Jarvie Journal - College of Dental Medicine - Columbia University

Volume 56, Spring 2013
Maxillary Sinus Augmentation and Vitamin D Insufficiency- a Systemic-
Local Connection
Wang, K 1 , Wu, C 2 , Dietrich, T 3 , Dibart, S 4 , Schulze-Späte, U 1 *
1 Division of Periodontics, College of Dental Medicine, Columbia University;
2 Division of Cardiology, Department of Medicine, Columbia University;
3 University of Birmingham; 4 Department of Periodontology, Boston University, MA *Faculty Mentor
Introduction: Implant placement in the edentulous maxilla often represents a clinical challenge due to
insufficient bone height after crestal bone resorption and maxillary sinus pneumatization. Tatum et al
was the first one describing a procedure, which utilizes existing space in the maxillary sinus by lifting up
the Schneiderian membrane from its bony surface and filling this newly created space with augmentation
material. Several grafting materials can be used to augment bone height in the posterior maxilla:
autogenous bone, allografts (harvested from human cadavers), alloplasts (synthetic materials), and
xenografts (grafts from nonhuman species). After graft placement, particles will partially be remodeled
and replaced by the patient`s own bone. This process is a complex mechanism and influenced by several
factors associated with overall bone metabolism.
Vitamin D plays an essential role in calcium homeostasis and is essential for bone formation and
remodeling. It promotes coupling of bone resorption to bone formation on a cellular level and, therefore,
optimizes bone remodeling. Whether low vitamin D serum levels are associated with less bone
remodeling after maxillary sinus augmentation has not been evaluated.
Objective: This pilot cohort study will investigate bone formation and remodeling after sinus
augmentation and determine Vitamin D levels throughout the treatment.
Materials & Methods: Patients (age: 48.6±12.6, 28.2±5.1) underwent sinus augmentation surgery using
β-tri-calcium phosphate as a grafting material (n=20). 24 weeks after sinus augmentation, implants were
placed and a bone core was harvested from the same site. The bone core was analyzed histologically and
histomorphometrically to evaluate bone regeneration and remodeling within the sinus graft. Blood
samples were collected at the baseline visit and after 2, 12 and 24 weeks to determine serum levels of
calcium and 25-hydroxyvitamin D (25-OHD). The association between 25-OHD serum levels and bone
regeneration in the grafted sinus was analyzed.
Results & Conclusions: Patients with deficient Vitamin D levels (25 (OH) D: 30ng/ml)
(41.13±4 vs. 48.8±3.6 % of total area), whereas the amount of remaining graft material was higher in
Vitamin D insufficient patients (16.1±6 vs. 13.9±2.6 % of total area). In line with these findings, more
osteoclasts were detected around bone and graft particles in bone cores taken from the Vitamin D
sufficient patient group (1.7±0.5 vs 2.6±0.7 (bone), 1.89±0.75 vs 2.71±1.05 (graft).
Discussion: Our findings suggest that sufficient Vitamin D serum levels might be advantageous for bone
remodelling after maxillary sinus augmentation. Bone biopsies taken from patients with insufficient
Vitamin D levels were less metabolically active and had less bone and more remaining graft material.
Several studies have demonstrated that vitamin D supplementation increases bone mineral density.
Therefore, future studies could evaluate whether Vitamin D supplementation might improve bone
formation after sinus grafting.
Kun Wang was supported by a College of Dental Medicine Pre-Doctoral Summer Research Fellowship.
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