Sinus Augmentation

Lateral Window Technique

Xenogenic bone substitutes - the most successful material

The implant survival rate with xenogenic materials, such as Bio-Oss shows the highest success rate in long-term follow-up. Elevation of the maxillary sinus floor with 100% Bio-Oss is a highly effective and predictable treatment option.1

Predictability of implant survival rates in lateral window sinus floor elevation

100 Percentage (%) Implant Survival 95 90 85 80 75 81.0 n=190 synthetic 88.0 n=1845 iliac crest 92.0 n=2904 autogenous 93.3 n=189 allogenic 95.6 n=443 xenogenic (e.g. Bio-Oss) 5128 Implants total Follow-up: 12-74 months

Increased bone mineral density & dimensional stability of the graft site
Bio-Oss is a highly osteoconductive biomaterial capable of preventing sinus graft slumping and able to sustain increasing vital bone formation over time. The long-term presence of Bio-Oss particles stabilizes the graft leading to retention of both volume and desired architectural form of augmented sites as well as increased bone mineral density. As a result of this increased bone mineral density, Bio-Oss grafted sites tend to function like Type 2 bone providing an ideal environment for long term implant survival.2

Long-term volume preservation

Augmentation volume in % 100 80 60 40 20 0

Long-term scaffolding
20 months 8 months
new bone Bio-Oss

new bone

Bio-Oss

10 years

new bone

Bio-Oss

90 days 180 days Bio-Oss + autologous

90 days 180 days Autologous bone

20

40

60

80

100

Proportion of bone to Bio-Oss

After sinus floor augmentation with a mixture of Bio-Oss and autologous bone, the percentage bone volume is preserved throughout the study period, while the height of a purely autologous bone graft diminishes or slumps markedly.3

Histomorphometric analysis of bone and BioOss in a patient demonstrates that Bio-Oss continues to act as an effective scaffold which is gradually integrated and remodeled into bone.4

Sinus Augmentation
Lateral Window Technique

Bio-Oss and Bio-Gide: 98% success rate in Sinus Augmentations5

A recently published long-term prospective study validates the use of 100% Bio-Oss and Bio-Gide for sinus augmentation procedures. The results of the study showed sinus augmentations using Bio-Oss and Bio-Gide had an implant survival rate of 98.1%, consistent with findings in the published literature that includes systematic reviews. As noted in the table below (left), implant survival rates were statistically equivalent regardless of the amount of native bone present at the time of implant placement. The chart on the right illustrates the histomorphometric results which revealed that at 10 - 12 months postgrafting with Bio-Oss (ABB): Newly regenerated bone occurred adjacent to residual Bio-Oss particles in all specimens Bio-Oss particles were also seen adjacent to normal bone marrow spaces Active resorption of Bio-Oss particles was frequently observed

Survival Rates for Implants According to the Amount of Native Bone

100 98.1 n=323 98.6 n=504

Histomorphometric Analysis of Bone Biopsy Cores (mean: 11.4 months)

% ABB 8.0 % Marrow 53.0

% Survival Rate

90

80

97.6 n=198

% New Bone 39.0

70

60

> 3 to 5

> 5 to 7

Amount of Native Bone (mm)

Improve Outcomes with Bio-Gide

When a lateral window approach is used, the placement of a barrier membrane over the osteotomy site improves vital bone formation and implant survival rates. Additionally, treatment with Bio-Gide over the osteotomy has been shown to be comparable to treatment with non-

Implant Survival Rates With and Without a Bio-Gide Membrane

100 93.1 n=29

% Implant Survival

resorbable e-PTFE membranes.6

90

80 78.1 n=32 70

60

With Bio-Gide

Without Bio-Gide

Sinus Augmentation
Lateral Window Technique

Sinus Floor Augmentation

Case by Dr. Pascal Valentini

Preoperative view

Window outlined with a diamond bur or ultrasonic handpiece.

Careful elevation of the Schneiderian membrane from the bone walls

Membrane is elevated up inside the subtranal space

Bio-Gide is placed to cover a perforation of the Schneiderian membrane. Bio-Oss is inserted into the subtranal space using a disposable syringe

Bio-Oss completely fills the lateral window aligned with the buccal wall

Bio-Gide is positioned over the lateral window

Tension free closure of the ridge and releasing incisions

Sinus Floor Augmentation

Case by Dr. Stephen Wallace

Preoperative view

Window is outlines with #8 diamond

Membrane freed with a Hu-Friedy KRA-3 curette

Membrane elevated up medial wall with Hu-Friedy CS6562 elevator

Application of Bio-Oss into the region to be augmented

Buccal contour is restored with light pressure to the graft leaving no voids

Bio-Gide membrane placed over window/Bio-Oss graft

Tension free closure

Our results indicate that implants placed in sinuses grafted exclusively with anorganic bovine bone (Bio-Oss) combined with a collagen membrane (Bio-Gide) led to an excellent and predictable survival rate of 98% 5

References
1. 2. 3. 4. 5. 6. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants 2007; 22 (Suppl): 49-70 Jensen O. The Sinus Bone Graft 2nd Edition. Quintessence Publishing Co., Inc. 2006 (211-239) Schlegel KA, Fichtner G, Schultze-Mosgau S, Wiltfang J. Histologic Findings in Sinus Augmentation with Autogenous Bone Chips Versus a Bovine Bone Substitute. Int J Oral Maxillofac Implants 2003; 18:53-58. Sartori S, Silvestri M, Forni F, Icaro Cornaglia A, Tesei P, Cattaneo V. Ten-year follow-up in a maxillary sinus augmentation using anorganic bovine bone (Bio-Oss). A case report with histomorphometric evaluation. Clin Oral Impl Res 2003, 14:369-372. Ferreira CEA, Novaes Jr. AB, Haraszthy VI, et al. A Clinical Study of 406 Sinus Augmentations With 100% Anorganic Bovine Bone. J Periodontology 2009; 80: 1920-1927. Tawil G, Mawla M. Sinus floor elevation using a bovine bone mineral (Bio-Oss) with or without the concomitant use of a bilayered collagen barrier (Bio-Gide): A Clinical Report of Immediate and delayed implant placement. Int J Oral Maxillofac Implants 2001; 16: 713-721.

Osteohealth Companys overriding goal is to develop and distribute with professionalism and integrity products of the highest quality that have been scientifically and clinically proven to enhance patient care. Osteohealth has dedicated its efforts towards the development of products based upon the principles of tissue engineering. In this regard, Osteohealth has made a major commitment to develop and distribute to health care providers superior products engineered to regenerate bone and other tissues in the field of dentistry. Osteohealth Company is a division of Luitpold Pharmaceuticals, Inc., a wholly owned subsidiary of Daiichi Sankyo Co., Ltd, a multinational corporation and one of Japans leading pharmaceutical companies. Incorporate Bio-Oss and Bio-Gide into your practice today by calling our Customer Service Representatives at

or visit our web site at www.osteohealth.com

Bio-Oss and Bio-Gide are registered trademarks of Ed. Geistlich Shne Ag Fur Chemische Industrie and are marketed under license by Osteohealth. Division of Luitpold Pharmaceuticals, Inc. Osteohealth 2010. All rights reserved. OHD056 Iss. 4/2010

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