Sinus augmentation analysis of the gradient of graft consolidation: a split-mouth histomorphometric study

Roni Kolerman, Joseph Nissan, Marina Rahmanov, José Luis Calvo-Guirado, Nirit Tager Green, Haim Tal

Research output: Contribution to journalArticlepeer-review


Objective: The aim of this study was to histomorphometrically test the hypothesis that graft consolidation originates from the sinus floor. Materials and methods: This prospective, randomized split-mouth study investigated patients undergoing bilateral maxillary lateral sinus floor augmentation using either freeze-dried bone allografts (FDBAs) or biphasic calcium phosphate (BCP) bone substitute. Apico-coronal core biopsies were harvested during implant placement 9 months after sinus floor augmentation, processed for histological observation, and measured histomorphometrically. Results: Biopsies were taken from 26 bilateral sites in 13 patients. The density of new bone (NB) decreased with increasing distance from the sinus floor. The percentage mean surface of NB ranged from 31 ± 9.5% at 2 mm from the sinus floor (G1) to 27.7 ± 11.2% at 4 mm (G2) for the FDBA specimens and from 30.0 ± 11.0% at G1 to 23.5 ± 9.9% at G2 for the BCP specimens. Evaluation of the residual graft particle (GP) area alone as a function of distance from the floor revealed a clear inverse gradient of 7.1 ± 6.6 to 9.1 ± 10.3 between G1 and G2 for the FDBA allografts, with the same tendency for the BCP alloplasts (21.9 ± 9.9 to 27.7 ± 6.6, respectively). Conclusion: Our results support the concept that osteogenesis initiates in regions proximal to the bony walls of the maxillary sinus and may be enhanced by them. Clinical relevance: The nature of the grafting material had a greater influence on the degree of NB formation in regions distant from the native walls where there is reduced inherent osteogenic potential.

Original languageEnglish
Pages (from-to)3397-3406
Number of pages10
JournalClinical Oral Investigations
Issue number8
StatePublished - 1 Aug 2019


  • Biomaterials
  • Bone substitute
  • Gradient
  • Native bone
  • Sinus floor elevation


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