What is the most effective rehabilitation method for posterior maxillae with 4 to 8 mm of residual alveolar bone height below the maxillary sinus with implant-supported prostheses? A frequentist network meta-analysis

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Essam Ahmed Al-Moraissi, Nashwan Hamid Altairi, Bassam Abotaleb, Ghassan Al-Iryani, Essam Helboub, Mohammed Sultan Alakhali‬‏

Abstract

Purpose

The most effective rehabilitation method for patients with edentulous posterior maxillae having an intermediate (4 to 8 mm) residual bone height (RBH) below maxillary sinus is unclear. Evidence derived from conventional meta-analysis is limited due to the lack of head to head studies. We performed this network meta-analysis (NMA) to identify the most effective method to treat patients with intermediate posterior RBH.

Material and Methods

We conducted NMA of randomized controlled clinical trials (RCTs) assessing various rehabilitation methods using implant supported prostheses for patients having intermediate posterior maxillary RBH (4-8 mm). The publications from 1970 to March 2018 in three major databases were searched. Both parallel and split mouth RCTs that reported the outcomes of interest with follow up of at least six months from initial loading were included. The predictor variables were short implants (SI) (≤8 mm) alone, SI in conjunction with osteotome sinus floor elevation (OSFE) with or without bone grafting, long implants (LI) in conjunction with OSFE with and without bone grafting, and LI combined with lateral sinus floor elevations (LSFE) with bone grafting. The outcome variables were implants and prostheses failure rates, marginal bone loss and complications. Frequentist NMA was performed using STATA software.

Results

We included a total of 20 RCTs involving 770 patients with intermediate posterior maxillary RBH and 837 concerned maxillary sinuses who received 1486 implants using any of the 4 rehabilitation methods. There were no statistical significant differences between the four groups in terms of implants and prosthesis failure rates and marginal bone loss at follow-up time which ranged from 6 months to 5 years after loading. There was a significant reduction in complications for SI alone compared to LI combined with LSFE. For implants and prosthesis survival rates, SI in conjunction with OSFE w/o bone grafting ranked first as the most effective option (77.1%) followed by LI+OSFE w/o bone grafting (62%), LI+LSFE with bone grafting (43.9%), and finally SI alone (24.8%).

Conclusion

There is a moderate quality evidence derived from this NMA showing that OSFE combined with short or long implants either with or without bone grafting or SI alone are superior to long implants combined with LSFE and bone grafting when used for patients with intermediate maxillary RBH (4 –8 mm). Furthermore, the results of this study are showing that LSFE for patients with intermediate RBH is not a suitable treatment option because of unjustified high cost and rate of complications.

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