ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Use of a Barrier Membrane Does Not Affect the Percent Vital Bone Formation Following Maxillary Sinus Floor Augmentation Utilizing the Lateral Window Technique
Clinical Question In patients receiving maxillary sinus floor augmentation with a lateral window approach, does the use of a barrier membrane result in greater vital bone formation?
Clinical Bottom Line The use of a barrier membrane did not result in greater vital bone formation of the augmented maxillary sinus.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25671628Suárez-López del Amo/201537 studies (4 RCTs)Meta-Analysis
Key resultsA meta-analysis of 37 studies evaluated the percent of vital bone, based on histomorphometric analysis, after maxillary sinus augmentation with a lateral window approach. Vital bone formation was compared with and without the use of a barrier membrane placed over the lateral window. With the membrane, a mean of 32.36% vital bone resulted compared to 33.07% vital bone when a barrier membrane was not utilized. The authors concluded that the use of a membrane did not significantly enhance the results of sinus augmentation.
#2) 24164570Garcia-Denche/2013104 patientsRCT
Key resultsA randomized controlled trial of 104 patients in a split mouth study design comparing histological measurements and implant survival in patients who received a membrane over the antrostomy in lateral window sinus augmentation. Patients received bilateral sinus augmentation, and sites were randomized as to which side received a membrane covering the antrostomy. 6 months after the procedure, bone biopsy was taken to determine vital bone and remaining graft material. Implant survival was also followed for 1 year following placement. In covered sites vital bone percentage was 19% versus 15% in non-covered sites, which is not a statistically significant difference. Implant survival was similar between the two groups; 96% in covered group versus 94% in non-covered sites. The study concluded there is not a significant difference between antrostomy sites that are covered or not covered with a membrane.
Evidence Search (("paranasal sinuses"[MeSH Terms] OR ("paranasal"[All Fields] AND "sinuses"[All Fields]) OR "paranasal sinuses"[All Fields] OR "sinus"[All Fields]) AND ("lifting"[MeSH Terms] OR "lifting"[All Fields] OR "lift"[All Fields]) AND lateral[All Fields] AND window[All Fields] AND ("membranes"[MeSH Terms] OR "membranes"[All Fields] OR "membrane"[All Fields])) AND (Review[ptyp] OR Clinical Trial[ptyp])
Comments on
The Evidence
Fernando Suárez-López del Amo in 2015 included 37 studies, all of which had at least 6 patients, but case studies and other low-level evidence were included. Garcia-Denche 2013 primarily looked at implant survival but reported percent new/vital bone in grafted sties. In this study they used Bio-Oss as the grafting material, which differs from other studies that used other grafting materials that resorb at different rates. Each study was able to directly compare percent vital bone from the reported literature, so although technique and materials maybe different, the outcome measurement was very uniform.
Applicability While the Suárez-López del Amo article suggests no difference in vital bone formation, the authors note that it is not the only criteria for implant success. Medical history and patient selection play a vital role, and these articles relate only to clinical technique. Garcia-Denche not only showed no difference in vital bone percentage, it also showed no significant difference in implant survival over a 1-year follow up period. Further studies will have to be done to determine any long-term effect.
Specialty/Discipline (Oral Surgery) (Periodontics)
Keywords maxillary sinus augmentation, lateral window, barrier membrane
ID# 2937
Date of submission: 11/02/2015spacer
E-mail corning@uthscsa.edu
Author Patrick Corning, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author David Lasho, DDS, MSD
Faculty mentor/Co-author e-mail LASHO@uthscsa.edu
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