Single-Stage Lateral Sinus Floor Elevation Using Different Grafts: A Systematic Review of Controlled Clinical Trials

To assess histologic and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, and compare different types of grafts.

This systematic review (SR) was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual investigations, were searched to identify clinical trials reporting specific requirements. The present study needed human histologic and imaging data of bone formation around implants inserted into the maxillary sinus simultaneously with elevation and augmentation procedures. Study selection, risk of bias (Rob 2.0 or ROBINS-I), quality of evidence (GRADE), and data collection were performed by two independent reviewers.

Of the 1,101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility, and 5 were included (4 randomized and 1 controlled clinical trial). As a result, 130 grafted sinuses with 179 placed implants in 103 patients were analyzed. The patients were aged between 24 and 79 years and followed up between 6 and 15 months. The heterogeneity between studies did not allow the data to be combined for meta-analysis. All graft materials proved to be viable options for the intervention. The use of biphasic calcium phosphate was related to higher bone-to-implant contact.

All of the assessed grafts are viable options for the addressed intervention. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical implant site under the sinus membrane. Longer chair time and donor site morbidity should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior bone-to-implant contact compared to deproteinized bovine bone.