Intrasinus bone gain with the osteotome sinus floor elevation technique: a review of the literature

Purpose: To evaluate the mean amount of intrasinus bone obtainable with the osteotome technique for transcrestal maxillary sinus elevation combined with simultaneous implant insertion, with and without the use of grafting materials. Materials and Methods: A review was conducted on PubMed, Scopus, and Cochrane central databases. Only human studies in which implant placement was contextual to the sinus elevation procedure, without additional crestal regenerative procedures and with a minimum 1-year followup, were selected. Seventeen studies were found to meet the selection criteria. Results: No statistically significant difference between the two procedures was detected. The mean intrasinus bone gain at 3 years after surgery was 2.99 mm in cases where no grafting material was used and 4.24 mm in cases in which grafting materials were used. The mean percentage of crestal height increase at the implant site at 3 years after surgery, referring to a selection of studies with initial bone height > 4 mm, was 47.28% in procedures without grafting material and 62.68% in procedures with grafting material. A different dimensional behavior of the newly formed bone during the first 3 years after surgery was found: a slight volumetric shrinkage in grafting procedures and a slight bone increase in procedures without grafting material. No statistically significant difference in implant survival rate was found. Conclusion: Both osteotome transcrestal sinus elevation procedures seem to guarantee predictable short- and medium-term results with reference to the intrasinus bone gain. However, the use of grafting materials, compared with their nonuse, does not seem to have substantial advantages in the short and medium term as far as mean intrasinus bone gain is concerned.