Abstract
To evaluate and compare the stability, quantity and quality of bone augmentation at maxillary sinus elevation sites by non-grafted transcrestal sinus floor elevation (TSFE) and platelet concentration grafted transcrestal sinus floor elevation (PC-TSFE). A complete literature search was performed up to April 2019. Clinical controlled trials, retrospective cohort studies, and prospective cohort studies were selected based on inclusion criteria. The clinical outcomes were implant survival rate (ISR), marginal/crestal bone loss (MBL/CBL) and endo-sinus bone gain (ESBG). Meta‐analysis was conducted on these 1-year based values. Furthermore, another meta-analysis on 1-year ISR value was conducted among studies with different residual bone heights (RBH) within the non-grafted TSFE group. A total of 18 studies were included: 13 in TSFE group and 5 in PC-TSFE group. No significant differences were displayed between the 1-year ISR of TSFE (97%, 95%CI = 0.96–0.99) and PC-TSFE group (99%, 95%CI = 0.97–1.00). Among the various studies with different RBH within TSFE group, no significant differences in 1-year ISR were displayed. The 1-year MBL/CBL value of PC-TSFE group (0.73 mm, 95%CI = 0.43–1.13 mm) did not show significant difference as compared to TSFE group (0.60 mm, 95%CI = 0.10–1.10 mm). Furthermore, no significant enhancement was observed on 1-year ESBG value on PC-TSFE group (3.51 mm, 95%CI = 2.31–4.71 mm) in comparison with the TSFE group (2.87 mm, 95%CI = 2.18m–3.55 mm). Grafting platelet concentrations around dental implants at TSFE sites did not significantly enhance the adjacent bone regeneration. Moreover, TSFE was shown to be a reliable therapeutic option for implant sites that need simultaneous maxillary sinus augmentation, even under limited RBH.
Highlights
To evaluate and compare the stability, quantity and quality of bone augmentation at maxillary sinus elevation sites by non-grafted transcrestal sinus floor elevation (TSFE) and platelet concentration grafted transcrestal sinus floor elevation (PC-TSFE)
18 studies were included in this systematic review and meta-analysis, among which were 13 non-grafted TSFE35– 47, 5 TSFE grafted with various platelet concentrations (PRP, plate-rich fibrin (PRF), concentrated growth factor (CGF) or platelet-rich growth factor (PRGF))[7,18,19,20,21]
This systematic review and meta-analysis compared the therapeutic outcomes of non-grafted transcrestal sinus floor elevation (TSFE) with platelet concentrations grafted TSFE (PC-TSFE)
Summary
To evaluate and compare the stability, quantity and quality of bone augmentation at maxillary sinus elevation sites by non-grafted transcrestal sinus floor elevation (TSFE) and platelet concentration grafted transcrestal sinus floor elevation (PC-TSFE). The TSFE is easy to handle with reduced surgical trauma compared with lateral maxillary sinus lift[5,6], it has few limitations including inability to directly visualize membrane augmentation procedures and increased risk of membrane perforations on the TSFE sites It is unsuitable for cases with severely compromised bone quantity (RBH < 4 mm)[5,6]. Various clinical studies have reported that TSFE on cases with limited RBH (4–6 mm) leads to favorable implant survival rates, as long as these cases can attain secured primary stability[7,8], the lateral/direct access of MSFA still remains as a “gold standard” for such cases with severely compromised bone quantity This is attributed to limited RBH resulting in unsecured primary stability around the implants, and the inability of TSFE to provide direct visualization of membrane augmentation, increasing the risk of membrane penetration during surgery[6,10]. Research gaps remain unaddressed including lack of investigations to find an appropriate osteoinductive bone substitutions, which is both soft and flexible (acts like buffer to protect the fragile Schneiderian membrane) into maxillary sinus in TSFE sites
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