfactory results for maxillary sinus lifting procedures regarding the maintenance of graft volume during the healing phase before the insertion of implants, as assessed by means of CBCT.
Mastoid bone graft in implantology. A case report
2012, Revue de Stomatologie et de Chirurgie Maxillo-Faciale
En implantologie orale, l’os autogène reste le matériau de référence pour reconstruire les déficits osseux horizontaux et verticaux. Le volume osseux nécessaire conditionne le type de prélèvement, intraoral pour les petites et moyennes augmentations, ou extra-oral pour les maxillaires sévèrement atrophiés. Nous présentons un cas clinique d’utilisation d’os cortical mastoïdien.
Une patiente de 63 ans présentant une pathologie bénigne intrasinusienne a bénéficiée au cours du même temps chirurgical du traitement de la pathologie intrasinusienne et de la reconstruction des volumes osseux permettant de réaliser une réhabilitation dentaire implanto-portée.
La mastoïde est une source d’os utilisable en implantologie orale. Son utilisation a fait ses preuves en oto-chirurgie. Ce prélèvement extra-oral bien qu’impliquant la présence d’un chirurgien ORL permet d’obtenir un greffon cortical et constitue un bon compromis tant d’un point de vue biologique, que fonctionnel et économique.
In implantology, autogenous bone remains currently a useful-material to rebuild horizontal and vertical osseous defects. Usually, it is the needed osseous volume that indicates the grafting procedure, intraoral one for small and middle volume and extraoral one for severely atrophied jaws. The originality of this case report is to show an alternative to usual grafting procedure borrowed from ENT surgeons: osseous mastoid graft.
A 63-year-old patient with maxillary sinus pathology underwent during same surgical time maxillary sinus curetting and osseous grafting to finalize the dental treatment.
Mastoid cortical bone is a source of bone usable in oral implantology. Its use has been proved to be reliable in oto-surgery. Mastoid bone harvesting implies the presence of ENT surgeon; it is nevertheless interesting to know this site from a biological point of view and because of its functional and economical aspects.
A non-steroidal anti-inflammatory drug (ketoprofen) does not delay β-TCP bone graft healing
2010, Acta Biomaterialia
β-Tricalcium phosphate (β-TCP) is a suitable biomaterial in oral and maxillofacial surgery since it can induce a rapid proliferation of woven bone. Granules, prepared by the polyurethane foam method, were implanted in critical size defects performed in the femoral condyles of New Zealand rabbits. Animals were studied after 8 and 28 days. Ketoprofen (a non-steroidal anti-inflammatory drug (NSAID)) was given for 8 and 28 days to evaluate its effects on the healing of the graft. Before euthanasia, the rabbits received an intravenous injection of fluorescent microbeads. Bones were analyzed by microcomputed tomography. β-TCP granules induced metaplastic bone trabeculae as early as 8 days post-surgery. At 28 days, the amount of bone was increased and the biomaterial volume decreased due to simultaneous macrophagic resorption. The amount of macrophages labeled with microbeads was less in the grafted area than in the vicinal intact marrow spaces. Ketoprofen had no effect on the amount of bone formed and on the number of labeled macrophages. The influence of small doses of NSAID, given in a short duration period, did not present deleterious effects on bone graft healing.

View all citing articles on Scopus

View full text

Article originalGreffes sinusiennes massives par phosphate tricalcique. Résultats à long termeMassive sinus-lift procedures with β-tricalcium phosphate: Long-term results

Résumé

Introduction

Matériel et méthode

Résultats

Discussion

Summary

Introduction

Material and method

Results

Discussion

Section snippets

Intoduction

Matériel et méthode

Résultats

Discussion

Remerciements

Br J Oral Maxillofac Surg

Rev Stomatol Chir Maxillofac

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Rev Stomatol Chir Maxillofac

J Oral Maxillofac Surg

Greffe sinusienne d’origine iliaque à visée pré-implantaire. Étude rétrospective des complications rencontrées à partir de 100 cas

Rev Stomatol Chir Maxillofac

Morbidity of mandibular bone harvesting: a comparative study

Int J Oral Maxillofac Implants

Bioactive glass granules as a bone adjunctive material in maxillary sinus floor augmentation

Clin Oral Implants Res

Evaluation of sinus floor elevation using a composite bone graft mixture

Clin Oral Implants Res

Article original
Greffes sinusiennes massives par phosphate tricalcique. Résultats à long termeMassive sinus-lift procedures with β-tricalcium phosphate: Long-term results