Dental implants combined with sinus augmentation: What is the merit of bone grafting? A systematic review

Purpose: The aim of the present study was to systematically assess the current evidence on the effect of nongrafted compared to graft-assisted maxillary sinus floor elevation on implant survival/failure, endosinus bone gain, crestal bone loss, and bone density around dental implants. Materials and methods: MEDLINE-PubMed, Cochrane-CENTRAL, and EMBASE databases were searched up to November 2015 for randomized controlled trials (RCTs) and controlled clinical trials-(CCTs), evaluating dental implants placed in combination with maxillary sinus elevation without and with bone grafting. Implant survival/failure served as the primary outcome, whereas endosinus bone gain, crestal bone loss, and bone density around dental implants were secondary outcomes. To assess possible bias, the Cochrane risk of bias tool was used. Data were extracted and a meta-analysis performed where appropriate. Results: Independent screening of 3180 papers resulted in six eligible experiments. Heterogeneity was observed among experiments. One experiment showed low, three unclear, and two a high risk of bias. The assessed outcomes showed no significant long-term differences between groups. Conclusion: Within the limit of the current systematic review, nongrafted maxillary sinus floor elevation seems to be characterized by new bone formation and high implant survival rate comparable to bone graft-assisted maxillary sinus floor augmentation. Further long-term studies are needed before definitive conclusions can be made. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.