Bone Formation after Sinus Membrane Elevation and Simultaneous Placement of Implants without Grafting Materials – A Systematic Review

Abstract: Background: Rehabilitation of the atrophied edentulous maxilla is complicated. Often the residual bone height is insufficient for implant placement due to crestal bone resorption and pneumatization of the sinus. The most common treatment has been a two-stage surgery using autogenous or synthetic grafting materials placed in the maxillary sinus before implant therapy. The sinus lift technique was introduced by Boyne et al. (1980) and much research has been done to evaluate this technique where the implants have been placed emerging into the sinus without grafting. This paper consists of a review of the literature available on sinus membrane elevation with simultaneous implant placement without the use of grafting materials and a comparison between lateral approach sinus floor elevation (LASFE) and osteotome sinus floor elevation (OSFE). Materials & Methods: PubMed was used as database to search for articles. Also, relevant journals and systematic reviews were evaluated. Clinical studies with sinus lift without grafting materials with simultaneous implant placement were included. A minimum of 6 months follow-up was an inclusion criteria. Experimental studies and studies with less than ten implants were excluded. Results: 22 articles were included, nine studies using LASFE and 13 using OSFE. The implant survival rate was 98.9% and 97.9% respectively. The MBL was 0.4 – 2.1±0.5 mm for LASFE and 0.2±0.8 – 1.4±0.2 mm for OSFE. New bone formation was 1.7±2.0 – 7.9±3.6 mm and 2.2±1.7 – 4.5±1.9 mm respectively. Conclusion: This review shows that grafting materials are not necessary to achieve a high implant survival rate. Some advantages with the less invasive non-grafting method are a decreased patient discomfort and a shorter treatment time. Both LASFE and OSFE without grafting have good outcomes. The surgeon should choose technique considering personal experience and the individual patient situation.