Residual Bone Height and New Bone Formation after Maxillary Sinus Augmentation Procedure Using Biomaterials: A Network Meta-Analysis of Clinical Trials

Abstract

Background. Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). Methods. PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). Results. A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. Conclusion. There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics.

Autologous leucocyte and platelet rich in fibrin (L-PRF) – is it a competitive solution for bone augmentation in maxillary sinus lift? A 6-month radiological comparison between xenografts and L-PRF

“…Bone grafts are divided into four main categories: xenografts, allografts, alloplasts and autologous grafts. Various combinations were studied: recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier, recombinant human platelet-derived growth factor-BB in combination with freeze-dried bone allograft or beta-tricalcium phosphate, autologous cell therapy [ 10 , 11 ]. In most cases, the quantity required for autologous bone is too significant.…”

Resorption Rates of Bone Graft Materials after Crestal Maxillary Sinus Floor Elevation and Its Influencing Factors

“…Some clinical protocols [25,26] suggested opting for lateral window maxillary sinus floor elevation when the remaining bone height is <5 mm to avoid the risk of sinus membrane tearing. In a study on the height variation of bone graft materials in the maxillary sinus, Khijimatgar et al [27] found that the height resorption rates of bone graft materials in the group with higher RBH were significantly higher than those in the lower RBH group. However, Taschieri et al [28] studied the impact of RBH on spatial change in bone graft materials after crestal maxillary sinus floor elevation and concluded that RBH did not correlate with the resorption of bone graft materials.…”

Maxillary Sinus Augmentation and Implant Installation with Commissuroplasty in a Patient with Burn-induced Microstomia

“…In the case of sinus-lifting through a lateral approach, sufficient buccal retraction is required for a lateral approach through the buccal vestibule. 8 Therefore, implant placement with sinus augmentation in patients with burn-induced microstomia is very difficult to treat.…”