Use of autogenous bone and beta-tricalcium phosphate in maxillary sinus lifting: histomorphometric study and immunohistochemical assessment of RUNX2 and VEGF

Int J Oral Maxillofac Surg. 2017 Apr;46(4):503-510. doi: 10.1016/j.ijom.2017.01.002. Epub 2017 Feb 6.


The aim of this study was to compare the use of beta-tricalcium phosphate (β-TCP) (chronOS) with autogenous bone grafts alone in maxillary sinus elevation surgery. The test samples were β-TCP alone, β-TCP mixed with autogenous bone grafts (1:1), and autogenous bone grafts alone. Twelve maxillary sinuses were grafted with β-TCP (group 1), nine with β-TCP+autogenous bone graft (group 2), and 12 with autogenous bone graft (group 3). After 6 months, biopsies were obtained concurrent to the placement of dental implants; these were subjected to histomorphometric analysis and immunohistochemical analysis for runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF). The average bone formation in group 1 was 46.3±11.6% in the pristine bone region, 47.6±9.9% in the intermediate region, and 44.8±22.1% in the apical region; in group 2, values were 35.0±15.8%, 32.5±13.7%, and 32.8±16.0%, respectively; in group 3, values were 43.1±16.0%, 31.0±13.0%, and 46.1±16.3%, respectively. Immunostaining of samples in group 2 showed high cellular activity and immature bone; this differed from groups 1 and 3, in which mature bone was demonstrated. Thus, this study showed that β-TCP presents the same behaviour as autogenous bone graft, which makes it a good bone substitute.

Keywords: bone graft; immunohistochemistry; maxillary sinus.

MeSH terms

  • Bone Substitutes / therapeutic use*
  • Bone Transplantation / methods*
  • Calcium Phosphates / therapeutic use*
  • Core Binding Factor Alpha 1 Subunit / metabolism*
  • Female
  • Humans
  • Immunohistochemistry
  • Male
  • Osteogenesis / physiology*
  • Prospective Studies
  • Sinus Floor Augmentation / methods*
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / metabolism*


  • Bone Substitutes
  • Calcium Phosphates
  • Core Binding Factor Alpha 1 Subunit
  • RUNX2 protein, human
  • Vascular Endothelial Growth Factor A
  • beta-tricalcium phosphate