Review

A histomorphometric meta-analysis of sinus elevation with various grafting materials

Jörg Handschel¹ , Melani Simonowska¹ , Christian Naujoks¹ , Rita A Depprich¹ , Michelle A Ommerborn² , Ulrich Meyer¹ and Norbert R Kübler²

¹  Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-Universität, Moorenstr. 5, D-40225 Düsseldorf, Germany

²  Department for Operative and Preventive Dentistry and Endodontics, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany

author email corresponding author email

Head & Face Medicine 2009, 5:12doi:10.1186/1746-160X-5-12

Published:	11 June 2009

Abstract

Several grafting materials have been used in sinus augmentation procedures including autogenous bone, demineralized freeze-dried bone (DFDBA), hydroxyapatite, β-tricalcium phosphate (β-TCP), anorganic deproteinized bovine bone and combination of these and others. Up to now a subject of controversy in maxillofacial surgery and dentistry is, what is the most appropriate graft material for sinus floor augmentation.

Purpose

The aim of this study is to provide a body of evidence-based data regarding grafting materials in external sinus floor elevation concerning the fate of the augmented material at the histomorphological level, through a meta-analysis of the available literature.

Materials and methods

The literature searches were performed using the National Library of Medicine. The search covered all English and German literature from 1995 until 2006. For analyzing the amount of bone the parameter "Total Bone Volume" (TBV) was assessed. TBV is determined as the percentage of the section consisting of bone tissue.

Results

In a relatively early phase after implantation the autogenous bone shows the highest TBV values. Interestingly, the different TBV levels approximate during the time. After 9 months no statistically significant differences can be detected between the various grafting materials.

Conclusion

From a clinical point of view, the use of autogenous bone is advantageous if a prosthetic rehabilitation (with functional loading) is expected within 9 months. In other cases the use of anorganic deproteinized bovine bone in combination with autogenous bone seems to be preferable. Donor side morbidity is ignored in this conclusion.