Department of Stomatology, 920th Hospital of Joint Logistics Support Force, Kunming, China.
Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.
Clin Oral Implants Res. 2023 Nov;34(11):1151-1175. doi: 10.1111/clr.14155. Epub 2023 Aug 7.
This paper addressed two focused questions: Focused question 1 (Q1) "what is the clinical efficacy of transcrestal sinus floor augmentation (TSFA), as compared to lateral sinus floor augmentation (LSFA) in sites with residual bone height (RBH) ≤6 mm, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; Focused question 2 (Q2) "what is the estimated effectiveness of TSFA for outcomes in Q1, in RCTs, CCTs or cohort studies?"
An electronic search (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials) and hand search were conducted from January 1986 until December 2022. All eligible clinical studies expressly reporting TSFA in sites with RBH ≤6 mm were included. The data were extracted, and the risk of bias in individual studies was evaluated. Meta-analysis was performed whenever possible.
Seven RCTs were included for Q1 and 25 studies (9 RCTs, 2 CCTs, 14 single arm cohort studies) for Q2. Q1: Meta-analysis did not show significant difference in the implant survival, sinus membrane perforation and marginal bone loss between TSFA and LSFA groups. Q2: Meta-analysis showed TSFA had a high implant survival rate (96.5%, 95% CI: 93.2%-98.9%) at least 1 year after surgery, and limited sinus membrane perforation (5.4%, 95% CI: 2.7%-8.8%). The results also presented higher patient satisfaction for TSFA.
With the limitations of the present study (high risk of bias in individual studies), it can be concluded that there was no significant difference in implant survival, Schneiderian membrane perforation and MBL between two approaches in sites with RBH ≤6 mm.
本文解决了两个重点问题：重点问题 1（Q1）“在剩余骨高度（RBH）≤6mm 的部位，经嵴窦底提升（TSFA）与经外侧窦底提升（LSFA）相比，随机临床试验（RCTs）和对照临床试验（CCTs）的临床疗效如何？”；重点问题 2（Q2）“在 RCTs、CCTs 或队列研究中，TSFA 对 Q1 中结局的估计效果如何？”
从 1986 年 1 月到 2022 年 12 月，进行了电子检索（PubMed、EMBASE、The Cochrane Central Register of Controlled Trials）和手工检索。所有明确报告 RBH≤6mm 部位行 TSFA 的合格临床研究均被纳入。提取数据并评估各研究的偏倚风险。只要有可能，就进行荟萃分析。
纳入 Q1 的 7 项 RCT 研究和 Q2 的 25 项研究（9 项 RCT、2 项 CCT、14 项单臂队列研究）。Q1：荟萃分析显示，TSFA 组和 LSFA 组在种植体存活率、窦膜穿孔和边缘骨吸收方面无显著差异。Q2：荟萃分析显示，TSFA 术后至少 1 年具有较高的种植体存活率（96.5%，95%CI：93.2%-98.9%），且窦膜穿孔发生率较低（5.4%，95%CI：2.7%-8.8%）。结果还表明 TSFA 患者满意度较高。
鉴于本研究存在的局限性（各研究的偏倚风险较高），可以得出结论，在 RBH≤6mm 的部位，两种方法在种植体存活率、Schneiderian 膜穿孔和 MBL 方面无显著差异。
