Survival of Implants Using The Osteotome Technique With or Without Grafting in The Posterior Maxilla: A Systematic Review
Survival of Implants Using The Osteotome Technique With or Without Grafting in The Posterior Maxilla: A Systematic Review
Survival of Implants Using The Osteotome Technique With or Without Grafting in The Posterior Maxilla: A Systematic Review
Purpose: The aim of this review was to systematically appraise survival rates of implants placed using the
osteotome technique with and without grafting in the published literature. Materials and Methods: An
electronic search was conducted to identify prospective and retrospective studies on osteotome sinus floor
elevation published between January 1, 2000 and October 30, 2015. Studies were included that (1) involved
use of the osteotome technique with or without grafting; (2) provided data regarding the implant survival
rates, residual bone height (RBH), and grafting materials; and (3) reported mean follow-up of at least 1 year
after functional loading and included a minimum of 10 patients. The mean weighted cumulative implant
survival rates were used to compare the two treatment strategies—grafted or nongrafted. The influence of
RBH and implant length on weighted cumulative implant survival was also evaluated. Results: After search
and evaluation of the literature according to the inclusion criteria, 34 studies involving 1,977 patients and
3,119 implants were included. Eighty-four out of 102 implant failures documented in the studies occurred
within 1 year of functional loading. Statistically significant differences in the cumulative survival rates were
found in the graft and nongraft groups (95.89% and 97.30%, respectively; P = .05). In the nongraft group,
no statistically significant difference in the cumulative survival rate was found when implants were placed
at RBH < 5 mm or ≥ 5 mm (95.04% and 97.63%, respectively; P = .12). In the graft group, however, a
statistically significant difference was found when implants were placed at RBH < 5 mm or ≥ 5 mm (92.19%
and 97.59%, respectively; P < .01). Significantly lower weighted mean cumulative implant survival rates were
found in the shorter (< 8 mm) implant group than in the longer (≥ 8 mm) implant group (83.33% and 96.28%,
respectively; P < .01). Conclusion: The cumulative survival rates were significantly higher in the nongraft
group than in the graft group. Early failures (< 1 year functional loading) accounted for the vast majority of the
implant failures. The cumulative survival rates in the graft group were significantly lower when the RBH was
< 5 mm, while the cumulative survival rates in the nongraft group demonstrated no statistically significant
difference based on RBH. Shorter (< 8 mm) implants demonstrated significantly lower cumulative survival
rates than longer implants. Int J Oral Maxillofac Implants 2016;31:1077–1088. doi: 10.11607/jomi.4321
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Identification
PubMed searching (n = 988) Manual searching added
CENTRAL searching (n = 52) (n = 2)
Studies included in
qualitative synthesis
(n = 34)
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No. of patients/
Residual bone height (mm) Grafting material implants Intervention Dropout (%)
4–10 ABG + DFDBA + β-TCP NR/265 Cosci’s OSFE NR
<5 ABG + CS NR/97 OSFE NR
2.87 (0.6–4) CS 34/58 OSFE NR
7.1 (3–10) ABG + DBBM 167/276 OSFE NR
4.2 DBBM 70/104 OSFE NR
9.1 None 40/75 OSFE 0
5.78 None 33/17 OSFE 0
ABG + DBBM 33/27
6–9 DBBM 323/588 OSFE 0.62
2–9 ABG+ Bioglass 26/35 Two-stage OSFE 0
9.6 DBBM 14/14 OSFE 0
7.2 (4–12) ABG+DBBM 45/57 OSFE NR
6.5 PRF 20/35 OSFE 3.2
6–9 None 33/40 OSFE 0
5.0 None 24/24 OSFE 0
8.1 None 181/164 OSFE NR
DBBM 181/88
3–7.9 None 36/92 OSFE 13.9
3.8 (1–6) None 32/54 OSFE 0
5–8 Porcine bone 30/60 OSFE with no dilators 3.62
5.6 None 202/191 OSFE NR
β-TCP+ABG 202/89
5.4 (1–8) None 17/25 OSFE 5.89
6.62 (≥ 5) None 20/30 OSFE NR
5–10 None 17/27 OSFE 0
6.6 None 36/53 OSFE 0
2.1 None 46/66 Two-stage OSFE NR
6.7 (4.1–8) None 22/27 OSFE 0
5.6 None 21/21 OSFE 0
4.67 None 20/20 OSFE 8.89
4.58 ABG+DBBM 21/21
4.46 (3–6) None 20/20 OSFE 0
<4 β-TCP + HA 35/40 OSFE NR
≥4 67/69
3.79 (2.0–4.9) Allograft 70/70 Cosci’s OSFE 2.86
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Table 4 Implant Survival Rates With and Without Grafting in Included Studies
Grafting
No. of implants
Study Year (failures) Y N
Cosci and Luccioli24 2000 265 (8) 265 (8)
Cavicchia et al23 2001 97 (11) 97 (11)
Winter et al47 2002 58 (5) 58 (5)
Toffler46 2004 276 (18) 276 (18)
Deporter et al26 2005 104 (2) 104 (2)
Leblebicioglu et al35 2005 75 (2) 75 (2)
Diserens et al27 2005 44 (0) 27 (0) 17 (0)
Ferrigno et al9 2006 588 (9) 588 (9)
Stavropoulos et al45 2007 35 (6) 35 (6)
Krennmair et al33 2007 14 (0) 14 (0)
Kermalli et al32 2008 57 (2) 57 (2)
Diss et al28 2008 35 (2) 35 (2)
Jurisic et al31 2008 40 (0) 40 (0)
Schmidlin et al41 2008 24 (0) 24 (0)
Pjetursson et al40 2009 252 (6) 88 (2) 164 (4)
Gabbert et al29 2009 92 (4) 92 (4)
Nedir et al38 2009 54 (0) 54 (0)
Calvo-Guirado et al21 2010 60 (2) 60 (2)
Lai et al34 2010 280 (12) 89 (7) 191 (5)
Nedir et al39 2010 25 (0) 25 (0)
Crespi et al25 2010 30 (0) 30 (0)
Senyilmaz et al13 2011 27 (0) 27 (0)
Fermergård et al11 2012 53 (2) 53 (2)
Bruschi et al12 2012 66 (3) 66 (3)
He et al30 2013 27 (0) 27 (0)
Fornell et al10 2012 21 (0) 21 (0)
Si et al42 2013 41 (2) 21 (1) 20 (1)
Cannizzaro et al22 2013 20 (1) 20 (1)
Gonzalez et al18 2014 109 (1) 109 (1)
Spinato et al44 2015 70 (8) 70 (8)
(Epub 2014)
Gu et al17 2016 37 (2) 37 (2)
(Epub 2014)
Nedir et al36 2014 14 (0) 14 (0)
Soydan et al43 2015 82 (3) 82 (3)
Nedir et al37 2016 37 (3) 37 (3)
(Epub 2015)
Mean survival ratea 3,119 (114) 2,118 (87) 1,001 (27)
95.89% 97.30%
aWeighted mean cumulative implant survival rates.
technique have been reported in both short- and long- < 5 mm was significantly lower when grafting ma-
term studies.17,18,37 terials were used (92.19% and 97.59%, respectively).
In the present review, implant survival rate was This result is partially in line with a previous system-
found not to be related to RBH (95.04% and 97.63%, atic review that used a similar assessment method.16 It
respectively) when no grafting materials were used. reported that the prognosis could be more favorable
However, the survival rate of implants placed in RBH when RBH > 5 mm. However, the subgroup analysis
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NR = not reported.
between the grafted and nongrafted groups was not In the present review, the influence of implant
performed. It remains unknown why the nongrafted length on implant survival was also assessed. Signifi-
protocol can improve implant survival rates. However, cantly lower implant survival rates were found among
caution should be taken before making the clinical the shorter (< 8 mm) implant group. This was con-
recommendation, as the sample size of the nongrafted sistent with a previous retrospective cohort study of
group was relatively small compared to the grafted 4,591 Straumann implants with up to 10-year follow-
group (782 and 1,735, respectively). up, which showed that shorter (6-mm) implants in
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*P < .05.
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