Effect of β-tricalcium phosphate particles with varying porosity on osteogenesis after sinus floor augmentation in humans

This study examines the effect of two β-tricalcium phosphate (TCP) particulate bone grafting materials with varying porosity on bone formation and on osteogenic marker expression 6 months after sinus floor augmentation. Unilateral sinus grafting was performed in 20 patients using a combination (4:1 ratio) of β-TCP particles with 35% porosity (TCP-C) or 65% porosity (TCP-CM) and autogenous bone chips. At implant placement cylindrical biopsies were sampled and processed for immunohistochemical analysis of resin embedded sections. Sections were stained for collagen type I (Col I), alkaline phosphatase (ALP), osteocalcin (OC) and bone sialoprotein (BSP). Furthermore, the area fraction of newly formed bone as well as the particle area fraction were determined histomorphometrically first, apically close to the Schneiderian membrane and second, in the center of the cylindrical biopsies. In the TCP-CM patient group a larger amount of bone formation and particle degradation was observed in the apical area and thus at the largest distance from the crestal bone compared to the TCP-C group. Good bone bonding behaviour was observed with both materials. This was accompanied by expression of ALP, Col I, BSP and OC in the newly formed bone and osteogenic mesenchym in contact with the degrading particles. Both TCP materials supported bone formation in the augmented sinus floor. Six months after implantation of both types of β-TCP particles, bone formation and matrix mineralization was still actively progressing in the tissue surrounding the particles. Consequently, a greater porosity appears to be advantageous for enhancing bone formation and particle degradation.