The Effect of Sinus Elevation and Onlay Grafts on Biologic and Technical Complications of Implants Placed in the Resorbed Posterior Maxilla: A Systematic Review and Analysis of Studies

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Survival rates 80.25% to 100%, success rates 91.5% to 100%

• Primary Outcome: Implant survival rates and biologic/technical complications

• Nnt Or Sensitivity: 18.1% of patients received SAOG versus 81.8% SA, suggesting limited comparative data

• Confidence Interval: Not reported

Clinical Application

Requires advanced oral surgery expertise and appropriate patient selection for complex grafting procedures Relevant to Australian oral surgery and prosthodontic practice, though PBS coverage for complex grafting procedures may vary. RACGP referral guidelines for specialist oral surgery would apply Patients with severe posterior maxillary resorption requiring implant rehabilitation

Abstract

PURPOSE: To evaluate whether biologic and technical complications differ when sinus elevation is used alone versus when used in combination with onlay grafting prior to implant placement in the severely resorbed posterior maxilla, with particular emphasis on the impact of crown-to-implant ratios (CIRs) on clinical outcomes. MATERIALS AND METHODS: An electronic search from January 2000 to December 2023 was performed in four databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with a focused Population/Problem, Intervention, Comparison, and Outcome (PICO) question. The quality of the reports was established using a modified Cochrane Collaboration tool. RESULTS: Out of 1,199 studies, 20 articles were selected, including 16 articles on sinus augmentation (SA) and 4 articles on both SA and onlay grafts (SAOG). The studies involved 1,245 patients, with 81.8% of patients receiving SA and 18.1% receiving SAOG. Implant survival rates ranged from 80.25% to 100%, with an overall success rate of 91.5% to 100%. Complications included biologic issues (eg, membrane perforation) and mechanical issues (eg, graft loss). The average follow-up period was 60 months. CONCLUSIONS: Limited evidence exists on implant outcomes following SA versus onlay grafting in the atrophied maxilla. Further randomized controlled trials are needed to compare these techniques, emphasizing prosthetically driven augmentation for optimal implant positioning.

References

1. 1.Hansrani, V., Duangsuwan, J., Shah, M., El Amami, Z., Abdallah, A., Filokyprou, T., Vasilaki, D., & Michalakis, K. (2026). The effect of sinus elevation and onlay grafts on biologic and technical complications of implants placed in the resorbed posterior maxilla: A systematic review and analysis of studies. The International Journal of Oral & Maxillofacial Implants. https://doi.org/10.11607/jomi.11339