Effect of Maxillary Sinus Augmentation on the Survival of Endosseous Dental Implants. A Systematic Review

Abstract

Background:Grafting the floor of the maxillary sinus has become the most common surgical intervention for increasing alveolar bone height prior to the placement of endosseous dental implants in the posterior maxilla. Outcomes of this procedure may be affected by specific surgical techniques, simultaneous versus delayed implant placement, use of barrier membranes over the lateral window, selection of graft material, and the surface characteristics and the length and width of the implants.

Rationale:The primary objective of this systematic review was to determine the efficacy of the sinus augmentation procedure and compare the results achieved with various surgical techniques, grafting materials, and implants.

Focused Question: In patients requiring dental implant placement, what is the effect on implant survival of maxillary sinus augmentation versus implant placement in the non-grafted posterior maxilla?

Search Protocol: MEDLINE, the Cochrane Oral Health Group Specialized Trials Register, and the Database of Abstracts and Reviews of Effectiveness were searched for articles published through April 2003. Hand searches were performed on Clinical Oral Implants Research, International Journal of Oral and Maxillofacial Implants, and the International Journal of Periodontics & Restorative Dentistry and the bibliographies of all relevant papers and review articles. In addition, researchers, journal editors, and industry sources were contacted to see if pertinent unpublished data that had been accepted for publication were available.

Selection Criteria

Inclusion criteria: Human studies with a minimum of 20 interventions, a minimum follow-up period of 1-year loading, an outcome measurement of implant survival, and published in English, regardless of the evidence level, were considered.

Exclusion criteria:Studies involving multiple simultaneous interventions (e.g., simultaneous ridge augmentation) and studies with missing data that could not be supplied by the study authors were excluded.

Data Collection and Analysis: Where adequate data were available, subgroups of dissimilar interventions (e.g., surgical techniques, graft materials, implant surfaces, membranes) were isolated and subjected to metaregression, a form of meta-analysis.

Reviewers' Conclusions: Insufficient data were present to statistically evaluate the effects of smoking, residual crestal bone height, screw versus press-fit implant design, or the effect of implant surface micromorphology other than machined versus rough surfaces. There are insufficient data to recommend the use of platelet-rich plasma in sinus graft surgery.

Ann Periodontol 2003;8:328-343