Effectiveness of Graftless Maxillary Sinus Floor Augmentation on Alveolar Crest Height and Implant Survival: A Review of Randomized Controlled Studies

Recent research has documented that new bone can form in and around the dental implants placed after maxillary sinus floor elevation (SFE) without the use of bone grafts. This article reviews the existing literature on the SFE technique without the use of bone grafts to determine the extent of research on this topic. The objectives of the study are to evaluate the vertical bone gain and implant survival rates associated with the technique.

A review was conducted by searching the relevant articles based on the inclusion and exclusion criteria. The main search engines were PubMed, Google Scholar, and Cochrane. We used special algorithms related to the keywords ‘maxillary sinus lift’ and ‘graftless’ to identify the randomized controlled trials (RCTs) that studied the effectiveness of the graftless SFE with respect to implant survival and vertical bone gain. We included only RCTs that studied the graftless sinus lift technique related to implant survival rates and vertical bone gain, including both direct and indirect approaches to graftless SFE, and studies with at least 6 months of follow-up. Only English-language articles were considered. We excluded non-randomized studies and studies that did not report implant survival rates and vertical bone gain.

Out of 429 articles, only ten RCTs involving 209 participants satisfied the inclusion criteria. Increased implant survival rates were demonstrated with the graftless procedure, using both direct and indirect approaches. Significant effectiveness in terms of endosinus bone gain (ESBG) using the graftless SFE technique was reported. The results were comparable to SFE with graft placement.

Traditional approaches for the maxillary sinus floor augmentation have utilised the use of bone grafts. Regardless of the high success documented with these techniques, the use of bone grafts has several limitations, such as prolonged operating time and disease transmission. Additionally, the risk of complications and failures is common. Consequently, the graft-free SFE appears to be a valid minimally invasive alternative. Using this approach, most of the complications can be prevented or eliminated. Therefore, understanding this technique is essential for optimizing dental implantology practices.

Graftless SFE may be a viable technique for maxillary sinus floor augmentation. The utility of this technique lies in mitigating the complications associated with the grafting materials, thereby reducing the morbidity of the procedure and the cost burden. Future research with large RCTs using standardised methods and outcome measures is required to provide more robust evidence on the utility of this technique.