Sinus augmentation using absorbable collagen sponge loaded with Escherichia coli-expressed recombinant human bone morphogenetic protein 2 in a standardized rabbit sinus model: A radiographic and histologic analysis

Objectives: The purpose of this pilot study was to determine the osteoinductive effect of absorbable collagen sponge (ACS) loaded with Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) and evaluate structural stability of ACS in a standardized rabbit sinus model. Material and methods: The maxillary sinuses were prepared bilaterally in six male white rabbits. The windows were prepared using a 6mm trephine bur, and circular bony windows were carefully removed. Following reflection of the sinus membrane, a saline-soaked ACS alone and an ErhBMP-2-loaded ACS were inserted into the left and right maxillary sinuses, respectively. After a healing period of 8 weeks, sections of the augmented sinus and surrounding bone were made and analyzed by microcomputed tomography and histologically for signs of window closure and bone augmentation. Results: Radiographic analysis revealed new bone formation in both groups of augmented sinus (i.e., with and without ErhBMP-2). The maximum augmented height did not differ significantly between the groups; however, window closure was significantly more advanced in the ErhBMP-2 group than in the control group (P=0.02). The defect was significantly deeper in the control group than in the ErhBMP-2-treated group (P=0.02). Conclusions: In conclusion, ErhBMP-2-loaded ACS showed enhanced osteoinductive potential, particularly with regard to bone closure of a sinus window and facilitated maturation of the newly formed bone within the rabbit sinus cavity. However, the structural durability of ACS was not sufficient to maintain the augmented volume in the sinus.