Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Dental Research Center, Research Institute for Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Periodontics, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran.
Br J Oral Maxillofac Surg. 2024 Oct;62(8):685-703. doi: 10.1016/j.bjoms.2024.05.006. Epub 2024 May 23.
This systematic review and meta-analysis assesses the clinical outcomes of implants inserted during or following transcrestal sinus lifts. The study protocol was prospectively registered on PROSPERO (CRD42024504513). PubMed, Web of Science, Embase, and Scopus databases were searched up to 21 February 2024, and randomised clinical trials utilising transcrestal sinus lifts were included. Qualitative and quantitative syntheses were conducted. A random effects model was used to pool the survival rate of implants placed with transcrestal sinus lifts using hand osteotomes without grafting, along with meta-regression and subgroup analyses. Funnel plots and Egger's linear regression were used to explore possible publication bias. Probabilities of less than 0.05 were considered significant. A total of 1807 records were identified after the initial search. Seventeen studies were included with 10 of them considered for meta-analysis. Studies used hand osteotomes, a combination of piezoelectric and hand osteotomes, drills, and smart lifts for sinus elevation. Only studies that used hand osteotomes reported subsequent vertigo and dizziness in patients. The meta-analysis showed a 100% (95% CI: 99% to 100%) survival rate for both grafted and non-grafted transcrestal sinus lifts using hand osteotomes. Meta-regression showed that follow-up time did not significantly affect the implants' survival. Subgroup analyses showed no significant difference between bone-level and tissue-level implants and one-stage or two-stage implants. On considering the limitations of this study it can be concluded that closed maxillary sinus elevation can be considered a relatively safe technique that is associated with a high survival rate. However, caution should be taken when using hand osteotomes because of a higher rate of sinus lining perforation and reported patient vertigo.
这篇系统评价和荟萃分析评估了在经牙槽嵴窦底提升术或之后植入的种植体的临床效果。研究方案已在 PROSPERO（CRD42024504513）前瞻性注册。我们检索了 PubMed、Web of Science、Embase 和 Scopus 数据库，检索截至 2024 年 2 月 21 日，并纳入了使用经牙槽嵴窦底提升术的随机临床试验。进行了定性和定量综合分析。使用随机效应模型，对不使用移植物的经牙槽嵴窦底提升术使用手骨凿植入的种植体的存活率进行了汇总，并进行了meta 回归和亚组分析。使用漏斗图和 Egger 线性回归来探索可能存在的发表偏倚。概率小于 0.05 被认为具有统计学意义。初步检索后共确定了 1807 条记录。纳入了 17 项研究，其中 10 项研究进行了荟萃分析。这些研究使用了手骨凿、压电和手骨凿联合、钻头和智能提升器进行窦提升。只有使用手骨凿的研究报告了患者随后出现的眩晕和头晕。荟萃分析显示，使用手骨凿进行牙槽嵴窦底提升术，无论是否使用移植物，种植体的存活率均为 100%（95%CI：99%至 100%）。meta 回归显示，随访时间对种植体的存活率没有显著影响。亚组分析显示，骨水平和软组织水平种植体以及一期或二期种植体之间没有显著差异。考虑到本研究的局限性，可以得出结论，闭合式上颌窦提升术可被视为一种相对安全的技术，其存活率较高。然而，由于窦黏膜穿孔的发生率较高，以及报道的患者眩晕，使用手骨凿时应谨慎。
