Sinus augmentation using rhBMP‐2/ACS in a mini‐pig model: Influence of an adjunctive ceramic bone biomaterial

• Published in: Journal of clinical periodontology 2018-08, Vol.45 (8), p.1005-1013
• Main Authors: Susin, Cristiano, Lee, Jaebum, Fiorini, Tiago, Freitas, Rubens Moreno, Chiu, Hsien‐Chung, Prasad, Hari S., Buxton, Amanda N., Wikesjö, Ulf ME
• Format: Article
• Language: English
• Subjects: BMP‐2; Bone biomaterials; Bone growth; Collagen; Dental implants; Dental prosthetics; Dental restorative materials; Dentistry; Maxillary sinus; Osseointegration; Osteogenesis; sinus augmentation; Sinuses; Tissue engineering; Transplants & implants
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/jcpe.12921

Background Recombinant human bone morphogenetic protein‐2 in an absorbable collagen sponge carrier (rhBMP‐2/ACS) has been shown to support significant bone formation when used to augment the maxillary sinus for implant dentistry. Nevertheless, bone biomaterials have been suggested to extend rhBMP‐2/ACS with limited support of the merits of such approaches. Objectives To evaluate local bone formation/dental implant osseointegration following implantation of rhBMP‐2/ACS combined with a ceramic bone biomaterial using a mini‐pig sinus augmentation model. Methods Twelve adult Göttingen mini‐pigs received rhBMP‐2/ACS (rhBMP‐2 adjusted to 0.43 mg/cc) alone or combined with an off‐the‐shelf biphasic ceramic (15%/85% HA/ß‐TCP) biomaterial at 3:1, 1:1 and 1:3 ratios randomized to contra‐lateral maxillary sinus sites yielding rhBMP‐2/ACS fractions of 100%, 75%, 50% and 25%, respectively. A 4‐cc implant volume was used for all sites. Two threaded dental implants (ø4.0 × 11.5 mm) were placed at each site. The animals were euthanized at 8 weeks for histologic analysis. Results Surgical execution and healing were generally uneventful, infraorbital local swelling was observed in all animals until suture removal. rhBMP‐2/ACS combined with the ceramic biomaterial did not significantly enhance local bone formation (range 9.0 ± 1.5 to 9.7 ± 2.1 mm) compared with rhBMP‐2/ACS alone (8.6 ± 1.1 mm; p > 0.05). Variations in rhBMP‐2/ACS to ceramic matrix ratios yielding rhBMP‐2 doses approximating 0.4, 0.9, 1.3 and 1.7 mg/sinus did not appreciably influence bone formation/osseointegration. Conclusions Whereas rhBMP‐2/ACS supports significant bone formation/osseointegration in the mini‐pig sinus augmentation model and thus appears an effective alternative for sinus augmentation procedures, adding a ceramic biomaterial to rhBMP‐2/ACS does not produce meaningful biological advantages.