Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?

Background: Sinus-lift (SL) is a pre-prosthetic procedure with the objective of increasing bone height to achieve implant insertion primary stability in implant-supported prostheses. The biomechanical properties of SL augmentation materials are influenced by their origin, manufacture, bioactive subs...

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Main Authors: Anida-Maria Băbțan, Claudia N. Feurdean, Anca Ionel, Willi A. Uriciuc, Radu Chifor, Chambon Antoine Bernard Jaques, Bianca A. Boșca, Aranka Ilea
Format: Article
Language:English
Published: MDPI AG 2025-04-01
Series:Journal of Functional Biomaterials
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Online Access:https://www.mdpi.com/2079-4983/16/4/133
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author Anida-Maria Băbțan
Claudia N. Feurdean
Anca Ionel
Willi A. Uriciuc
Radu Chifor
Chambon Antoine Bernard Jaques
Bianca A. Boșca
Aranka Ilea
author_facet Anida-Maria Băbțan
Claudia N. Feurdean
Anca Ionel
Willi A. Uriciuc
Radu Chifor
Chambon Antoine Bernard Jaques
Bianca A. Boșca
Aranka Ilea
author_sort Anida-Maria Băbțan
collection DOAJ
description Background: Sinus-lift (SL) is a pre-prosthetic procedure with the objective of increasing bone height to achieve implant insertion primary stability in implant-supported prostheses. The biomechanical properties of SL augmentation materials are influenced by their origin, manufacture, bioactive substances addition, receiver, and surgical procedure. This systematic review provides insights into state-of-the-art SL biomaterials, focusing on autologous bone grafting as the gold standard. Methods: The study followed the PRISMA flow diagram, searching WoS (Web of Science), Embase, Cochrane, and PubMed databases using the search terms «sinus lift» OR «sinus augmentation» OR «bone graft» OR «bovine» OR «porcine» OR «autologous» OR «allogenic» OR «xenogeneic» OR «alloplastic» OR «hydroxyapatite» OR «β-tricalcium phosphate (β-TCP)» OR «equine» OR «PRF». Results: The highest bone gain was provided by Bioglass at 42%. Articles written between 2014 and 2024 in English or French, containing human studies and with full text available, were included. Participants were required to be in good general health, without acute, chronic, or congenital diseases, or substance abuse (drugs, alcohol, or nicotine). SL surgery was performed using the lateral approach, with no Schneiderian membrane perforation or postoperative complications. The network meta-analysis was conducted using the R statistical computing environment. To assess the inconsistency between direct and indirect evidence, we used a net heat plot. To evaluate heterogeneity across studies, we used the chi-squared-based Q-test and I<sup>2</sup> statistic. A significance level of 0.05 was applied throughout all analyses. Results: Allogeneic bovine bone and hydrox yapatite demonstrated the lowest resorption rates. Significant differences were found for residual graft and connective tissue between allogenous bovine bone (ABB) + AlB vs. β-TCP + PRF (<i>p</i> = 0.028); ABB + AlB vs. β-TCP (<i>p</i> = 0.034); ABB + AlB vs. BCP (<i>p</i> = 0.037). Meta-analysis showed that the overall heterogeneity was 51.8% (6.9–75%; <i>p</i> = 0.019), with significant heterogeneity within designs (<i>p</i> = 0.007) and no significant heterogeneity between designs (<i>p</i> = 0.39). AB had a better bone regeneration ratio compared to many of the other interventions, but only two passed the threshold of significance: A1B and B-TCP + AB. Conclusions: A grafting material’s superiority is determined by its new bone formation ratio, connective tissue integration, residual graft content, and bone resorptionratio. Although autologous bone grafting has exhibited superior bone regeneration compared to other biomaterials, it was not favored due to its unpredictable connective tissue concentration and bone resorption ratio. Additionally, autologous bone exhibited the fastest metabolic turnover among all grafting materials.
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spelling doaj-art-5bd1a18c36894a17a7992dfceda0b3f82025-08-20T02:17:59ZengMDPI AGJournal of Functional Biomaterials2079-49832025-04-0116413310.3390/jfb16040133Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?Anida-Maria Băbțan0Claudia N. Feurdean1Anca Ionel2Willi A. Uriciuc3Radu Chifor4Chambon Antoine Bernard Jaques5Bianca A. Boșca6Aranka Ilea7IIIrd Department-Oral Rehabilitation, Faculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaIIIrd Department-Oral Rehabilitation, Faculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaIIIrd Department-Oral Rehabilitation, Faculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaFaculty Nursing and Science for Health, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, RomaniaIIIrd Department-Oral Rehabilitation, Faculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaFaculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaIst Department-Histology, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaIIIrd Department-Oral Rehabilitation, Faculty of Dentistry, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, RomaniaBackground: Sinus-lift (SL) is a pre-prosthetic procedure with the objective of increasing bone height to achieve implant insertion primary stability in implant-supported prostheses. The biomechanical properties of SL augmentation materials are influenced by their origin, manufacture, bioactive substances addition, receiver, and surgical procedure. This systematic review provides insights into state-of-the-art SL biomaterials, focusing on autologous bone grafting as the gold standard. Methods: The study followed the PRISMA flow diagram, searching WoS (Web of Science), Embase, Cochrane, and PubMed databases using the search terms «sinus lift» OR «sinus augmentation» OR «bone graft» OR «bovine» OR «porcine» OR «autologous» OR «allogenic» OR «xenogeneic» OR «alloplastic» OR «hydroxyapatite» OR «β-tricalcium phosphate (β-TCP)» OR «equine» OR «PRF». Results: The highest bone gain was provided by Bioglass at 42%. Articles written between 2014 and 2024 in English or French, containing human studies and with full text available, were included. Participants were required to be in good general health, without acute, chronic, or congenital diseases, or substance abuse (drugs, alcohol, or nicotine). SL surgery was performed using the lateral approach, with no Schneiderian membrane perforation or postoperative complications. The network meta-analysis was conducted using the R statistical computing environment. To assess the inconsistency between direct and indirect evidence, we used a net heat plot. To evaluate heterogeneity across studies, we used the chi-squared-based Q-test and I<sup>2</sup> statistic. A significance level of 0.05 was applied throughout all analyses. Results: Allogeneic bovine bone and hydrox yapatite demonstrated the lowest resorption rates. Significant differences were found for residual graft and connective tissue between allogenous bovine bone (ABB) + AlB vs. β-TCP + PRF (<i>p</i> = 0.028); ABB + AlB vs. β-TCP (<i>p</i> = 0.034); ABB + AlB vs. BCP (<i>p</i> = 0.037). Meta-analysis showed that the overall heterogeneity was 51.8% (6.9–75%; <i>p</i> = 0.019), with significant heterogeneity within designs (<i>p</i> = 0.007) and no significant heterogeneity between designs (<i>p</i> = 0.39). AB had a better bone regeneration ratio compared to many of the other interventions, but only two passed the threshold of significance: A1B and B-TCP + AB. Conclusions: A grafting material’s superiority is determined by its new bone formation ratio, connective tissue integration, residual graft content, and bone resorptionratio. Although autologous bone grafting has exhibited superior bone regeneration compared to other biomaterials, it was not favored due to its unpredictable connective tissue concentration and bone resorption ratio. Additionally, autologous bone exhibited the fastest metabolic turnover among all grafting materials.https://www.mdpi.com/2079-4983/16/4/133sinus liftbone graftbiomaterialsgrowth factorsbone regeneration
spellingShingle Anida-Maria Băbțan
Claudia N. Feurdean
Anca Ionel
Willi A. Uriciuc
Radu Chifor
Chambon Antoine Bernard Jaques
Bianca A. Boșca
Aranka Ilea
Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
Journal of Functional Biomaterials
sinus lift
bone graft
biomaterials
growth factors
bone regeneration
title Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
title_full Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
title_fullStr Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
title_full_unstemmed Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
title_short Insights into Sinus-Lift Bone Grafting Materials: What’s Changed?
title_sort insights into sinus lift bone grafting materials what s changed
topic sinus lift
bone graft
biomaterials
growth factors
bone regeneration
url https://www.mdpi.com/2079-4983/16/4/133
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