Major maxillary sinus augmentation techniques for dental implant: a systematic review

Abstract

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. It will increase its volume towards the location where the roots existed and this will often make it difficult or unfeasible to restore implants in that location. Various surgical techniques can be used to reconstruct the atrophic alveolar ridge, techniques alone or associated with autogenous, allogeneic, xenogeneic grafts, and alloplastic biomaterials. Objective: It was to develop a systematic review to list the main clinical and surgical approaches to bone elevation techniques for dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from January to March 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, 35 articles were evaluated in full and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=71.6%>50%. It was concluded that the placement of the implant with the simultaneous use of PRP or PRF creates a good relationship between the hard tissue and the soft tissue. The Bio-Oss® biomaterial is one of the most used in guided bone regeneration procedures in regenerative dentistry, and its particles become an integral part of the newly formed bone structure and retain their volume in the long term. Furthermore, Bio-Oss® offers a lot of space for the formation of blood vessels (angiogenesis) and the deposit of neoformed bone, helping the growth of osteoblasts. Notable studies have shown results on the combined use of Bio-Oss® and PRF. Also, it is possible to develop a pre-operative planning method, associated with the area of implant dentistry, using digital images. Furthermore, the conventional surgical guide has some advantages such as being cheaper, simpler, and easier to perform, however, it leads to a greater operative risk for the patient. However, the accuracy of the location to be implanted is not the best and there is a greater probability of this guide becoming worn out, due to the contact of the drills with it.