Private Practice, Miami, FL, United States.
Department of Postgraduate Education, Faculty of Oral and Dental Medicine, J. W. Goethe-University, Frankfurt am Main, Germany.
J Craniomaxillofac Surg. 2018 Sep;46(9):1616-1624. doi: 10.1016/j.jcms.2018.06.012. Epub 2018 Jun 15.
To perform a systematic review and individual- and aggregate-data meta-analysis of observational studies to determine the success rate of the lateral sinus floor elevation with simultaneous implant placement and without grafting materials.
We included prospective and retrospective observational studies analyzing survival rate of implants in patients who underwent graftless lateral sinus floor elevation. Secondary outcomes included increase of bone height, marginal bone loss (MBL), implant stability, and adverse events such as sinus membrane perforation and signs of infection in the maxillary sinuses. Survival rate and proportion of adverse outcomes were calculated using the variance-stabilizing Freeman-Tukey double-arcsine transformation. Meta-analyses of bone gain and MBL were performed based on changes from baseline and sampling variance. Implant stability was analyzed at follow-up. Individual participant data were modeled using a one-step approach. The survival probability was determined using the Kaplan-Meier method, and the Cox proportional-hazards regression was applied to investigate the association between survival time of implants and covariates.
11 observational studies were included in the study. The meta-analysis based on 660 implants and 17 failures showed a pooled survival rate of 97.5% (CI 95% 95.8 to 98.9). Pooled analysis also showed an increase in mean bone height of 5.7 mm (CI 95% 4.78 to 6.56), MBL of 1.2 mm (CI 95% 0.84 to 1.51), and implant stability quotient of 70.5 (CI 95% 64.2 to 76.9). A pooled rate of 20.0% (CI 95% 10.9 to 30.6) and 3.0% (CI 95% 0.5 to 6.8), respectively, for membrane perforations and sinus infection was found. Individual-data meta-analysis showed an overall 5-year survival of 93.1% (SE 2.67%) with a mean survival time of 6.7 years (SE 0.08). Longer implants were associated with a decreased hazard ratio (0.64; CI 95% 0.41 to 0.99).
Current available evidence based on aggregate and individual patient data meta-analysis suggests that lateral maxillary sinus floor elevation without grafting, and simultaneous implant placement, is a safe and effective technique with high survival rates, especially for implants with more than 13 mm in length.
对观察性研究进行系统评价和个体及汇总数据荟萃分析，以确定在不使用移植物的情况下同时进行上颌窦底提升和植入物植入的成功率。
我们纳入了分析接受无植骨上颌窦底提升的患者中植入物存活率的前瞻性和回顾性观察性研究。次要结果包括骨高度增加、边缘骨丧失（MBL）、种植体稳定性以及上颌窦窦膜穿孔和感染迹象等不良事件。使用方差稳定的 Freeman-Tukey 双弧形变换计算存活率和不良事件比例。基于基线和采样方差的变化进行了骨增量和 MBL 的荟萃分析。使用一步法分析种植体稳定性。使用 Kaplan-Meier 法确定生存概率，并应用 Cox 比例风险回归分析种植体生存时间与协变量之间的关系。
纳入了 11 项观察性研究。基于 660 个种植体和 17 个失败的荟萃分析显示，总体存活率为 97.5%（95%CI 95%95.8 至 98.9）。汇总分析还显示，平均骨高度增加 5.7mm（95%CI 95%4.78 至 6.56），MBL 增加 1.2mm（95%CI 95%0.84 至 1.51），种植体稳定性指数增加 70.5（95%CI 95%64.2 至 76.9）。膜穿孔和窦感染的汇总发生率分别为 20.0%（95%CI 95%10.9 至 30.6）和 3.0%（95%CI 95%0.5 至 6.8）。个体数据荟萃分析显示，总体 5 年存活率为 93.1%（SE 2.67%），平均生存时间为 6.7 年（SE 0.08）。较长的种植体与降低的风险比（0.64；95%CI 95%0.41 至 0.99）相关。
基于汇总和个体患者数据荟萃分析的现有证据表明，不使用移植物的上颌窦底提升和同期植入物植入是一种安全有效的技术，具有较高的存活率，特别是对于长度超过 13mm 的植入物。
