Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus

Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R, Worthington HV, Coulthard P

Published Online:

April 14, 2010

Sufficient bone quantity is required for dental implant placement. Bone quantity towards the back of the upper jaw may be insufficient for dental implant placement because of the presence of the maxillary sinus, a natural cavity within the bone. This cavity may enlarge following tooth loss. There are a number of techniques, termed sinus lift procedures, aimed at increasing bone quantity prior to implant placement. These techniques utilise bone graft material, either the patients own bone (autogenous bone), a range of commercially available materials (biomaterials) or a combination of the two.

Short implants (5 to 8 mm) may be as effective and cause fewer complications than longer implants placed using a more complex technique. It is not clear that bone graft materials are needed or whether some bone graft materials are more effective than others. Biomaterials might be used in place of autogenous bone. There is no evidence to suggest factors extracted from the patients blood improve bone healing.

Abstract (click to read)

Background:

Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone and/or commercially available biomaterials.

Objectives:

To determine whether and when augmentation of the maxillary sinus are necessary and which are the most effective augmentation techniques for rehabilitating patients with implant-supported prostheses.

Search strategy:

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched on 7th January 2010. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted.

Selection criteria:

Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants reporting the outcome of implant success/failure at least to abutment connection.

Data collection and analysis:

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odds ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient.

Main results:

Ten RCTs out of 29 met the inclusion criteria. One trial of 15 patients evaluated implants 5 mm long with 6 mm diameter as an alternative to sinus lift in bone with a residual height of 4 to 6 mm. Nine trials with 235 patients compared different sinus lift techniques; of these four trials (114 patients) evaluated the efficacy of platelet-rich plasma (PRP). Due to the variety of techniques evaluated, meta-analysis was only possible of use of PRP for implant failure (two trials) and complications (three trials). No statistically significant difference was observed.

Authors' conclusions:

Conclusions are based on few small trials, with short follow-up, and judged to be at high risk of bias. Therefore conclusions should be viewed as preliminary and interpreted with great caution. It is still unclear when sinus lift procedures are needed. 5 mm short implants can be successfully loaded in maxillary bone with a residual height of 4 to 6 mm but their long-term prognosis is unknown. Elevating the sinus lining in presence of 1 to 5 mm of residual bone height without the addition of a bone graft may be sufficient to regenerate new bone to allow rehabilitation with implant-supported prostheses. Bone substitutes might be successfully used as replacements for autogenous bone. If the residual alveolar bone height is 3 to 6 mm a crestal approach to lift the sinus lining, to place 8 mm implants may lead to fewer complications than a lateral window approach, to place implants at least 10 mm long. There is no evidence that PRP treatment improves the clinical outcome of sinus lift procedures with autogenous bone or bone substitutes.

This record should be cited as:

Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R, Worthington HV, Coulthard P. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD008397. DOI: 10.1002/14651858.CD008397

Assessed as up to date:

January 7, 2010

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Craniofacial anomalies > Orthodontic treatment

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Independent high-quality evidence for health care decision making

Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus

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