Über den Autor
Dagmar E. Slot, Shaimaa Nasr, Samah Bahaa, Christof E Dörfer
Implants with Sinus Augmentation-The Merit of Bone Grafting? A Systematic Review
Dental implants’ placement in the maxillary posterior region with reduced bone quality and quantity presents a challenging clinical situation, frequently requiring maxillary sinus floor elevation. In the context of evidence-based decision-making, the aspect of cost-benefit is of pronounced significance and should be taken into consideration, when a medical procedure, as in the case of bone-graft-assisted maxillary sinus floor augmentation in combination with dental implants’ placement is routinely advocated among clinicians. The present study’s aim was to systematically asses the current evidence on the effect of non-grafted compared to graft-assisted maxillary sinus floor elevation on implants’survival/failure, endosinus bone gain, crestal bone loss and bone density around dental implants.
MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases as well as grey literature were searched up to November 2015 for randomized-controlled-trials-(RCTs) and controlled-clinical-trials-(CCTs), evaluating dental implants placed in combination with maxillary sinus elevation without and with bone grafting. Implants’ survival/failure served as primary outcome, while endosinus bone gain, crestal bone loss and bone density around dental implants as secondary outcomes. To assess possible bias, the Cochrane risk of bias tool (Higgings and Green, 2009) was used. Data were extracted and a meta-analysis performed where appropriate.
Independent screening of 3180 papers resulted in six eligible experiments (Altintas et al., 2013; Nedir et al., 2013; Nedir et al., 2015; Si et al., 2013; Lai et al., 2010; Esposito et al., 2010; Felice et al., 2009; Borges et al., 2011) (Figure 1). The six experiments evaluated 485 implants in 300 participants. Heterogeneity was observed between experiments. One experiment showed low, three unclear and two high risk of bias (Table 1). Implants’ survival/failure, endosinus bone gain, crestal bone loss and bone density around dental implants showed no significant long-term differences between maxillary sinus floor elevation without and with bone grafting (Figure 2 A-F). Altogether, the recommendation for non-grafted sinus floor elevation in combination with dental implants’ placement in the maxillary posterior region was considered ‘moderate’ based on the quality and body of evidence (Table 2).
Within current systematic review’s limits, non-grafted maxillary sinus floor elevation seems to be characterized by high implants’ survival and new bone formation, comparable to bone-graft-assisted maxillary sinus floor elevation. Given the additional cost and manpower involved, the current lack of a clear advantage questions the clinical significance of the bone grafting’s routine use during sinus floor elevation in combination with dental implants insertion. Further long-term clinical and radiographic studies (10 years and beyond) focusing on patient-relevant outcome measures are needed, before definitive conclusions can be made.