Demineralized bone allograft fibers versus particulate in sinus augmentation: A double-arm randomized controlled and histomorphometric study.

BACKGROUND: The primary aim of this study was to evaluate histologic wound healing of demineralized freeze-dried bone allograft (DFDBA), in particulate (P) or fiber (F) form, in combination with deproteinized bovine bone mineral (DBBM) for maxillary sinus floor augmentation. Two stains were used to evaluate whether the type of stain had an effect on histologic analysis. METHODS: This two-arm, parallel, randomized controlled trial included 29 patients with maxillary posterior edentulism requiring maxillary sinus augmentation to facilitate implant placement. Patients were blindly randomized into one of two groups: DBBM+F or DBBM+P. After 6 months of healing, bone cores were collected for histologic evaluation of vital bone, residual allograft, residual xenograft, and connective tissue (CT)/other using two stains (hematoxylin and eosin [H&E] and Masson's trichrome). RESULTS: No statistically significant differences were observed between the DBBM+F and DBBM+P groups for percent vital bone formation, residual graft, or CT/other on mixed linear model analysis (all p > 0.05). Paired analysis demonstrated no statistically significant differences between H&E and trichrome staining for percent vital bone formation, residual allograft, or residual xenograft (all p > 0.05). However, a statistically significant difference was observed for CT/other, with trichrome staining yielding lower mean values than H&E (mean paired difference -8.03%, p = 0.0146). CONCLUSION: Both graft combinations demonstrated comparable histomorphometric outcomes within the limits of this study. Masson's Trichrome staining may improve discrimination between osteoid/collagen matrix and mineralized tissue interfaces during histomorphometric analysis.