Cochrane · intervention · CD008397
Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus
Esposito, M, Felice, P, Worthington, HV · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
51
current version
GRADE rated
3
No studies
1
Included studies
18
as reported
No studies 1 · 2%Ungraded 47 · 92.2%Very low 0 · 0%Low 1 · 2%Moderate 2 · 3.9%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with missing teeth and an atrophic posterior maxilla who may require augmentation of the maxillary sinus prior to or at placement of dental implants | 650 patients from 18 trials; residual alveolar bone height about 1 to 9 mm below the maxillary sinus; 102 in the sinus-lift-versus-no-lift comparison and 548 in the different-techniques comparisons (n=650) |
| Intervention | Any bone augmentation technique, active agent (e.g. bone morphogenetic proteins, platelet-rich plasma, stem cells) or biomaterials used together with osseointegrated, root-formed dental implants; when comparing with no augmentation, implants may be shorter and wider, angulated or trans-sinus | Sinus lift with long implants (n=102 comparison); rotary instruments; bone graft (Bio-Oss); autogenous bone; one bone substitute; graft with PRP; membrane to seal window; one-stage augmentation; one-stage autogenous bone block; crestal sinus lift; osteotomes with mallet; hand mallet |
| Comparison | No augmentation (short implants); a different augmentation technique/material | Short implants without augmentation (n=102 comparison); piezosurgery; no bone graft; bone substitute; a different bone substitute; graft without PRP; no membrane; two-stage augmentation; two-stage particulate bone; lateral sinus lift; rotary instruments; electric mallet |
| Outcomes | Primary: Prosthesis failure; Implant failure. Secondary: Augmentation procedure failure; Complications at treated sites (incl. bone donor sites); Patient satisfaction; Patient preference; Bone gain; Duration of treatment time; Treatment costs | Prosthesis failure (n=18 trials); Implant failure (n=18 trials); Augmentation procedure failure (n=18 trials); Complications (n=16 trials); Patient satisfaction (n=1 trial); Patient preference (n=5 trials); Bone gain (n=3 trials); Duration of treatment time (n=18 trials); Treatment costs (n=0) |
| Study designs | Randomised controlled trials (RCTs) including split-mouth studies | RCTs including parallel-group and split-mouth designs (n=18) |
| Timing | At least four months after initial loading; between four months to one year; three years; five years after loading | Follow-up from five months to five years after loading |
Search date: 2014-01. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OVID); EMBASE (OVID)
Questions and results
Show all 2 versionsMaxillary sinus lift (augmentation) with long implants vs Short implants (5 to 8.5 mm) without sinus augmentation
Population: Patients with missing teeth and an atrophic posterior maxilla, with residual bone height between 4 and 9 mm below the maxillary sinus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient preference 4 to 5 months after loading | Felice 2009a: all patients expressed no preference (biased by design). Esposito 2012: five months after loading, 15 patients preferred short implants whereas 5 described both procedures as equally acceptable. | 2 studies | Ungraded |
Implant failure median 1 year after loading | Peto OR 0.44 [0.10, 1.99] 71 per 1000 (study population) vs 33 per 1000 | 4 studies · 137 participants | Moderate Downgraded: imprecision |
Augmentation procedure failure 1 year after loading | One bilateral augmentation failure occurred in one trial only (Felice 2011). | 1 study | Ungraded |
Patient satisfaction 5 months after loading | Patient satisfaction was reported by one trial (Felice 2011); no usable pooled data. | 1 study | Ungraded |
Complications (at treated sites) median 1 year after loading | Peto OR 4.77 [1.79, 12.71] 43 per 1000 (study population) vs 176 per 1000 | 4 studies · 137 participants | Low Downgraded: imprecision, inconsistency |
Treatment costs | Treatment costs: no trials reported this outcome (extrapolated by the review authors). Additional costs were associated with the long-implant + augmentation group (extra surgery, biomaterial, barrier, hospitalisation… | 0 studies | No studies |
Prosthesis failure median 1 year after loading | Peto OR 0.37 [0.05, 2.68] 55 per 1000 (study population) vs 21 per 1000 | 3 studies · 109 participants | Moderate Downgraded: imprecision |
One-stage lateral sinus lift with monocortical autogenous bone blocks (iliac crest) vs Two-stage lateral sinus lift with autogenous particulate bone (iliac crest)
Population: Patients with 2 to 7 mm of residual alveolar bone height in the edentulous maxillary sinus floor
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications (sinus membrane perforation) 3 years after loading | OR 0.82 [0.24, 2.84] | 1 study · 40 participants | Ungraded |
Implant failure 3 years after loading | OR 1.56 [0.42, 5.76] | 1 study · 40 participants | Ungraded |
Prosthesis failure 3 years after loading | OR 1.00 [0.06, 17.18] | 1 study · 40 participants | Ungraded |
Autogenous bone graft (two-stage lateral sinus lift) vs Bone substitute (anorganic bovine bone / Bio-Oss)
Population: Patients with an atrophic posterior maxilla requiring maxillary sinus augmentation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications up to 1 year | OR 2.11 [0.18, 25.35] | 1 study · 40 participants | Ungraded |
Implant failure abutment connection to 1 year | OR 4.20 [0.81, 21.79] | 2 studies · 51 participants | Ungraded |
One-stage crestal-approach sinus lift with autogenous bone and 8 mm implants vs Lateral-window sinus lift with 50% autogenous bone/50% Bio-Oss and implants at least 10 mm long
Population: Patients with 3 to 6 mm of residual bone height at the sinus floor
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 5 years after loading | OR 0.30 [0.03, 3.15] | 1 study · 40 participants | Ungraded |
Partial graft loss 5 years after loading | OR 0.63 [0.09, 4.24] | 1 study · 40 participants | Ungraded |
Prosthesis failure 5 years after loading | OR 0.47 [0.04, 5.69] | 1 study · 40 participants | Ungraded |
Complications 1 year after loading | OR 0.21 [0.02, 2.08] | 1 study · 40 participants | Ungraded |
Augmentation (graft) procedure failure 5 years after loading | OR 0.18 [0.01, 4.01] | 1 study · 40 participants | Ungraded |
Sinus lift with bone graft (granular Bio-Oss) vs Sinus lift without bone graft (Inion resorbable rigid barrier maintaining space / no bone)
Population: Patients with an atrophic maxillary sinus requiring augmentation (1 to 5 mm residual bone height)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bone gain 18 months after augmentation | MD -0.10 [-0.47, 0.27] | 1 study · 39 participants | Ungraded |
Bone gain 6 months after augmentation | MD 0.26 [-0.91, 1.43] | 1 study · 9 participants | Ungraded |
Prosthesis failure 1 year after loading | OR 0.63 [0.10, 4.22] | 1 study · 44 participants | Ungraded |
Bone gain 30 months after augmentation | MD 0.10 [-1.04, 1.24] | 1 study · 39 participants | Ungraded |
Complications 1 year after loading | OR 0.50 [0.01, 9.60] | 1 study · 9 participants | Ungraded |
Augmentation procedure failure 1 year after loading | OR 0.48 [0.04, 5.67] | 1 study · 44 participants | Ungraded |
Implant failure 1 year after loading | OR 0.52 [0.10, 2.82] | 2 studies · 53 participants | Ungraded |
Bone gain 6 months after augmentation | MD 3.60 [2.99, 4.21] | 1 study · 41 participants | Ungraded |
Bone graft with platelet-rich plasma (PRP) vs Bone graft without PRP
Population: Patients with insufficient bone below the maxillary sinus requiring dental implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications 2 years after loading | Raghoebar 2005: 1 complication in the non-PRP arm, OR 0.27 (0.01 to 8.46), P = 0.46; Torres 2009 (PRP only = 3, no-PRP only = 2), OR 1.49 (0.15 to 15.07), P = 1.00. No statistically significant difference. | 2 studies · 62 participants | Ungraded |
Implant failure 2 years after loading | No statistically significant difference for implant failures. Per trial: Raghoebar 2005 1 failure in the PRP arm, OR 3.67 (0.12 to 113.73), P = 0.46; Torres 2009 (PRP only = 1, no-PRP only = 2), OR 0.50 (0.01 to… | 2 studies · 62 participants | Ungraded |
Partial graft loss 2 years after loading | OR 1.5 [0.17, 17.96] | 1 study · 57 participants | Ungraded |
Rotary instruments to open the lateral sinus window vs Piezosurgery to open the lateral sinus window
Population: Patients undergoing lateral-window maxillary sinus lift
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complications at donor site 1 year after loading | Rickert 2013 (N = 36): no complications at donor site. | 1 study · 36 participants | Ungraded |
Augmentation procedure failure 1 year after loading | Rickert 2013 (N = 36): no augmentation procedure failures. | 1 study · 36 participants | Ungraded |
Prosthesis failure 1 year after loading | Rickert 2013 (split-mouth, N = 36): no prosthesis failures in either group. | 1 study · 36 participants | Ungraded |
Implant failure 1 year after loading | Rickert 2013 (N = 36): no implant failures in either group. | 1 study · 36 participants | Ungraded |
Complications at augmented site 1 year after loading | OR 1.00 [0.27, 3.74] | 1 study · 36 participants | Ungraded |
Bone substitute (anorganic bovine bone / Bio-Oss) vs A different bone substitute
Population: Patients undergoing two-stage maxillary sinus augmentation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Augmentation procedure failure 1 year after loading | Augmentation procedure failure 0/11 versus 0/11; none. | 1 study · 11 participants | Ungraded |
Implant failure 1 year after loading | OR 1.00 [0.05, 18.30] | 1 study · 11 participants | Ungraded |
Prosthesis failure 1 year after loading | Lindgren 2012 (split-mouth, 11 patients): prosthesis failures 0/11 versus 0/11; none. | 1 study · 11 participants | Ungraded |
Complications at augmented site 1 year after loading | OR 3.29 [0.12, 89.8] | 1 study · 11 participants | Ungraded |
Resorbable barrier (membrane) to seal the lateral window vs No membrane to seal the lateral window
Population: Patients undergoing lateral-window maxillary sinus lift
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prosthesis failure 1 year after loading | OR 2.63 [0.75, 9.14] | 1 study · 104 participants | Ungraded |
Implant failure 1 year after loading | OR 2.63 [0.75, 9.14] | 1 study · 104 participants | Ungraded |
One-stage augmentation (implants placed simultaneously) vs Two-stage augmentation (delayed implant placement)
Population: Patients requiring maxillary sinus augmentation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant failure 1 year after loading (before loading) | OR 3.48 [0.34, 35.61] | 1 study · 58 participants | Ungraded |
Prosthesis failure 1 year after loading | OR 0.35 [0.01, 6.83] | 1 study · 58 participants | Ungraded |
Complications 1 year after loading | OR 2.23 [0.19, 26.06] | 1 study · 58 participants | Ungraded |
Osteotomes with mallet (Summers' technique) vs Rotary instruments (Cosci technique)
Population: Patients undergoing crestal maxillary sinus lift
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prosthesis failure 3 years after loading | Checchi 2010 (split-mouth, N = 12): no prosthetic failures in either group. | 1 study · 12 participants | Ungraded |
Implant failure 3 years after loading | Checchi 2010 (N = 12): no implant failures in either group. | 1 study · 12 participants | Ungraded |
Patient preference 5 months after loading | Five months after loading, 13 of 15 patients preferred the side treated with the Cosci (rotary) technique; binomial test P = 0.007 (significant). Basis for the review's low-quality-evidence statement that patients may… | 1 study · 15 participants | Ungraded |
Complications 3 years after loading | OR 7.86 [0.75, 82.13] | 1 study · 12 participants | Ungraded |
Hand mallet (osteotomes) vs Electric mallet
Population: Patients undergoing one-stage crestal maxillary sinus lift without bone grafts (baseline residual bone height about 6.5 mm)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Augmentation procedure failure 19 months to 3 years after loading | Augmentation failures 0/40 versus 0/40; none. | 1 study · 80 participants | Ungraded |
Implant failure before loading | OR 1.00 [0.06, 16.56] | 1 study · 80 participants | Ungraded |
Complications at augmented site 19 months to 3 years after loading | OR 3.16 [0.31, 31.78] | 1 study · 80 participants | Ungraded |
Prosthesis failure 19 months to 3 years after loading | Crespi 2012 (parallel, 40 per group): prosthesis failures 0/40 versus 0/40; none. | 1 study · 80 participants | Ungraded |
Bone gain after augmentation | MD 0.10 [-0.52, 0.72] | 1 study · 80 participants | Ungraded |