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Meta-Analysis
. 2014 May 13;2014(5):CD008397.
doi: 10.1002/14651858.CD008397.pub2.

Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus

Marco Esposito  1 , Pietro Felice, Helen V Worthington
Affiliations
Meta-Analysis

Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus

Marco Esposito et al. Cochrane Database Syst Rev. .

Abstract

Background: Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone or commercially available biomaterials, or both. This is an update of a Cochrane review first published in 2010.

Objectives: To assess the beneficial or harmful effects of bone augmentation compared to no augmentation when undertaking a sinus lift procedure. Secondly, to compare the benefits and harms of different maxillary sinus lift techniques for dental implant rehabilitation.

Search methods: We searched the Cochrane Oral Health Group's Trials Register (to 17 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 12), MEDLINE via OVID (1946 to 17 January 2014) and EMBASE via OVID (1980 to 17 January 2014). There were no language or date restrictions on the searches of the electronic databases.

Selection criteria: Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants that report the outcome of implant success or failure at least to four months after initial loading.

Data collection and analysis: Screening of eligible studies, assessment of the risk of bias of the trials, and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed using fixed-effect models as there were either less than four studies or we used Peto odds ratios (ORs) for dichotomous data when there were zero cells in either the treatment or control or both arms and the number of trials was small. The statistical unit of the analysis was the patient.

Main results: Eighteen RCTs out of 64 potentially eligible study reports met the inclusion criteria. They compared undertaking a sinus lift with not doing so, and the use of different sinus lift techniques. There were 650 patients providing data for the outcomes evaluated. Five studies were assessed as low risk of bias, 11 were assessed as high risk of bias, and in two the risk was unclear. Sinus lift versus no sinus lift Four trials of moderate quality (three trials at low and one at high risk of bias) with 102 participants evaluated short implants (5 to 8.5 mm long) as an alternative to sinus lift in bone with residual height between 4 and 9 mm. One year after loading there was insufficient evidence to claim differences between the two procedures for prosthesis failure (OR (Peto) 0.37, 95% confidence interval (CI) 0.05 to 2.68; three trials) or implant failure (OR (Peto) 0.44, 95% CI 0.10 to 1.99; four trials). There was however an increase in complications at treated sites when undertaking the sinus lift (OR (Peto) 4.77, 95% CI 1.79 to 12.71, P value = 0.002; four trials). Different sinus lift techniques Fourteen trials with 548 participants compared different sinus lift techniques. Only three comparisons included more than one trial (two trials for each). These were bone graft versus no bone graft, autogenous bone versus bone substitute, bone graft with or without platelet-rich plasma (PRP). There was insufficient evidence to claim a benefit for any of these techniques for the primary outcomes of prosthesis and implant failure. For the other reported outcomes, in a single study at high risk of bias, only bone gain was greater for the bone graft site than the site without a graft six months after augmentation, however this was not significant at 18 or 30 months.The other comparisons with single studies were rotary versus piezosurgery to open a lateral sinus window, two different bone substitutes, use or not of a membrane to seal the lateral window, one- versus two-stage lateral sinus lift, two-stage granular bone versus one-stage autogenous bone blocks, and crestal versus lateral sinus lift; two trials compared three different crestal sinus lifting techniques: rotatory versus hand malleting (patients preferred rotatory instruments over hand malleting) and hand versus electric malleting. There was no evidence of a benefit for any sinus lift procedure compared to any other for the primary outcomes prosthesis or implant failure.

Authors' conclusions: There is moderate quality evidence which is insufficient to determine whether sinus lift procedures in bone with residual height between 4 and 9 mm are more or less successful than placing short implants (5 to 8.5 mm) in reducing prosthesis or implant failure up to one year after loading. However, there are more complications at sites treated with sinus lift procedures. Many trials compared different sinus lift procedures and none of these indicated that one procedure reduced prosthetic or implant failures when compared to the other. Based on low quality evidence, patients may prefer rotary instruments over hand malleting for crestal sinus lift.

PubMed Disclaimer

Conflict of interest statement

Marco Esposito and Pietro Felice are among the authors of eight of the included trials, however, they were not involved in the quality assessment of these trials. Helen V Worthington: no interests to declare.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Long implants with sinus lift versus short implants without augmentation, Outcome 1 Prosthesis failures 1 year.
1.2
1.2. Analysis
Comparison 1 Long implants with sinus lift versus short implants without augmentation, Outcome 2 Implant failures 1 year.
1.3
1.3. Analysis
Comparison 1 Long implants with sinus lift versus short implants without augmentation, Outcome 3 Complications 1 year.
2.1
2.1. Analysis
Comparison 2 Different sinus lift procedures, Outcome 1 Bone versus no bone graft.
2.2
2.2. Analysis
Comparison 2 Different sinus lift procedures, Outcome 2 Bone versus no bone graft.
2.3
2.3. Analysis
Comparison 2 Different sinus lift procedures, Outcome 3 Autogenous bone versus bone substitute.
2.4
2.4. Analysis
Comparison 2 Different sinus lift procedures, Outcome 4 Autogenous bone or Bio‐Oss +/‐ PRP.
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Cannizzaro 2009 {published data only}
    1. Cannizzaro G, Felice P, Leone M, Viola P, Esposito M. Early loading of hydroxyapatite coated implants in the atrophic posterior maxilla: lateral sinus lift with autogenous bone and Bio‐Oss versus crestal mini‐sinus lift and 8 mm implants. A randomized controlled clinical trial. European Journal of Oral Implantology 2009;2:25‐38. - PubMed
    1. Cannizzaro G, Felice P, Minciarelli AF, Leone M, Viola P, Esposito M. Early implant loading in the atrophic posterior maxilla: 1‐stage lateral versus crestal sinus lift and 8 mm hydroxyapatite‐coated implants. A 5‐year randomised controlled trial. European Journal of Oral Implantology 2013;6:13‐25. - PubMed
Checchi 2010 {published and unpublished data}
    1. Checchi L, Felice P, Soardi Antonini E, Cosci F, Pellegrino G, Esposito M. Crestal sinus lift for implant rehabilitation: a randomised clinical trial comparing the Cosci and the Summers techniques. A preliminary report on complications and patient preference. European Journal of Oral Implantology 2010;3:231‐2. - PubMed
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Crespi 2012 {published data only}
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Esposito 2012 {published and unpublished data}
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Felice 2009a {published data only}
    1. Esposito M, Pellegrino G, Pistilli R, Felice P. Rehabilitation of posterior atrophic edentulous jaws: prostheses supported by 5 mm short implants or by longer implants in augmented bone? One‐year results from a pilot randomised clinical trial. European Journal of Oral Implantology 2011;4:21‐30. - PubMed
    1. Felice P, Checchi V, Pistilli R, Scarano A, Pellegrino G, Esposito M. Bone augmentation versus 5 mm long dental implants in posterior atrophic jaws. Four‐month post‐loading results from a randomized controlled clinical trial. European Journal of Oral Implantology 2009;2:267‐81. - PubMed
Felice 2009b {published data only}
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Felice 2011 {published data only}
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Felice 2012 {published and unpublished data}
    1. Felice P, Pistilli R, Piattelli M, Soardi E, Corvino V, Esposito M. Posterior atrophic jaws rehabilitated with prostheses supported by 5x5 mm implants with a novel nanostructured calcium‐incorporated titanium surface or by longer implants in augmented bone. Preliminary results from a randomised controlled trial. European Journal of Oral Implantology 2012;5:149‐61. - PubMed
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Felice 2013 {published and unpublished data}
    1. Felice P, Pistilli R, Piattelli M, Soardi E, Barausse C, Corvino V, et al. 1‐stage versus 2‐stage lateral sinus lift procedures: 1‐year post‐loading results of a multicenter randomised controlled trial. European Journal of Oral Implantology 2014;7:in press. - PubMed
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Hallman 2002 {published and unpublished data}
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Lindgren 2012 {published and unpublished data}
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Merli 2013 {published data only}
    1. Merli M, Moscatelli M, Mariotti G, Rotundo R, Nieri M. Autogenous bone versus deproteinised bovine bone matrix in 1‐stage lateral sinus floor elevation in the severely atrophied maxilla: a randomised controlled trial. European Journal of Oral Implantology 2013;6:27‐37. - PubMed
Raghoebar 2005 {published and unpublished data}
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Rickert 2013 {published and unpublished data}
    1. Rickert D, Vissink A, Huddleston Slater JJR, Meijer HJA, Raghoebar GM. Comparison between conventional and piezoelectric surgical tools for maxillary sinus floor elevation. A randomized controlled clinical trial. Clinical Implant Dentistry and Related Research 2013;15:297‐302. - PubMed
Si 2013 {published data only}
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Torres 2009 {published and unpublished data}
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Torres 2013 {published and unpublished data}
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References to studies excluded from this review

Aimetti 2008 {published and unpublished data}
    1. Aimetti M, Romano F, Dellavia C, Paoli S. Sinus grafting using autogenous bone and platelet‐rich plasma: histologic outcomes in humans. The International Journal of Periodontics and Restorative Dentistry 2008;28:585‐91. - PubMed
Badr 2010 {published data only}
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Barone 2005 {published data only}
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Barone 2008 {published data only}
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Barone 2013 {published data only}
    1. Barone A, Ricci M, Grassi RF, Nannmark U, Quaranta A, Covani U. A 6‐month histological analysis on maxillary sinus augmentation with and without use of collagen membranes over the osteotomy window: randomized clinical trial. Clinical Oral Implants Research 2013;26:1‐4. - PubMed
Bensaha 2011 {published data only}
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Bettega 2009 {published data only}
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Borges 2011 {published data only}
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Boyne 2005 {published data only}
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Canullo 2009 {published data only}
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Choi 2009 {published data only}
    1. Choi KS, Kan JY, Boyne PJ, Goodacre CJ, Lozada JL, Rungcharassaeng K. The effects of resorbable membrane on human maxillary sinus graft: a pilot study. International Journal of Oral and Maxillofacial Implants 2009;24:73‐80. - PubMed
Consolo 2007 {published data only}
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Cordaro 2008 {published data only}
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Corinaldesi 2013 {published data only}
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Crespi 2009 {published data only}
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Froum 1998 {published data only}
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Froum 2006 {published data only}
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Froum 2008 {published data only}
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Froum 2013 {published data only}
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Gassling 2013 {published data only}
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Ghanaati 2014 {published data only}
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Hallman 2008 {published data only}
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Hermund 2012 {published data only}
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Kassolis 2005 {published data only}
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Khairy 2013 {published data only}
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Kim 2009 {published data only}
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Kock 2010 {published data only}
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Kühl 2012 {published data only}
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Kühl 2013 {published data only}
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Payer 2013 {published data only}
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Sammartino 2011 {published data only}
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Schaaf 2008 {published and unpublished data}
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Silvestri 2013 {published data only}
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Steigmann 2005 {published data only}
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Suba 2006 {published data only}
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Szabó 2005 {published and unpublished data}
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Tawil 2001 {published data only}
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Testori 2013 {published data only}
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Triplett 2009 {published data only}
    1. Triplett RG, Nevins M, Marx RE, Spagnoli DB, Oates TW, Moy PK, et al. Pivotal, randomized, parallel evaluation of recombinant human bone morphogenetic protein‐2/absorbable collagen sponge and autogenous bone graft for maxillary sinus floor augmentation. Journal of Oral and Maxillofacial Surgery 2009;67:1947‐60. - PubMed
Trombelli 2012 {published data only}
    1. Trombelli L, Franceschetti G, Rizzi A, Minenna P, Minenna L, Farina R. Minimally invasive transcrestal sinus floor elevation with graft biomaterials. A randomized clinical trial. Clinical Oral Implant Research 2012;23:424–32. - PubMed
Wagner 2012 {published data only}
    1. Wagner W, Wiltfang J, Pistner H, Yildirim M, Ploder B, Chapman M, et al. Bone formation with a biphasic calcium phosphate combined with fibrin sealant in maxillary sinus floor elevation for delayed dental implant. Clinical Oral Implants Research 2012;23:1112‐7. - PubMed
Yilmaz 2013 {published data only}
    1. Yilmaz S, Ozkan Karaca E, Dirikan Ipci S, Cakar G, Kuru BE, Kullu S, et al. Radiographic and histologic evaluation of platelet‐rich plasma and bovine‐derived xenograft combination in bilateral sinus augmentation procedure. Platelets 2013;24:308‐15. - PubMed

References to studies awaiting assessment

Rickert 2014 {published data only}
    1. Rickert D, Vissink A, Slot WJ, Sauerbier S, Meijer HJ, Raghoebar GM. Maxillary sinus floor elevation surgery with BioOss® mixed with a bone marrow concentrate or autogenous bone: test of principle on implant survival and clinical performance. International Journal of Oral and Maxillofacial Surgery 2014;43(2):243‐7. - PubMed

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References to other published versions of this review

Coulthard 2003
    1. Coulthard P, Esposito M, Jokstad A, Worthington HV. Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD003607] - DOI - PubMed
Esposito 2006a
    1. Esposito M, Grusovin MG, Worthington HV, Coulthard P. Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment. Cochrane Database of Systematic Reviews 2006, Issue 1. [DOI: 10.1002/14651858.CD003607.pub2] - DOI - PubMed
Esposito 2006b
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Esposito 2008
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Esposito 2010
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