Clinical outcomes of sinus floor augmentation for implant placement using autogenous bone or bone substitutes: a systematic review.
BACKGROUND
To date, there are still no clear cut guidelines for the use of autogenous bone or bone substitutes.


OBJECTIVE
The aim of the present review was to analyze the current literature in order to determine whether there are advantages of using autogenous bone (AB) over bone substitutes (BS) in sinus floor augmentation. The focused question was: is AB superior to BS for sinus floor augmentation in partially dentate or edentulous patients in terms of implant survival, patient morbidity, sinusitis, graft loss, costs, and risk of disease transmission?


METHODS
The analysis was limited to titanium implants with modified surfaces placed in sites with 6 mm of residual bone height and a lateral wall approach to the sinus. A literature search was performed for human studies focusing on sinus floor augmentation.


RESULTS
Twenty-one articles were included in the review. The highest level of evidence consisted of prospective cohort studies. A descriptive analysis of the constructed evidence tables indicated that the type of graft did not seem to be associated with the success of the procedure, its complications, or implant survival. Length of healing period, simultaneous implant placement or a staged approach or the height of the residual alveolar crest, sinusitis or graft loss did not modify the lack of effect of graft material on the outcomes. Three studies documented that there was donor site morbidity present after the harvest of AB. When iliac crest bone was harvested this sometimes required hospitalization and surgery under general anesthesia. Moreover, bone harvest extended the operating time. The assessment of disease transmission by BS was not a topic of any of the included articles.


CONCLUSIONS
The retrieved evidence provides a low level of support for selection of AB or a bone substitute. Clear reasons could not be identified that should prompt the clinician to prefer AB or BS.
Nkenke
Emeka
E
Department of Oral and Maxillofacial Surgery, University Hospital of Erlangen, Erlangen, Germany. emeka.nkenke@uk-erlangen.de
Stelzle
Florian
F
D018786:Bone Substitutes / Q000009:adverse effects; D016025:Bone Transplantation / Q000009:adverse effects; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D019232:Dental Restoration Failure; D018562:Disease Transmission, Infectious; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D008443:Maxillary Sinus / Q000601:surgery*; D015523:Maxillary Sinusitis / Q000209:etiology; D013516:Oral Surgical Procedures, Preprosthetic / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
D018786:Bone Substitutes; D015921:Dental Implants