4.2. Surgery and Bone Retrieval

Ten partially edentulous patients (six women and four men), whose ages ranged from 41 to 71 years, came to the Department of Oral and Maxillofacial Surgery, who had <5 mm subantral alveolar bone in the vertical direction, determined by conventional tomographic radiography. They were treated by a maxillary sinus floor augmentation procedure and delayed implant placement. Patients who received treatment with bisphosphonates or steroids, those currently undergoing chemotherapy and/or radiation to the oral cavity, and those with uncontrolled systemic disease or endocrine disorders were excluded from the study.

The protocol for harvesting bone samples was approved by the University Ethics Committee and informed consent was obtained from all patients. This study is consistent with the ethical principles set out in the Declaration of Helsinki for experimentation on human subjects. All the patients received antibiotics prior to surgery. Each subject was required to take 2 g of amoxycillin 1 h prior to surgery. For any patient allergic to amoxycillin, 600 mg of clindamycin were administered 1 h before surgery. All the surgical procedures were performed under local anesthesia (lidocaine hydrochloride 2% with 1:100,000 epinephrine or mepivacaine/carbocaine 3%, without epinephrine). Maxillary sinus augmentation was performed as previously described Tatum [79]. The grafts material was carefully packed in the space created by mucous membrane elevation. DBHa was placed in a subantral compartment and DPHa was placed in the contralateral subantral compartment. Upon implant surgery, and six months after the healing period, a biopsy was taken for histology purposes at the time of implant placement. Bone cores were harvested using a 3 × 10 mm diameter trephine bur under sterile saline solution irrigation conditions. Sixty bone samples were retrieved for the analysis. Two biopsies per individual were obtained. Nevertheless, the biopsy value we used in our analysis was unique for each individual and was computed as the average value of its biopsies.