ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Short-Term Survival of Dental Implants Requiring Osteotome Sinus Floor Elevation Is Comparable Whether Bone Grafting Is or Is Not Performed
Clinical Question For dental implant patients requiring osteotome sinus floor elevation, does bone grafting result in greater short-term implant survival?
Clinical Bottom Line Short-term survival rates of dental implants requiring osteotome sinus floor elevation are not improved by bone grafting as opposed to not bone grafting.
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) 28084057Chen/20177 studies with a total of 463 implants in patients without grafting and 415 implants in patients with graftingMeta-Analysis
Key results“Seven studies were included in the review. The random-effect model meta-analysis showed that the risk ratio difference of survival rates was 1.010 (95%CI, 0.910, 1.120), which did not reach statistical significance (p = 0.99). No significant difference of crestal bone loss was reported between graft and non-graft groups.”
#2) 27632263Shi/201634 studies with a total of 1,977 patients and 3,119 implantsSystematic review of randomized trials
Key results“Eighty-four out of 102 implant failures documented in the studies occurred within 1 year of functional loading. Statistically significant differences in the cumulative survival rates were found in the graft and non-graft groups (95.89% and 97.30%, respectively; P = .05). Six of the 34 studies directly compared the implant survival rates in the grafted and non-grafted groups. All six studies showed similar implant survival rates among the two groups.” In addition, when bone grafting was utilized with less than 5 mm in residual bone height, short-term implant survivability was decreased relative to not grafting (92.19% and 97.59%, respectively).
Evidence Search Pubmed: “dental implant + osteotome sinus floor elevation”
Comments on
The Evidence
Validity: When articles are selected for meta-analysis, often it is inevitable that some must be excluded to be able to more easily synthesize the results. While this is common practice, there is the potential for selection bias when authors choose which articles to analyze. Chen et al. identified four of the seven articles analyzed as being potentially at high risk for bias. Shi et al. did not include any analysis for the potential of bias. Perspective: While the overwhelming majority of current literature does not show short-term survival benefits to bone grafting in conjunction with osteotome sinus floor elevation, long-term studies, with randomized control trials, will be needed to demonstrate if there are long-term survival benefits of combining bone grafting with dental implants requiring osteotome sinus floor elevation. Caution is recommended in applying the referenced findings into the surgical setting. The use of bone grafts placed in the osteotomy site aids in carefully elevating the sinus membrane, thereby minimizing the risk of sinus membrane perforation. Secondly, it appears advantageous to have the apical portion of the dental implant surrounded by the bone graft material at the time of its placement.
Applicability Based on these two systematic reviews, bone grafting in association with osteotome sinus floor elevation does not significantly improve the short-term survival of dental implants. Including bone grafting with osteotome sinus floor elevations, when residual bone height is less than 5 mm, may be unwarranted as it generally decreases short-term survival and potentially increases the cost of the surgical procedure. When the residual bone height is greater than 5 mm, there are no significant short-term survival benefits when incorporating bone grafting.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Osteotome sinus floor elevation; dental implants; survival rates; systematic review
ID# 3148
Date of submission: 03/22/2017spacer
E-mail splinterd@livemail.uthscsa.edu
Author Daniel Splinter
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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