Maxillary Sinus Floor Augmentation Research Articles

Long-Term Volumetric Stability of Maxillary Sinus Floor Augmentation Using a Xenograft Bone Substitute and Its Combination with Autologous Bone: A 6+ Year Retrospective Follow-Up Study Using Cone Beam Computed Tomography

Deproteinised bovine bone (DBB) is widely used as bone substitute in maxillary sinus floor augmentation (MSFA) surgery. No previous studies have shown the long-term volumetric changes in the augmented bone when using DBB. The selected patients had MFSA performed using a lateral window technique and a xenograft, alone or in combination with the patient’s autologous bone from the mandible. Cone beam computed tomography (CBCT) images were used to compare the volumetric changes in the augmented bone for patients over a period of 6 or more years. No significant bone reduction was seen in the augmented bone region when comparing MSFA after 7 months and 6 or more years after dental implantation.

Maxillary sinus floor augmentation with autogenous bone graft compared with composite grafts: A one-year single-blinded randomized controlled trial.

The objective was to assess the one year implant treatment outcome and patient-related outcome measures (PROMs) following maxillary sinus floor augmentation (MSFA) with autogenous bone graft (ABG) from the zygomatic buttress (control) compared with 1:1 mixture of ABG and anorganic porcine bone mineral (APBM) (Test I) or biphasic bone graft material (BBGM) (Test II). Sixty healthy patients (34 females, 26 males) were randomly allocated to either control or test groups. Outcome measures included survival of suprastructures and implants, implant stability quotient, health status of peri-implant tissue, peri-implant marginal bone loss, frequency of complications, and PROMs using Oral Health Impact Profile-14 combined with questionnaire assessing patient perception of peri-implant soft tissue, prosthetic solution, implant function, and implant treatment outcome using visual analogue scale. Mean differences were expressed with standard deviation and 95% confidence interval. Level of significance was .05. All suprastructures and implants were well-functioning after one year of functional implant loading. There was no significant difference between control and test groups in any of the applied outcome measures. The implant stability significantly increased from implant placement to abutment connection within all groups (p < .001). High patient satisfaction and significant improvement in oral health-related quality of life was also reported within all groups. This study demonstrates that MSFA with composite grafts containing minimal amounts of ABG reveals comparable implant treatment outcomes as compared with ABG alone, after one year of functional implant loading. Extensive ABG harvesting in conjunction with MSFA therefore seems not to be needed.

Efficacy of hydroxyapatite and fibrin sealant as carriers for bone morphogenetic protein-2 in maxillary sinus floor augmentation: a retrospective study

The aim of this retrospective study was to assess the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) with hydroxyapatite (HA) granules and fibrin sealant (FS) in maxillary sinus floor augmentation (MSFA), with a focus on the volume change. Fifty-two of 137 patients who underwent MSFA with rhBMP-2/HA grafting between June 2016 and December 2022 met the study inclusion criteria; 25 had received rhBMP-2/HA without FS and 27 had received rhBMP-2/HA with FS. Computed tomography (CT) images were obtained preoperatively, immediately following the operation, and at 6 months postoperative. These images were three-dimensionally reconstructed to measure the volumetric and height changes following MSFA. The mean ± standard deviation percentage of volumetric change at 6 months was 48.75 ± 37.44% in the group with FS and 29.77 ± 13.42% in the group without FS (P = 0.019). The vertical height measured at a specific site of the grafted area showed a mean percentage change at 6 months of 4.05 ± 12.08% in the group with FS and 6.07 ± 10.15% in the group without FS (P = 0.518). The additional use of FS as a carrier for rhBMP-2/HA in MSFA was found to improve surgical convenience and bone regeneration ability.

Sling Suture Technique Used to Stabilize the Collagen Membrane on the Lateral Bone Window During Maxillary Sinus Floor Augmentation With a Lateral Approach: A Retrospective Case Series.

Maxillary sinus floor augmentation is a safe and predictable technique used to increase bone volume under sinus cavity for implant placement in atrophic posterior maxilla before implant placement. Despite conflicting results concerning the new bone formation rates with or without a barrier membrane, the benefits of using a collagen membrane to cover the lateral bone window has been demonstrated, in order to prevent bone substitute particles dislodgement that may occur from the sinus cavity through the sinus antrostomy towards the oral mucosa, and to significantly reduce the postoperative swelling and pain reactions. The purpose of this case series is to present a sling suture technique used to stabilize the collagen membrane against the lateral bone window so as to improve the bone substitute stability inside the sinus cavity. Maxillary sinus floor augmentation with lateral approach using sling suture technique to maintain the collagen membrane against the lateral bone window was performed in 17 patients (8 women/ 9 men, mean age: 58.2 years). Postoperative cone-beam computed tomography (CBCT) images up to 6-month follow-up were performed to control the bone graft stability at the level of the lateral antrostomy. The clinical postoperative pain and swelling were assessed through a Visual Analogue Scale (VAS) questionnaire from level 1 (low), level 5 (acceptable), to level 10 (high) at one week postoperative. No bone substitute displacement was observed for all clinical cases on the CBCT images at 6-month postoperative. The pain and swelling level observed at one-week post operative were significantly low (respectively 1.6±1.0/2.1± 0.9). Within the limits of this case series, the use of sling suture technique to maintain the barrier membrane at the level of the lateral bone window in case of maxillary sinus floor augmentation with lateral approach surgery revealed to be a predictable protocol to prevent bone substitute displacement outside the sinus cavity.

Quantitative analysis of change in bone volume 5 years after sinus floor elevation using plate-shaped bone substitutes: a prospective observational study

PurposeTricalcium phosphate (TCP) has osteoconductive ability and reportedly offers similar clinical results as autogenous bone grafts in dental implant treatment. However, few reports quantify temporal changes in augmented bone volume after sinus augmentation. We aimed to establish a three-dimensional (3D) quantification method to assess bone volume after sinus augmentation and to evaluate biocompatibility of the TCP plate.MethodsMaxillary sinus floor augmentation was performed employing the lateral window technique, and plate-shaped β-TCP (TCP plate) was used instead of granular bone grafting materials. After lifting the sinus membrane, the TCP plate was inserted and supported by dental implants or micro-screws. The changes in bone volumes in the maxillary sinus before and after surgery were recorded using cone-beam computed tomography, saved as Digital Imaging and Communications in Medicine-formatted files, and transformed to Standard Triangle Language (STL)-formatted files. Pre- and post-operative STL data of bone volume were superimposed, and the augmented bone volume was calculated. Moreover, changes in bone volumes, TCP plate resorption rates, and bone heights surrounding the implants were three dimensionally quantified.ResultsFifteen implants in nine subjects were included in this study. TCP plates secured long-term space making, with results similar to those of granular bone substitutes. Newly formed bone was identified around the implant without bone graft material. TCP plate was absorbed and gradually disappeared.ConclusionsA novel 3D quantification method was established to evaluate changes in bone volume. Clinical application of TCP plate in sinus augmentation could be a better procedure in terms of prognosis and safety.

The Use of CAD-CAM Templates in Lateral Sinus Floor Augmentation Procedure: A Systematic Review.

Maxillary sinus floor augmentation is a procedure known for its long-term success and predictable outcomes. However, the perforation of the Schneiderian membrane remains the most common complication associated with this procedure. This systematic review aims to determine the presence of complications during maxillary sinus floor augmentation procedures using CAD-CAM surgical templates. An electronic search was carried out in MEDLINE (via PubMed), Web of Science, and Scopus. A descriptive analysis of the data was performed. Studies that have performed lateral sinus floor augmentation were included in the inclusion criteria. The CAD-CAM surgical template design and the intraoperative complications were registered. A total of 13 studies were included. Seven were case reports, four were case series, and two were randomized clinical trials. A total of 94 lateral SFA procedures were included (84 using CADCAM templates and 10 without using templates). Three of the 84 maxillary sinus floor augmentation procedures using a CAD-CAM template presented intraoperative complications. Maxillary sinus floor augmentation performed by using CAD-CAM surgical templates could be related to low rates of complications, however, due to the heterogeneity of the articles included, more standardized studies are needed to confirm these outcomes.

A case that performed maxillary sinus floor augmentation in the presence of antral retention cyst

A case that performed maxillary sinus floor augmentation in the presence of antral retention cyst

Clinical outcomes and risk factor analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study.

To evaluate the 3- to 8-year outcomes of dental implants placed with lateral sinus floor augmentation (LSFA) and to identify factors affecting implant survival. This retrospective study was performed by screening all implants placed with LSFA procedures, which were conducted between January 2012 and December 2016. Subantral bone gain (SABG) and apical bone height (ABH) were assessed using panoramic radiographs. The cumulative survival rate of implants was analysed using life-table analysis and Kaplan-Meier survival curves. The influential risk factors affecting survival were assessed using univariate log-rank tests and multivariable mixture cure rate model. Implant complications were recorded. Based on the established criteria, a total of 449 patients (760 implants) were included in this study. In the 3- to 8-year follow-up (mean ± SD, 5.81 ± 1.33 years), 15 implants in 14 patients failed, with a CRS of 96.81% on an implant basis and 95.07% on a patient basis. A history of periodontitis and poor compliance with supportive periodontal treatment was associated with a significantly higher risk of implant failure at both implant and patient levels. Significant decreases in ABH occurred during each yearly interval except for 3 years. A similar trend has been observed for SABG at 1, 2, 6 and 8 years. The total complication rate was 31.84% on implant basis, with peri-implant mucositis (21.58%) being the most frequent biologic complication and porcelain cracking (5.00%) being the most common technical complication. Implant with LSFA is a reliable treatment option in atrophic maxilla. A history of periodontitis without regular supportive periodontal treatment was identified as a predictor for implant failure. Slight but significant shrinkage of vertically augmented bone can be observed after implant placement.

New perspectives in the treatment of the severe atrophic posterior maxilla: interpositional sandwich osteotomy combined with sinus floor grafting - a novel technique

Purpose: Dental implant installation in the posterior maxilla depends fundamentally on the presence of an adequate bone quantity. Tooth loss in the posterior maxilla is followed by extensive loss of the alveolar ridge and increased maxillary sinus pneumatization that often makes implant installation difficult to achieve. Maxillary sinus floor augmentation is traditionally the common surgical technique to overcome this situation. When the deficiency in the vertical dimension relates more to severe ridge resorption, crestal ridge augmentation should also be considered. Posterior maxillary sandwich osteotomy combined with sinus augmentation, using inter–positional bone graft might be a viable option to address this problem. This study describes a successful implementation of this technique to solve a severe vertical osseous ridge defect under the sinus floor. Material and Methods: A two–stage lateral wall sinus floor augmentation combined with inter–positional sandwich osteotomy followed by the insertion of dental implants with adequate length and diameter was performed. Deproteinized natural bovine bone mineral (DBBM) covered by a resorbable collagen membrane were used. Rehabilitation of this area was completed by a standard prosthetic protocol. Results: As a result of completing the above procedure favourable bone mass and form was created to enable implant placement in positions that are optimal from a prosthetic and esthetic point of view in terms of reshaping the alveolar crest and normali- zing the interocclusal distance improving the crown–implant ratio. Conclusion: This case demonstrates a step–by–step illustration of an innovative technique for overcoming a vertical ridge defect combined with increased maxillary sinus pneumatization. It can be concluded that this novel technique is recommended to meet the dimensional requirements of bone augmentation both crestal and intrasinusal in severe atrophic posterior maxilla to achieve an improved alveolar plane, equalized crown–to–implant ratios, and a more favourable gingival shape.

Maxillary Sinus Floor Augmentation With Allograft Alone Compared With Alternate Grafting Materials: A Systematic Review and Meta-Analysis.

A meta-analysis of scientific literature was conducted to ascertain the superiority between allografts and other regenerative grafts for maxillary sinus floor augmentation (MSFA). Review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in PROSPERO-CRD42023392766. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from 2000 to December 2022 for studies reporting MSFA using allografts or other regenerative grafts. Quality assessment of included studies was evaluated using the Cochrane risk of bias (ROB)-2 tool for randomized controlled trials through its domains. Risk of bias summary graph and ROB summary applicability concern were plotted using RevMan software version 5.3. The standardized mean difference was used as a summary statistic measure with random effect model and P value <0.05 as statistically significant. Four studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which all 4 studies were suitable for meta-analysis. Pooled estimate through standardized mean difference signifies that new bone formation was more or less similar for both graft materials, whereas regenerative grafts showed more residual bone grafts (P>0.05). Publication bias through funnel plot showed symmetric distribution with the absence of systematic heterogeneity. Both allografts and other regenerative grafts are equally effective in the MSFA in terms of new bone formation, whereras regenerative grafts showed more residual bone grafts. Furthermore, randomized controlled trials are required to establish evidence in outcomes involving sinus floor augmentation and different graft materials.

Do recombinant, purified or concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation? A systematic review and meta-analysis.

The clinical use of bioactive substances, such as growth factors, have significantly increased, however, potential regenerative effects derived from the addition of different growth factors to bone substitutes on maxillary sinus floor augmentation (MSA) procedures is still controversial. This systematic review (SR) aimed at answering the following question: "Do recombinant, purified and concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation?". Human studies comparing histomorphometric data of the outcomes of interest new bone formation, residual graft material, and fibrous tissue ratio following MSA procedures employing particulate bone grafts/substitutes in combination or not with growth factors were retrieved from PubMed/MEDLINE, Web of Science, Cochrane and Scopus online databases and complemented with a hand search. Controlled studies published in English up to December 2022 and reporting on histomorphometric data expressed as percent volume of the outcomes of interest were considered. Risk of bias was assessed, and a meta-analysis (MA) was performed to investigate the effects of supplementary growth factors on new bone formation, remaining graft particles and fibrous tissue ratio. Data of 613 samples from 477 patients reported in 22 publications were included. MA showed PRP or PRF resulted in 49% more new bone formation than in areas in control groups (P=0.004), and those areas supplemented with growth factors presented 57% less residual graft particles after healing (P<0.0001). A significant (P=0.03) 1.85-fold increase in connective tissue formation was noted in areas treated with rhBMP after healing. The MA provided evidence that selective supplementary growth factors may enhance new bone formation and accelerate particulate graft turnover, while rhBMP may significantly increase connective tissue formation in MSA procedures in humans.

Maxillary Sinus-Floor Augmentation by Porcine-Apatite Xenograft: A Prospective Case Series Study.

Bone substitutes sometimes are unsuccessful in replacing the autogenous bone graft, combining the advantages and disadvantages to achieve satisfactory results. The aim of this work was to clinically and histologically evaluate the outcome of porcine-apatite xenograft used to elevate the maxillary sinus floor in severe atrophy ridge. A two-stage crestal window sinus lift protocol was conducted in 24 patients with crestal bone ≤2mm. Highly porous porcine carbonate apatite moistened with saline solution was placed in the elevated sinus cavity as the sole grafting material. Bone core biopsies were taken at 6, 9 and 12 months after the sinus augmentation surgery at the time of implant placement. The treatment outcome was assessed using the μCT (micro computed tomogram) and histological analysis. Statistical analysis was performed using the nonparametric Kruskal-Wallis test, followed by the post-hoc Dunn multiple comparison test. At 6 months after implant placement, all implants achieved good primary stability (≥ 30 Ncm of insertion torque) and successfully osseointegrated. The residual graft amount (m±SE) was low (11.91±1.99%) at 6 months, and further decreased (6.11±2.64%) at 12 months after the sinus augmentation surgery. On the contrary, the amount of new bone detected was 18.94±4.08% at 6 months, and significantly (p<0.05) increased (40.16±5.27%) 12 months after sinus augmentation surgery. Histological assessment revealed existing of osteoclasts in resorbing the graft as well as the osteoblasts in forming the new bone. In the severely atrophic maxilla, the porcine-apatite xenograft promotes new bone formation while being slowly absorbed. In conclusion, within the limited sample size, the porcine-apatite xenograft seems to be a good material to be used as the graft material for crestal window sinus augmentation.

Endo-sinus bone gain following sinus membrane elevation without graft compared with sinus floor augmentation and a composite graft: a one-year single-blind randomized controlled trial

The objective of this study was to assess endo-sinus bone gain (ESBG) and bone density (BD) following maxillary sinus membrane elevation without graft (test) compared with maxillary sinus floor augmentation and 1:1 ratio of autogenous bone from the buccal antrostomy and deproteinized porcine bone mineral (control) using two- and three-dimensional radiographic methods. Forty healthy patients were randomly allocated to the test and control groups. Cone beam computed tomography scans were obtained at enrolment (T0), immediately after surgery (T1), at delivery of the prosthetic rehabilitation (T2), and 1 year after functional implant loading (T3). Mean differences were expressed with the 95% confidence interval. Significance was set at ≤ 0.05. ESBG and BD were significantly higher in the control group than test group at T1, T2, and T3 (P < 0.001). A significant decrease in ESBG and increase in BD was observed from T1 to T3 with both treatments (P < 0.001). There was a non-significant positive correlation of ESBG with implant protrusion length and non-significant negative correlation with residual bone height. In conclusion, test was associated with significantly lower ESBG and BD compared with control. However, the lower ESBG and BD did not appear to negatively affect the implant stability quotient or implant treatment outcome after 1 year of functional implant loading.

Enhancing Osteogenic Ability and Nutritional Status with Combined Platelet-Rich Fibrin and Ginkgo Biloba Extracts In Maxillary Sinus Floor Augmentation: A Clinical Study

This study investigated the effects of combined platelet-rich fibrin and Ginkgo biloba extracts on osteogenic ability following maxillary sinus floor augmentation. The study enrolled 77 patients at our institution. The control group (41 patients) received Bio-Oss TM bone powder, while the research group (36 patients) received platelet-rich fibrin. We compared periodontal conditions, complications, changes in maxillary bone mineral density, and growth factor levels pre-and post-surgery. The results indicated significant improvements in the research group compared to the control group, including lower bleeding index, probing depth, and attachment loss, alongside increased bone height and thickness (P &lt; 0.05). The research group exhibited a lower incidence of postoperative oral mucosal inflammation and swelling, higher bone mineral density, and elevated growth factor levels compared with the control group (P &lt; 0.05). Nutritional assessments indicated better lipid profiles and less mild malnutrition in the research group (P &lt; 0.05). Mouse osteoblast MC3T3 cells were treated with platelet-rich fibrin to assess cell proliferation and expression of RUNX2 and OCN. Results showed enhanced cell viability, increased RUNX2 and cyanate levels, and reduced apoptosis (P &lt; 0.05). In conclusion, combined platelet-rich fibrin and Ginkgo biloba extracts significantly enhanced osteogenic ability and nutritional status following maxillary sinus floor augmentation, suggesting substantial clinical value.

Potentials of pure xenograft materials in maxillary ridge augmentation: A case series

Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.

Featured Cover

The cover image is based on the Original Article Endoscope‐assisted maxillary sinus floor augmentation with a mini‐lateral window: A retrospective study by Guanchen Ye MDS et al., https://doi.org/10.1111/cid.13223. image

Bone regeneration after maxillary sinus floor augmentation with different ratios of autogenous bone and deproteinized bovine bone mineral an in vivo experimental study.

Test the hypothesis of no difference in bone regeneration after maxillary sinus floor augmentation (MSFA) with different ratios of iliac or mandibular autogenous bone (AB) graft and deproteinized bovine bone mineral (DBBM). Forty minipigs were randomly allocated to bilateral MSFA using: (A) 100% AB, (B) 75% AB and 25% DBBM, (C) 50% AB and 50% DBBM, (D) 25% AB and 75% DBBM, or (E) 100% DBBM. The animals were euthanized 12 weeks after surgery. Percentage of bone, non-mineralized tissue, and residual DBBM were estimated by histomorphometric analysis in a randomly selected region of interest and summarized as mean percentage with 95% confidence interval (CI). Mean percentage of bone following MSFA with iliac or mandibular AB graft was: (A) 55.5% and 64.2%, (B) 60.3% and 61.6%, (C) 54.4% and 52.1%, (D) 51.8% and 53.1%, and (E) 47.6%, respectively. There was a significant trend toward a higher percentage of bone, with a higher ratio of AB within the graft (p < .01), regardless of the origin of AB graft (iliac or mandible). The hypothesis was rejected since percentage of bone was significantly increased with larger proportions of AB within the graft. Consequently, AB or a mixture of AB and diminutive quantities of DBBM seem to be the preferred graft for MSFA based solely on histomorphometric assessment. However, it should be emphasized that newly formed bone and residual AB graft particles could not be distinguished by the applied histologic procedure.

SMOKERS MAY BE SUBJECT TO A HIGHER RISK OF SCHNEIDERIAN MEMBRANE PERFORATION THAN NONSMOKERS DURING MAXILLARY SINUS AUGMENTATION.

Association between smoking and Schneiderian membrane perforation during maxillary sinus floor augmentation: A systematic review and meta-analysis. Wang, X., Ma, S., Lin, L., & Yao, Q. Clinical Implant Dentistry and Related Research. 2022., 25.1: 166-176. National Natural Science Foundation of China, Grant/Award Number: 81801021; Hunan Provincial Health Commission, Grant/Award Number: B202308056991. Systematic review and meta-analysis.

Addition of recombinant human bone morphogenic protein-2 to the graft materials improves the clinical outcomes of implants placed in grafted maxillary sinus

Background/purposeThe long-term outcomes of implants placed in grafted sinuses using recombinant human bone morphogenetic protein-2 (rhBMP-2) are unclear. This study aimed to compare 3- and 5-year implant survival rates and marginal bone loss (MBL) during functional loading. Materials and methodsIn this retrospective study, we analyzed 63 implants inserted after maxillary sinus floor augmentation (MSFA) in 45 patients between January 2016 and April 2019. The outcome variables were: 1) 3- and 5-year cumulative survival rates of the implants and 2) MBL after functional loading. Other assessed variables included patient demographic information, preoperative residual bone height (RBH), surgical site, implant length and diameter, graft material, healing period before loading, prosthetic type, and opposing dentition. ResultsThe cumulative 3- and 5-year survival rates of the implants were 100% in the rhBMP-2 group and 95.5% and 86.4% in the non-rhBMP-2 group, respectively. The average 3- and 5-year MBL were 1.14 ± 0.67 mm, 1.30 ± 0.74 mm in the rhBMP-2 group and 1.68 ± 0.90 mm, 2.27 ± 1.29 mm in the non-rhBMP-2 group, respectively. Significant differences were observed between 3 and 5 years between the two groups. ConclusionAddition of the rhBMP-2 to the graft materials positively affects implant placement in the grafted maxillary sinus in terms of implant survival and MBL when preoperative RBH is unfavorable.

Survival rate of implants following maxillary sinus floor augmentation using freeze-dried allografts vs bovine derived xenografts: A retrospective multicenter study

IntroductionThis study aims to compare the surgical and clinical complications, and the dental implant survival rate after maxillary sinus floor augmentation using demineralized freeze-dried bone allografts (DFDBA) versus bovine derived xenografts. Material and methodsA retrospective study enrolled 107 patients (52 males and 55 females, mean age group 1: 54,4 years; group 2: 56,4 years) requiring maxillary bone reconstruction prior to implantation. A total of 141 sinuses were grafted and 191 implants were placed. Data on various variables, including patient characteristics, implant placement details, and outcomes, were collected through medical records and patient questionnaires. ResultsThe study found no significant differences in implant survival rates between the two groups (94,0% versus 94,4%; p = 0,919). Overall complications were observed in 19.6% of patients, with a higher incidence in the allograft group (23,6% versus 15,4%; p = 0,283). Multiple logistic regression analysis identified a two-stage surgical protocol (OR= 2,8; p = 0,045), and a preoperative alveolar ridge height of less than 4 mm (OR= 5,3; p = 0,004) as significant predictors of complications. The risk of implant failure was raised by a preoperative alveolar ridge height of less than 4 mm (OR= 6,1; p = 0,038) and smoking (OR= 5,8; p = 0,012). DiscussionDFDBA is a reliable treatment option for extensive rehabilitation of atrophic maxilla, with a success rate comparable to xenografts used in sinus augmentation. Implant failure was significantly correlated with smoking and a residual ridge height of less than 4 mm.