Case report
Clinical, radiographic and histomorphometric behaviour of the autologous tooth as a biomaterial in lateral access maxillary sinus elevation. Case report with six months of post-prosthetic loading follow-up
Introduction: Bone loss after extractions may require a sinus elevation to be performed in the posterior maxilla for the correct placement of implants. Autologous bone is considered the gold standard, but has a high rate of resorption and morbidity, leading to other alternatives such as autologous tooth, with good results in regenerative procedures. This case report evaluates at the clinical, radiographic and histomorphometric level the use of the autologous tooth in maxillary sinus elevation and the behaviour of two implants placed in a delayed manner.
Case report: The case is presented of a 48-year-old woman who came for consultation to replace the right posterior sector. The extraction of 4.8 as a donor tooth was performed to use it as a biomaterial in a lateral access sinus elevation, placing two implants six months after the intervention, and evaluating them six months after their prosthetic loading.
Discussion: The autologous tooth in this case report showed 30.56% of newly formed bone following a six-month wait, with better results than when allografts and xenografts were used. In addition, different cultural and ethnic aspects support the acceptance of the autologous tooth by patients. However, more long- term studies are needed to evaluate the stability of this type of graft in maxillary sinus elevation.
Conclusions: The autologous tooth in the sinus elevation offers biocompatibility, low incidence of complications and good patient acceptance, with good clinical and radiographic behaviour of the implants, despite the short time elapsed in this case after loading.
Three months after dental extraction, there is a loss of 50% of the initial bone dimensions of the socket, which is particularly significant in the posterior region of the maxilla. In this anatomical region, the loss of antral teeth results in three-dimensional pneumatization of the maxillary sinus, which may extend to the alveolar crest and the anterior region, the tuberosity area, and the zygomatic bone. This dual process of pneumatization and bone remodelling reduces bone availability both horizontally and vertically, potentially compromising implant treatment and its long-term stability1-6.
In such cases, the most predictable technique for bone reconstruction is the maxillary sinus elevation, which enables correct placement of implants and subsequent implant-supported restoration, thereby improving the quantity and quality of bone at the implant site. Among the maxillary sinus elevation techniques, the lateral approach is indicated when the vertical bone height is ≤ 4 mm, with delayed placement of the implants, whereas with a height
≥ 5 mm, the transcrestal sinus elevation technique and shorter implants are recommended, or the open technique with simultaneous placement of longer implants7,8.
The lateral approach sinus lift, also known as the open technique, is a well-documented procedure, having been described by Tatum9 in 1976 and subsequently published by Boyne and James10 in 1980. This consists of raising a full-thickness flap to access the anterolateral wall of the maxillary sinus, and, by means of osteotomy, creating a window in the buccal cortical bone to expose the Schneiderian membrane. Once this membrane is exposed, it is carefully detached and elevated until it reaches a horizontal position to form the new sinus floor, after which a graft biomaterial is placed. A membrane may be placed, either resorbable or non-resorbable, prior to suturing, to prevent displacement of the graft and colonisation of the sinus interior by periosteum originating from the flap11,12.
Among the biomaterials employed in this technique, autologous bone is currently regarded as the gold standard, as it provides an effective scaffold for osteoconduction, contains growth factors to promote osteoinduction, and osteocompetent cells to facilitate osteogenesis. However, certain disadvantages, such as donor site morbidity, limited availability, and a high rate of resorption, may restrict its use13,14.
For these reasons, various bone substitutes have been utilised (allografts, xenografts, and alloplastic materials). Most of these biomaterials exhibit only osteoconductive properties and have highly variable resorption times, ranging from very short (derived from polyglycolic and polylactic acid) to very long (hydroxyapatites), whilst others may provoke immune reactions (allografts). Owing to these disadvantages, studies on the clinical behaviour of tooth material in various regenerative procedures have increased in recent years, due to its similarity to human bone15,16.
Kim et al.17 described the osteoinductive and osteoconductive properties of tooth material, as well as lower morbidity and greater patient acceptance, with its favourable clinical and radiographic behaviour having been demonstrated in maxillary sinus elevation procedures, guided bone regeneration, and alveolar preservation18.
The objective of this clinical case is to evaluate, clinically, radiographically, and histomorphometrically, the use of autologous tooth as a biomaterial in maxillary sinus elevation, as well as the clinical and radiographic behaviour of two implants placed in a delayed manner following the sinus elevation, and their progress six months after prosthetic loading.
Beca Campoy, Tomás
Private practice in surgery and implants, Madrid. PhD candidate in Surgery and
Odonto-stomatology at the University of Salamanca (USAL).
Sánchez-Labrador, Luis
Honorary Associate Lecturer. Department of Clinical Dental Specialties.
Complutense University of Madrid (UCM).
Cortés-Bretón, Jorge
Associate Lecturer in Oral Surgery. Department of Clinical Dental Specialties. Complutense University of Madrid (UCM).
Blanco Antona, Leticia Alejandra
Associate Lecturer, Department
of Surgery, Faculty of Medicine, University of Salamanca (USAL).
Martínez-González, José María
Senior Lecturer in Maxillofacial Surgery. Faculty of Dentistry. Complutense University of Madrid (UCM).