A Meta-Analysis of Histomorphometric Results and Graft Healing Time of Various Biomaterials Compared to Autologous Bone Used as Sinus Floor Augmentation Material in Humans

Background: To date, no studies have been published in which histomorphometric data from a large group of patients comparing various biomaterials for sinus floor augmentation procedures were evaluated. Materials and Methods: A meta-analysis of the English literature from January 1993 till April 2009 was carried out. Out of 147 titles, according to our criteria, 64 articles were selected for analysis describing the use of autologous bone and their alternatives, such as allogenic, xenogenic, and alloplastic materials. Results: On the basis of autologous bone grafting, a reference value for total bone volume (TBV) of 63% was found. Particulation of the bone graft resulted in a general reduction of -18% in TBV. Delayed implant placement reduced the TBV with -7%. Overall TBV was 8% or 6% higher if a biopsy was, respectively, taken before 4.5 months or after 9.0 months after initial sinus augmentation surgery. Allogenic, xenogenic, alloplastic, or combinations of graft materials all resulted in a significant lower amount of TBV compared to autologous bone grafting ranging from -7% to -26%. Inventorying the effect of biopsy time'' for autologous bone, the TBV was significantly higher before 4.5 and after 9.0 months of healing time compared to period in between. Surprisingly, no significant differences in TBV with respect to biopsy time'' for bone substitutes were found. Conclusions: On the basis of the aspect of TBV autologous bone still has to be considered to be the gold standard in sinus augmentation surgery. However, the consequence of the TBV for implant survival is still unraveled yet.