Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Compared with a Composite Grafting Material or Bone Substitute Alone: a Systematic Review and Meta-Analysis Assessing Volumetric Stability of the Grafting Material

Thomas Starch-Jensen, Daniel Deluiz, Julie Vitenson, Niels Henrik Bruun, Eduardo Muniz Barretto Tinoco, Thomas Starch-Jensen, Daniel Deluiz, Julie Vitenson, Niels Henrik Bruun, Eduardo Muniz Barretto Tinoco

Abstract

Objectives: Test the hypothesis of no difference in the volumetric stability of the grafting material following maxillary sinus floor augmentation with autogenous bone graft compared with composite grafting material or bone substitute alone applying the lateral window technique.

Material and methods: MEDLINE (PubMed), Embase, Cochrane library and hand-search of relevant journals were conducted. Human studies published in English until the 9th of October 2020 were included. Outcome measures included three-dimensional volumetric changes of the grafting material and potential predictive parameters. Volumetric changes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval.

Results: Electronic search and hand-searching resulted in 102 entries. Four randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. The volumetric stability of the grafting material was significantly improved by mixing autogenous bone graft with a non-resorbable xenograft compared with autogenous bone graft. Meta-analyses assessing absolute and relative volumetric changes demonstrated no significant differences between autogenous bone graft compared with allogeneic bone graft, synthetic biomaterials combined with autogenous bone graft or used alone. Association between volumetric changes of the grafting material and potential predictive parameters were not assessed in the included studies.

Conclusions: Volumetric reduction of the augmented area seems inevitable following maxillary sinus floor augmentation regardless of the grafting material. The volumetric stability of autogenous bone graft is improved with addition of xenograft compared with autogenous bone graft. However, conclusions drawn from this systematic review should be interpreted with caution since only four studies using three-dimensional radiographic measurements were included.

Keywords: alveolar ridge augmentation; dental implants; oral surgical procedures; review; sinus floor augmentation.

Copyright © Starch-Jensen T, Deluiz D, Vitenson J, Bruun NH, Tinoco EMB. Published in the JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH (http://www.ejomr.org), 31 March 2021.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram demonstrating the results of the systematic literature search.
Figure 2
Figure 2
Random-effects meta-analysis using Sidik-Jonkman estimation method revealing no statistically significant differences in absolute (mm3) volumetric changes between the used grafting materials.
Figure 3
Figure 3
Funnel plot to visualized heterogenicity among the included studies for assessment of differences in absolute (mm3) volumetric changes. Larger studies with higher power are placed towards the top (smaller standard errors) and lower powered studies towards the bottom. An asymmetry in the funnel plot indicate bias. Eggers test did not indicate small-study effects (P-value = 0.8982).
Figure 4
Figure 4
Random-effects meta-analysis using Sidik-Jonkman estimation method revealing no statistically significant differences in relative (%) volumetric changes between the used grafting materials.
Figure 5
Figure 5
Funnel plot to visualized heterogenicity among the included studies for assessment of differences in relative (%) volumetric changes. Larger studies with higher power are placed towards the top (smaller standard errors) and lower powered studies towards the bottom. An asymmetry in the funnel plot indicate bias. Eggers test did not indicate small-study effects (P-value = 0.0987).

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