Evaluating Bone Graft Substitutes Combined with Sinus Floor Elevation for Posterior Maxillary Implant Stability
Abstract
Atrophic posterior maxilla is often encountered with insufficient alveolar bone height due to the resorption and maxillary sinus pneumatization. Sinus floor elevation is a procedure that can be performed with either a lateral window, transcrestal osteotome or osseodensification approach, and is one of the most predictable pre-implant augmentation procedures, but the success of this procedure is dependent on the biological response of the sub-antral space to the bone graft material used to fill the space. Current evidence from the literature regarding autogenous bone, allogeneic bone, xenogeneic bone mineral, alloplastic ceramics, composite grafts, graftless and biologic adjuncts (platelet-rich fibrin and recombinant bone morphogenetic protein-2) is summarized with a focus on the relative effects of these materials on implant stability quotient, vertical bone gain, graft volumetric stability and implant survival. In the literature, the implant survival rate is consistently good and the rates are greater than 95% in most studies irrespective of the type of graft, whereas the graft volumetric stability, the histological bone quality, and, to a lesser degree, implant stability quotient curves show a significant difference. Xenogeneic and alloplastic materials provide excellent long-term volume maintenance, biologic adjuncts have variable, but generally weak, early stabilization effects, and grafting alternatives, or shorter implants, can provide comparable early stabilization, if there is sufficient residual bone height. Comparative outcome data is presented in tabular and graphical format to aid in the selection of materials for posterior maxillary implant rehabilitation.