Sinus augmentation analysis of the gradient of graft consolidation: a split-mouth histomorphometric study

  • Roni KolermanEmail author
  • Joseph Nissan
  • Marina Rahmanov
  • José Luis Calvo-Guirado
  • Nirit Tager Green
  • Haim Tal
Original Article



The aim of this study was to histomorphometrically test the hypothesis that graft consolidation originates from the sinus floor.

Materials and methods

This prospective, randomized split-mouth study investigated patients undergoing bilateral maxillary lateral sinus floor augmentation using either freeze-dried bone allografts (FDBAs) or biphasic calcium phosphate (BCP) bone substitute. Apico-coronal core biopsies were harvested during implant placement 9 months after sinus floor augmentation, processed for histological observation, and measured histomorphometrically.


Biopsies were taken from 26 bilateral sites in 13 patients. The density of new bone (NB) decreased with increasing distance from the sinus floor. The percentage mean surface of NB ranged from 31 ± 9.5% at 2 mm from the sinus floor (G1) to 27.7 ± 11.2% at 4 mm (G2) for the FDBA specimens and from 30.0 ± 11.0% at G1 to 23.5 ± 9.9% at G2 for the BCP specimens. Evaluation of the residual graft particle (GP) area alone as a function of distance from the floor revealed a clear inverse gradient of 7.1 ± 6.6 to 9.1 ± 10.3 between G1 and G2 for the FDBA allografts, with the same tendency for the BCP alloplasts (21.9 ± 9.9 to 27.7 ± 6.6, respectively).


Our results support the concept that osteogenesis initiates in regions proximal to the bony walls of the maxillary sinus and may be enhanced by them.

Clinical relevance

The nature of the grafting material had a greater influence on the degree of NB formation in regions distant from the native walls where there is reduced inherent osteogenic potential.


Biomaterials Sinus floor elevation Bone substitute Native bone Gradient 



The authors wish to thank Prof. Marilena Vered, head of the Department of Oral Pathology at Tel-Aviv University for her help, Ms. Esther Eshkol for editorial assistance, and Ilana Gerlatner from the Department of Biostatistics, Tel-Aviv University.

Author’s contribution

Roni Kolerman—Sinus floor elevation, implant placement, data collection, analysis, and interpretation, manuscript writing and revision.

Joseph Nissan—Study concept/design, data analysis.

Marina Rahmanov—Histomorphometric measurements.

José Luis Calvo-Guirado—Critical revision of the manuscript.

Nirit Tager Green—Study concept/design, critical revision of the manuscript.

Tal Haim—Study concept/design, critical revision of the manuscript.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding information

This study was partially supported by the Gerald A. Niznick Chair of Implantology at Tel-Aviv University.

Compliance with ethical standards


All participants signed a consent form after being fully informed about the nature of the procedure. The ethics committee of Tel-Aviv University approved the study protocol.

Conflicts of interest

I, Roni Kolerman, hereby declare that I have no conflicts of interest.

I, Joseph Nissan, hereby declare that I have no conflicts of interest.

I, Marina Rahmanov, hereby declare that I have no conflicts of interest.

I, Calvo Guirado Luis, hereby declare that I have no conflicts of interest.

I, Nirit Tagger Green, hereby declare that I have no conflicts of interest.

I, Haim Tal, hereby declare that I have no conflicts of interest.

Ethical approval

All procedures performed in this study are in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Periodontology, the Maurice and Gabriela Goldschleger School of Dental Medicine, The Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  2. 2.Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, the Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  3. 3.Department of General and Implant Dentistry, Faculty of Medicine and DentistryUniversity of MurciaMurciaSpain

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