Esposito Marco, Grusovin Maria Gabriella, Rees Jonathan, Karasoulos Dimitrios, Felice Pietro, Alissa Rami, Worthington Helen V, Coulthard Paul
Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
Cochrane Database Syst Rev. 2010 Mar 17(3):CD008397. doi: 10.1002/14651858.CD008397.
Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone and/or commercially available biomaterials.
To determine whether and when augmentation of the maxillary sinus are necessary and which are the most effective augmentation techniques for rehabilitating patients with implant-supported prostheses.
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched on 7th January 2010. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted.
Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants reporting the outcome of implant success/failure at least to abutment connection.
Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odds ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient.
Ten RCTs out of 29 met the inclusion criteria. One trial of 15 patients evaluated implants 5 mm long with 6 mm diameter as an alternative to sinus lift in bone with a residual height of 4 to 6 mm. Nine trials with 235 patients compared different sinus lift techniques; of these four trials (114 patients) evaluated the efficacy of platelet-rich plasma (PRP). Due to the variety of techniques evaluated, meta-analysis was only possible of use of PRP for implant failure (two trials) and complications (three trials). No statistically significant difference was observed.
AUTHORS' CONCLUSIONS: Conclusions are based on few small trials, with short follow-up, and judged to be at high risk of bias. Therefore conclusions should be viewed as preliminary and interpreted with great caution. It is still unclear when sinus lift procedures are needed. 5 mm short implants can be successfully loaded in maxillary bone with a residual height of 4 to 6 mm but their long-term prognosis is unknown. Elevating the sinus lining in presence of 1 to 5 mm of residual bone height without the addition of a bone graft may be sufficient to regenerate new bone to allow rehabilitation with implant-supported prostheses. Bone substitutes might be successfully used as replacements for autogenous bone. If the residual alveolar bone height is 3 to 6 mm a crestal approach to lift the sinus lining, to place 8 mm implants may lead to fewer complications than a lateral window approach, to place implants at least 10 mm long. There is no evidence that PRP treatment improves the clinical outcome of sinus lift procedures with autogenous bone or bone substitutes.
骨量不足是无牙上颌后牙区种植支持修复中常见的问题。上颌窦的存在以及牙槽骨高度的丧失限制了骨量。上颌窦提升术通过使用自体骨和/或市售生物材料扩大上颌窦腔来增加骨量。
确定上颌窦增容是否必要以及何时必要，以及哪些是用于种植支持修复患者的最有效的增容技术。
2010年1月7日检索了Cochrane口腔健康组试验注册库、Cochrane系统评价数据库、医学索引在线和荷兰医学文摘数据库。对几本牙科杂志进行了手工检索。检查了综述文章的参考文献，并检索了个人参考文献。还联系了55多家种植体制造公司。
关于不同技术和材料用于上颌窦增容以进行牙种植修复的随机对照试验（RCT），报告至少到基台连接时种植体成功/失败的结果。
对符合条件的研究进行筛选、对试验的方法学质量进行评估以及数据提取，均由两人独立进行。就任何缺失信息与作者进行了联系。结果以随机效应模型表示，连续结局采用均数差，二分结局采用比值比，并给出95%置信区间。分析的统计单位是患者。
29项研究中有10项RCT符合纳入标准。一项纳入15例患者的试验评估了长度为5mm、直径为6mm的种植体作为剩余高度为4至6mm的骨中上颌窦提升替代方法的效果。9项纳入235例患者的试验比较了不同的上颌窦提升技术；其中4项试验（114例患者）评估了富血小板血浆（PRP）的疗效。由于所评估技术的多样性，仅对PRP用于种植体失败（两项试验）和并发症（三项试验）进行了荟萃分析。未观察到统计学上的显著差异。
结论基于少数小型试验，随访时间短，且被判定存在高偏倚风险。因此，结论应视为初步结论，并应极为谨慎地解读。目前仍不清楚何时需要上颌窦提升术。5mm短种植体可成功植入剩余高度为4至6mm的上颌骨中，但其长期预后未知。在剩余骨高度为1至5mm时提升上颌窦黏膜而不添加骨移植可能足以再生新骨，以允许进行种植支持修复。骨替代物可能成功用作自体骨的替代品。如果剩余牙槽骨高度为3至6mm，采用嵴顶入路提升上颌窦黏膜、植入8mm种植体可能比外侧开窗入路植入至少10mm长的种植体并发症更少。没有证据表明PRP治疗能改善自体骨或骨替代物上颌窦提升术的临床效果。
