Histological and immunohistochemical evaluation in patients who underwent maxillary sinus lifting surgery using autogenous or heterogenous bone. A clinical randomised trial





Biomaterials; Maxillary sinus; Graft bone.


Objectives: This study evaluated, through histological and immunohistochemical analysis the bone formation and remodeling after a maxillary sinus lift. Material and methods: 25 patients from 41 to 65 years of age, with inadequate bone volume in the posterior maxillary region and remaining native bone less than or equal to 5 mm, as measured radiographically, were selected and underwent maxillary sinus lift surgery, through the open technique. They were distributed in 3 groups: A - particulate, autogenous bone, AB - autogenous and heterogeneous bone, and B - only heterogeneous bone.  Six months after this intervention, the patients were submitted to a surgery for the installation of implants and concomitant removal of the grafted bone sample from the surgical site. Results: The histological evaluation showed bone formation in the three groups, with presence of mature bone. In groups B and AB, the presence of granules of the biomaterial surrounded by bone tissue was observed. A statistical analysis showed significant difference (ANOVA p=0,002), suggesting greater bone formation in the autogenous group. In an immunohistochemical evaluation, no statistically significant differences were observed in the comparison between the experimental groups (A, B and AB), as well as in the proteins analyzed (OC: p= 0.657; VEGF: p= 0,133; TRAP: p= 0.163). Conclusion: The use of Bio-Oss ®, whether or not associated to autogenous bone, for a maxillary sinus lift through the side window technique results in bone repair. A predictable amount of bone formation is attained when this osteoconductive biomaterial is used.


Abrahams, J. J., & Hayt, M. W. (2000). Original Report Sinus Lift Procedure of the Maxilla in Patients with Inadequate Bone for Dental Implants: Radiographic. AJR Am J Roentgenol, 1289–1292. http://doi.org/10.2214/ajr.174.5.1741289

Artzi, Z., Weinreb, D. M. D. M., Givol, D. M. D. N., Rohrer, D. M. D. M. D., Nemcovsky, C. E., Prasad, D. M. D. H. S., & Tal, M. D. T. H. (2004). Biomaterial Resorption Rate and Healing Site Morphology of Inorganic Bovine Bone and beta-Tricalcium Phosphate in the Canine: A 24-month Longitudinal Histologic Study and Morphometric Analysis. The International Journal of Oral & Maxillofacial Implants, 357–368.

Beretta M, Cicciu M, Bramanti E, Maionara C. (2012). Schneider membrane elevation in presence of sinus septa: anatomic features and surgical management. International Journal Dentistry, 1-6. http://doi.org/10.1155/2012/261905.

Bonardi, J. P., Pereira, R. S., Boos, F. B. J. D., Faverani, L. P., Griza, G. L., Okamoto, R., & Hochuli-Vieira, E. (2017). Prospective and Randomized Evaluation of ChronOS and Bio-Oss in Human Maxillary Sinuses: Histomorphometric and Immunohistochemical Assignment forRunx2, Vascular Endothelial Growth Factor, and Osteocalcin. J Oral Maxillofac Surg, 1.e1-1.e11. https://doi.org/10.1016/j.joms.2017.09.020

Chiapasco, M., Casentini, P., & Zaniboni, D. (2009). Bone Augmentation Procedures in Implant Dentistry. The International Journal of Oral & Maxillofacial Implants, 237–259.

De Souza-Nunes, L. S., De Oliveira, R. V., Holgado, L.A., Nary Filho, H., Ribeiro, D. A., & Matsumoto, M. A. (2010). Immunoexpression of Cbfa-1 / Runx2 and VEGF in sinus lift procedures using bone substitutes in rabbits. Clin. Oral Impl. Res., 584–590. http://doi.org/10.1111/j.1600-0501.2009.01858.x

Donizeti, M., Soeiro, L., Nunes, D. S., Victor, R., Oliveira, D., Andrade, L., & Araki, D. (2012). Bovine hydroxyapatite (Bio-Oss) induces osteocalcin, RANK-L and osteoprotegerin expression in sinus lift of rabbits. Journal of Cranio-Maxillo-Facial Surgery, 40, 315–320. http://doi.org/10.1016/j.jcms.2012.01.014

Ewers, R. (1999). Histologic findings at augmented bone areas supplied with two different bone substitute materials combined with sinus floor lifting Report of one case. Clin. Oral Impl. Res., 96–100. http://doi.org/10.1111/j.1600-0501.2004.00987.x

Galindo-Moreno, P., Gustavo, A., Ferna, J. E., Sa, E., & Wang, H. (2007). Evaluation of sinus floor elevation using a composite bone graft mixture. Clin. Oral Impl. Res., 376–382. http://doi.org/10.1111/j.1600-0501.2007.01337.x

Hawthorne, A. C., Salvador, L., Antunes, A. A., Antunes, A. A., & Salata, L. A. (2012) Histological study on onlay bone graft remodeling. Part III : allografts. Clin. Oral Impl. Res., 1–9. http://doi.org/10.1111/j.1600-0501.2012.02528.x

Jensen, T., Svendsen, P. A., & Gundersen, H. J. G. (2011). Volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios : a radiographic study in minipigs. Clin. Oral Impl. Res., 1–9.. http://doi.org/10.1111/j.1600-0501.2011.02245.x

Jensen, T., Schou, S., Stavropoulos, A., Terheyden, H., & Maxillary, P. H. (2012). Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft in animals: a systematic review. International Journal of Oral & Maxillofacial Surgery, 41(1), 114–120. http://doi.org/10.1016/j.ijom.2011.08.010

Köche, J C (2011). Fundamentos de metodologia científica : teoria da ciência e iniciação à pesquisa. (3a ed.), Editora Vozes.

Maridati P, Stofella E, Speroni S, Cicciu M, Maiorana C. (2014). Alveolar antral artery isolation during sinus lift procedure with the double window technique. Open Dentistry Journal. 8, 95-103. 10.2174/1874210601408010095

Orsini, G., Traini, T., Scarano, A., Degidi, M., Perrotti, V., & Piccirilli, M. (2005). Maxillary Sinus Augmentation with Bio-Oss® Particles : A Light, Scanning , and Transmission Electron Microscopy Study in Man. J Biomed Mater Res B Appl Biomater, 448–457. http://doi.org/10.1002/jbm.b.30196

Pettinicchio, M., Traini, T., Murmura, G., Caputi, S., Degidi, M., Mangano, C., & Piattelli, A. (2012). Histologic and histomorphometric results of three bone graft substitutes after sinus augmentation in humans. Clin Oral Invest, 45–53. http://doi.org/10.1007/s00784-010-0484-9

Pjetursson, B.E., Tan, W.C., Zwahlen, M., & Langa, N.P. (2008). A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation Part I : Lateral approach. J Clin Periodontol, 35, 216–240. http://doi.org/10.1111/j.1600-051X.2008.01272.x

Raja, S. V. (2009). Management of the Posterior Maxilla with Sinus Lift : Review of Techniques. International Journal of Oral & Maxillofacial Surgery, 67(8), 1730–1734. http://doi.org/10.1016/j.joms.2009.03.042

Rancitelli D, Borgonovo AE, Cicciu M, Re D, Rizza F, Frigo AC, Maiorana C. (2015) Maxillary Sinus Septa and Anatomic Correlation With the Schneiderian Membrane. Journal of Craniofacial Surgery. 26(4), 1394-1398. 10.1097/SCS.0000000000001725

Rickert, D., Slater, J. J. R. H., Meijer, H. J. A., & Vissink, A. (2012). Maxillary sinus lift with solely autogenous bone compared to a combination of autogenous bone and growth factors or (solely) bone substitutes. A systematic review. Int J Oral Maxillofac Surg, 160–167. http://doi.org/10.1016/j.ijom.2011.10.001

Schmitt, C. M., Schmitt, C. M., Doering, H., Schmidt, T., Lutz, R., Wilhelm, F., & Schmitt, C. M. (2012). Histological results after maxillary sinus augmentation with Straumann ® trolled clinical trial. Clin Oral Implants Res, 1–10. http://doi.org/10.1111/j.1600-0501.2012.02431.x

Schweikert, M., Lang, N. P., & Botticelli, D. (2011). Use of a titanium device in lateral sinus floor elevation : an experimental study in monkeys. Clin Oral Implants Res, 100–105. http://doi.org/10.1111/j.1600-0501.2011.02200.x

Srouji, S., Ben-David, D., Funari, A., Riminucci, M., & Bianco, P. (2012). Evaluation of the osteoconductive potential of bone substitutes embedded with schneiderian membrane or maxillary bone marrow-derived osteoprogenitor cells. Clinical Oral Implant Research. 1–7. http://doi.org/10.1111/j.1600-


Stacchi C, Lombardi T, Cusimano P, Berton F, Lauritano F, Cervino G, Lenarda R, Cicciu M. (2017). Bone Scrapers Versus Piezoelectric Surgery in the Lateral Antrostomy for Sinus Floor Elevation. Journal of Craniofacial Surgery, 28(5), 1191-1196. 10.1097/SCS.0000000000003636.

Stern, A., & Green, J. (2012). Sinus Lift Procedures: An Overview of Current Techniques. Dent Clin North Am, 56, 219–233. http://doi.org/10.1016/j.cden.2011.09.003

Tapety, F.I., Amizuka, N., Uoshima, K., Nomura, S. & Maeda A. (1983). A histological evaluation of the involvement of Bio-Oss in osteoblastic differentiation and matrix synthesis. Clin Oral Implants Res, 315–324. http://doi.org/10.1111/j.1600-0501.2004.01012.x

Tatum, H. (1986). Maxillary and sinus implant reconstructions. Dent Clin North Am, 30, 207-229.

Zaffe, D. (2005). Histological study on sinus lift grafting by Fisiograft and Bio-Oss. J Mater Sci Mater Med, 16, 789-793. http://doi.org/10.1007/s10856-005-3574-5

Zhang, Z., Egaña, J. T., Reckhenrich, A. K., Schenck, T. L., Lohmeyer, J. A., Schantz, J. T., & Schilling, A. F. (2012). Cell-based resorption assays for bone graft substitutes. Acta Biomaterialia, 8, 13–19. http://doi.org/10.1016/j.actbio.2011.09.020




How to Cite

GRIZA, G. L.; OKAMOTO, R.; COLET, D.; CONCI, R. A. .; MAGRO-FILHO, O. Histological and immunohistochemical evaluation in patients who underwent maxillary sinus lifting surgery using autogenous or heterogenous bone. A clinical randomised trial . Research, Society and Development, [S. l.], v. 10, n. 4, p. e48010414143, 2021. DOI: 10.33448/rsd-v10i4.14143. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/14143. Acesso em: 8 may. 2021.



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