Performance of β-tricalcium phosphate granules and putty, bone grafting materials after bilateral sinus floor augmentation in humans

Sinus floor augmentation (SFA) using bone grafting materials, and in particular calcium phosphates (CaP), is a well-established pre-implantology procedure. The use of CaP simplifies SFA procedures. β-tricalcium phosphate (β-TCP) is amply used for SFA. This study evaluated the clinical and osteogenic performance of β-TCP granules (TCP-G) and a β-TCP putty (TCP-P) bone graft material. TCP-P consisted of TCP-G in a hyaluronic acid (HyA) carrier. Bone formation, volume stability and osteogenic marker expression after bilateral SFA in patients was assessed. Eight patients were selected for a split-mouth design. Biopsies obtained six months after SFA, were processed for immunohistochemical analysis of collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Histomorphometric analysis determined bone, grafting material and marrow space percentages. Cone-beam computed tomography was used to calculate the graft volume and its stability. Both materials allowed excellent bone regeneration and volume stability. TCP-P displayed better surgical handling properties, greater bone formation, higher expression of Col I, ALP, OC and BSP; as well as significantly lower grafting volume reduction values. HyA had no adverse effect on TCP-P performance. Due to its clinical and osteogenic performance, TCP-P can be regarded as excellent bone grafting material for SFA.