Esposito Marco, Grusovin Maria Gabriella, Rees Jonathan, Karasoulos Dimitrios, Felice Pietro, Alissa Rami, Worthington Helen, Coulthard Paul
The University of Manchester, Manchester, UK.
Eur J Oral Implantol. 2010 Spring;3(1):7-26.
CONFLICT-OF-INTEREST STATEMENT: Marco Esposito, Pietro Felice and Paul Coulthard are among the authors of four of the included trials, however, they were not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus' published in The Cochrane Library (see http:// www.cochrane.org/ for information). Cochrane systematic reviews are regularly updated to include new research and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration.
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 test whether and when augmentation of the maxillary sinus is necessary and which are the most effective augmentation techniques for rehabilitating patients with implant-supported prostheses.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were hand searched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. The last electronic search was conducted on 7th January 2010.
Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants reporting the outcome of implant therapy 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 potentially eligible trials were suitable for inclusion. One trial including 15 patients, evaluated whether 5-mm-long implants with a diameter of 6 mm could be an alternative to sinus lift in bone having a residual height of 4 to 6 mm. Nine trials with 235 patients compared different sinus lift techniques and, of these, four trials (114 patients) evaluated the efficacy of platelet-rich plasma (PRP). Since different techniques were evaluated in different trials, only two meta-analyses evaluating the efficacy of PRP could be performed for implant failures (two trials) and complications (three trials). No statistically significant difference was observed for any of the evaluated interventions.
Conclusions are based on few trials, usually underpowered, having short follow-ups, and often judged to be at high risk of bias, therefore they should be viewed as preliminary and interpreted with great caution. It is still unclear when sinus lift procedures are needed. Short implants (5 mm) 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 the 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 lifting the sinus lining and placing 8 mm implants may lead to less complications than a lateral window approach and placing implants at least 10 mm long. PRP treatment does not seem to improve the clinical outcome of sinus lift procedures with autogenous bone or bone substitutes.
马尔科·埃斯波西托、彼得罗·费利切和保罗·库尔瑟德是纳入的四项试验的作者之一，然而，他们未参与这些试验的质量评估。本综述基于发表在《考克兰系统评价》（见http://www.cochrane.org/获取信息）上的一篇题为“修复缺失牙的干预措施：上颌窦增高术”的考克兰系统评价。考克兰系统评价会定期更新，以纳入新的研究，并回应读者的意见和批评。如果您希望对本综述发表评论，请将您的评论发送至考克兰网站或马尔科·埃斯波西托。应查阅《考克兰图书馆》以获取该综述的最新版本。考克兰综述的结果可能因人们的观点和情况而有不同解读。请仔细考虑所呈现的结论。它们是综述作者的意见，不一定得到考克兰协作网的认同。
骨量不足是无牙上颌后牙区采用种植体支持修复时常见的问题。骨量受上颌窦的存在以及牙槽骨高度丧失的限制。上颌窦提升术通过用自体骨和/或市售生物材料增大窦腔来增加骨量。
测试上颌窦增高是否必要以及何时必要，以及哪些是用于修复种植体支持修复患者的最有效增高技术。
检索了考克兰口腔健康组试验注册库、考克兰对照试验中央注册库（CENTRAL）、MEDLINE和EMBASE。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。最后一次电子检索于2010年1月7日进行。
关于使用不同技术和材料增高上颌窦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的种植治疗结果。
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独立且重复进行。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项潜在符合条件的试验中有10项RCT适合纳入。一项纳入15名患者的试验评估了直径6 mm、长度5 mm的种植体是否可替代在剩余高度为4至6 mm的骨中进行的上颌窦提升术。9项纳入235名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名患者）评估了富血小板血浆（PRP）的疗效。由于在不同试验中评估了不同技术，因此仅能对种植失败（两项试验）和并发症（三项试验）进行两项评估PRP疗效的Meta分析。对于任何评估的干预措施均未观察到统计学上的显著差异。
结论基于少数试验，这些试验通常样本量不足、随访时间短，且常被判定存在高偏倚风险，因此应将其视为初步结论并谨慎解读。目前仍不清楚何时需要进行上颌窦提升术。短种植体（5 mm）可成功植入剩余高度为4至6 mm的上颌骨中，但其长期预后未知。在剩余骨高度为1至5 mm时不添加骨移植而提升窦黏膜可能足以再生新骨以允许采用种植体支持修复。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6 mm，采用嵴顶入路提升窦黏膜并植入8 mm种植体可能比侧窗入路并植入至少10 mm长的种植体并发症更少。PRP治疗似乎并未改善采用自体骨或骨替代物进行上颌窦提升术的临床结局。
