**5. Sinus bone graft**

If there is any material whose resorption speed is not too high and whose bone healing process approximates that of autogenous bone graft, it may be useful in maxillary sinus bone grafting. Likewise, more excellent clinical achievement may be expected when these materials are used in mixture with other bone substitutes with slow resorption properties [61,62,63]. With evidence presented in the foregoing paragraphs, AutoBT® developed by the author, et al was proven to exhibit bone healing ability through osteoinduction and osteoconduction, demon‐ strating a histological healing process similar to that of free bone grafting being resorbed over 3~6 months [3]. Accordingly, AutoBT® is regarded as a possible substitute when autogenous bone is needed for sinus bone graft, and it may wield a useful effect on increasing the volume of bone graft materials and minimizing repneumatization (Figure 14).

A retrospective study on sinus bone graft was performed. One hundred implants in 51 patients were selected, with the patients receiving maxillary sinus augmentation and implant place‐ ment using autogenous tooth graft materials at Chosun University Dental Hospital and Seoul National University Bundang Hospital (SNUBH) between July 2009 and November 2010. In cases of using autogenous tooth bone graft alone or together with other graft material, the implant survival rate was 96.15%. Based on the histomorphologic examination, autogenous tooth bone graft materials showed gradual resorption and new bone formation through osteoconduction and osteoinduction. The results suggest that autogenous tooth bone graft materials are appropriate for use in maxillary sinus augmentation [64].

**Type Number of implants** GBR 29 (53.7%)

Total 54 (100%)

**Type Number of patients**

Powder 32 (86.5%) Block 2 (5.4%) Powder + Block 3 (8.1%)

Total 37 (100%)

**Type Number of implants**

Wound dehiscence 7 Hematoma 1

Osseointegration failure 4

If there is any material whose resorption speed is not too high and whose bone healing process approximates that of autogenous bone graft, it may be useful in maxillary sinus bone grafting. Likewise, more excellent clinical achievement may be expected when these materials are used in mixture with other bone substitutes with slow resorption properties [61,62,63]. With evidence presented in the foregoing paragraphs, AutoBT® developed by the author, et al was proven to exhibit bone healing ability through osteoinduction and osteoconduction, demon‐ strating a histological healing process similar to that of free bone grafting being resorbed over 3~6 months [3]. Accordingly, AutoBT® is regarded as a possible substitute when autogenous bone is needed for sinus bone graft, and it may wield a useful effect on increasing the volume

of bone graft materials and minimizing repneumatization (Figure 14).

Total 12

Sinus graft (lateral approach) 14 (25.9%) Sinus lifting (crestal approach) 7 (13.0%) Ridge augmentation 4 (7.4%)

**Table 4.** Types of surgery

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**Table 5.** Types of AutoBT

**Table 6.** Types of complications

**5. Sinus bone graft**

Lee, et al [65] conducted a study to evaluate histomorphometrically and compare the efficiency of various bone graft materials and autogenous tooth bone graft material used in the sinus bone graft procedure. The subjects were 24 patients who had been treated with sinus bone graft using the lateral approach from October 2007 to September 2009 at SNUBH. The average age was 52.51±11.86 years. All cases were taken after 4 months of procedure and divided into 3 groups according to bone graft material: Group 1 for autogenous tooth bone graft material (AutoBT), Group 2 for OrthoblastII (Integra Lifescience Corp., Irvine, US)+Biocera (Osscotec, Cheonan, Korea), and Group 3 for DBX (Synthes, West Chester, PA, USA), BioOss (Geistlich Pharm AG, Wolhusen, Switzerland). A total of 37 implant placement areas was included and evaluated (7 in group 1, 10 in group 2, 20 in group 3). The evaluation of new bone formation, ratio of woven bone to lamellar bone, and ratio of new bone to graft material was performed on each tissue section. The Kruskal-Wallis test was used for statistical analysis (SPSS Ver. 12.0, USA). New bone formation was 52.5±10.7 % in group 1, 52.0±23.4% in group 2, and 51.0±18.3% in group 3 (Table 7) (Figure 15-18). There were no statistically significant differences between groups, however. The ratio of woven bone to lamella bone was 82.8±15.3% in group 1, 36.7 ±59.3% in group 2, and 31.0±51.2% in group 3. The ratio of new bone to graft material was 81.3±10.4% in group 1, 72.5±28.8% in group 2, and 80.3±24.0% in group 3. After a 4-month healing period, all groups showed favorable new bone formation and around the graft material and implant. Within the limitation of our study, autogenous tooth bone graft material may be used as a novel bone graft material for sinus bone graft. Kim, et al and Lee, et al performed sinus bone graft and guided bone regeneration using autogenous tooth bone from humans and took the tissue specimen 2 months and 4 months later for histomorphometric analysis. They found favorable new bone formation as a result and suggested that autogenous tooth bone graft materials could be used in various bone grafts [65,66].


**Table 7.** Histomorphometric data on new bone formation (Mean±SD)

**Figure 14.** A case of sinus bone graft performed by the mixture of AutoBT, autogenous maxillary tuberosity bone and synthetic bone. a) Panoramic radiography of a 64-year-old man at the first examination. b) Radiography after placing implants simultaneously with the sinus bone graft on the right side. c) Panoramic radiography after 2 weeks of maxil‐ lary left 1st molar extraction. The prosthodontic therapy for the upper right maxillary bone was completed, and the extracted tooth was replaced with bone graft materials. d) Intraoral photography before operation. e) View of mix‐ ture of AutoBT and maxillary tuberosity bone. f) Grafted in the mixture with a synthetic bone, OSTEON (GENOSS, Su‐ won, Korea). g) Panoramic radiography after sinus bone graft. h) Panoramic radiography taken in a private dental clinic after 3 months of bone grafting. Performing implant placement in a private dental clinic was decided due to the medical costs. i) Panoramic radiography one year after final prosthetic delivery. The bone materials grafted on the maxillary sinus are maintained stably.

(a) (b) (c)

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(d) (e) (f)

(h) (i) (g)

maxillary sinus are maintained stably.

**Figure 14.** A case of sinus bone graft performed by the mixture of AutoBT, autogenous maxillary tuberosity bone and synthetic bone. a) Panoramic radiography of a 64-year-old man at the first examination. b) Radiography after placing implants simultaneously with the sinus bone graft on the right side. c) Panoramic radiography after 2 weeks of maxil‐ lary left 1st molar extraction. The prosthodontic therapy for the upper right maxillary bone was completed, and the extracted tooth was replaced with bone graft materials. d) Intraoral photography before operation. e) View of mix‐ ture of AutoBT and maxillary tuberosity bone. f) Grafted in the mixture with a synthetic bone, OSTEON (GENOSS, Su‐ won, Korea). g) Panoramic radiography after sinus bone graft. h) Panoramic radiography taken in a private dental clinic after 3 months of bone grafting. Performing implant placement in a private dental clinic was decided due to the medical costs. i) Panoramic radiography one year after final prosthetic delivery. The bone materials grafted on the

**Figure 15.** Overview of biopsy of Group I (Auto BT® ). New bone formation (arrows) was identified around the graft material (asterisks). (Hematoxylin & Eosin stain, x40. scale bar measures 500um)

**Figure 16.** Histomorphometric image of Group I (Auto BT® ). New bone formation (arrows) was identified around the graft material (asterisks). Confluent new bone formation was observed (open asterisk) (Hematoxylin & Eosin stain, x200. scale bar measures 200um)

**Figure 17.** Microphotograph 4 months after Orthoblast/Biocera transplantation (Group II). Higher magnification demonstrated new bone formation (arrows) around the implant chips (asterisks). (Hematoxylin & Eosin stain, x200. scale bar measures 100um)

**Figure 18.** Microphotograph 4 months after DBX/BioOss transplantation (Group III). Higher magnification demon‐ strated new bone formation (arrows) around the implant chips (asterisks). (Hematoxylin & Eosin stain, x200. scale bar measures 100um)
