Successful craniofacial reconstruction needs both a well-known and a reliable
reconstruction material. However, there is often a lack of long-term knowledge of the tissue
reactions and healing process in the human body. In this study, frontal sinus obliterations with
bovine bone natural hydroxyapatite derivative (BHA), synthetic bioactive glass S53P4 (BAG) and
hydroxyapatite cement (HAC) were investigated with clinical, histologic, scanning electron
microscopic (SEM) and energy dispersive x-ray analysis (EDXA) 27, 12 and 3 years
postoperatively. The aim was to determine the long-term clinical biocompatibility of the used
materials. Histologic studies revealed bone formation with BHA particles and lamellar bone with
BAG granule remnants in close contact to the new bone formation. In HAC reconstruction there
was scattered fibroconnective tissue growth without new bone formation in the surface of HAC
implantation. Neither foreign body reaction nor any abnormal findings were seen. SEM studies
revealed a CaP layer on the surface of BAG granule remnants. In EDXA studies, composition
profiles showed Ca-, P- and Si- rich layers on the BAG granule surface. No differences were found
in CaO and P2O5 levels between BHA granules and HAC implantation and the surrounding bone.
All investigated biomaterials were well tolerated in long-term applications.