Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome

Abstract

Objectives The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique. Material and Methods MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25 th of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI). Results Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively. Conclusions Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.

Deproteinized bovine bone and freeze‐dried bone allograft in sinus floor augmentation: A randomized controlled trial

“…In addition, our maxillary sinus augmentation surgery was performed in closed space, therefore bone grafts are less likely to leak from the void space. These findings are supported by previous studies that used histomorphometry as a major method to investigate the difference between grafts and found that DBB resorption was slower than other graft materials 11,28 …”

Patient’s perception of recovery after maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: a single-blinded randomized controlled trial

“…Nevertheless, patients with impaired OHRQoL generally Table 4 Percentage distribution of responses to each question of OHIP-14 questionnaire 0 = never; 1 = hardly ever or nearly never; 2 = occasionally; 3 = fairly often or many times; 4 = very often BBGM biphasic bone graft material, DPBM deproteinized porcine bone mineral, SD standard deviation significantly associated with impaired patient´s perception of recovery. MSFA with autogenous bone graft used alone or in combination with different ratios of bone substitutes generates more newly formed bone, higher bone-toimplant contact, and earlier bone formation compared with the use of a bone substitute alone [13,[29][30][31]. However, harvesting of extraoral and intraoral autogenous bone graft negatively influences postsurgical OHRQoL due to increased pain, impaired eating and speaking ability, sleep impairment, limitation in daily routine, and sick leave [12,[32][33][34].…”

“…MSFA with autogenous bone graft used alone or in combination with different ratios of bone substitutes generates more newly formed bone, higher bone-to-implant contact, and earlier bone formation compared with the use of a bone substitute alone [ 13 , 29 – 31 ]. However, harvesting of extraoral and intraoral autogenous bone graft negatively influences postsurgical OHRQoL due to increased pain, impaired eating and speaking ability, sleep impairment, limitation in daily routine, and sick leave [ 12 , 32 – 34 ].…”

Bone regeneration after maxillary sinus floor augmentation with different ratios of autogenous bone and deproteinized bovine bone mineral an in vivo experimental study

“…Autogenous bone (AB) harvested from intraoral or extraoral sources is generally considered as the preferred graft due to its osteoinductive, osteoconductive, and osteogenic properties. It has been concluded in recently published systematic reviews focusing on histomorphometric assessment after MSFA that AB enables the highest amount of bone formation compared with other biomaterials (Corbella et al, 2016; Danesh‐Sani et al, 2017; Starch‐Jensen et al, 2020). However, AB is associated with unpredictable resorption of the graft, which may compromise staged implant placement or necessitates additional bone augmentation (Pesce et al, 2021; Shanbhag et al, 2014).…”