New bone formation comparison in grafted sinuses performed in heavy smokers and non-smokers

Background

Sinus lift procedures using the lateral window technique and anorganic bovine bone (ABB) as a graft material is considered a safe and predictable option for bone gain in the posterior maxillae. There is consistent information in literature demonstrating that smoking habits negatively influence regenerative procedures. However, limited information is available regarding the influence of smoking habits in new bone formation in maxillary sinuses grafted exclusively with anorganic bovine bone.

Aim/Hypothesis

This study presents histological information of biopsies taken from grafted sinuses using exclusively anorganic bovine bone performed in heavy smokers and non-smokers.

Material and Methods

Maxillary sinuses were grafted with the lateral window (LW) technique using exclusively ABB and a collagen membrane to cover the window. Twenty-four patients were included in the study. Twelve were non-smokers and twelve were classified as heavy smokers (≥10 cigarettes day). All patients provided a written informed consent. Bone biopsies were retrieved using a trephine bur with an inner diameter of 2 mm and outer of 2.8 mm, following the planned long axis of the implant (i.e. crestal approach) which would be immediately installed in the site 8–10 months after sinus graft. The biopsies were stored in paraformaldehyde 4%. The evaluation included new bone formation, connective tissue and residual ABB. Implant survival was considered to be any implant that remained in situ, non-mobile, free from peri-implant radiolucency or infection, and without associated pain, either spontaneous or under pressure.

Results

The twenty-four patients provided one biopsy core each. A total of twelve biopsies were analyzed for smokers and non-smokers. The new bone formation, residual ABB particles and connective tissue was 25.67 ± 8.46%, 26.28 ± 8.61%, and 47.75 ± 9.33, for smokers and 27.97 ± 0.90%, 20.61 ± 0.71% and 51.42 ± 0.94% for non-smokers, respectively. A total of 26 and 28 implants were installed in smokers and non-smokers presenting an implant survival rate of 96.15% and 100%, respectively, after 2 years of functional loading. There were no differences between the smokers and non-smokers.

Conclusion and Clinical Implications

The bone formation and the implants survival in grafted areas with ABB was similar between the smokers and non-smokers.