Relative performance of various biomaterials used for maxillary sinus augmentation: A Bayesian network meta‐analysis

• Published in: Clinical oral implants research 2021-02, Vol.32 (2), p.135-153
• Main Authors: Trimmel, Bálint, Gede, Noémi, Hegyi, Péter, Szakács, Zsolt, Mezey, Gyöngyi Anna, Varga, Eszter, Kivovics, Márton, Hanák, Lilla, Rumbus, Zoltán, Szabó, György
• Format: Article
• Language: English
• Subjects: Animals; Augmentation; Autografts; Bayesian analysis; bayesian method; Biocompatible Materials; Bioglass; Biological activity; Biomaterials; Biomedical materials; Biopsy; Bone biomaterials; bone grafting; Bone marrow; Bone marrow transplantation; Bone Substitutes; Bone Transplantation; Cattle; Clinical trials; Conditional probability; Dentistry; Glass ceramics; Grafting; Grafts; Healing; Hydroxyapatite; Mathematical analysis; Maxilla; Maxillary Sinus; Meta-analysis; morphometric analysis; Network Meta-Analysis; Ranking; Review; Silica; Silica gel; Silicon dioxide; Sinus Floor Augmentation; sinus floor elevation; Substitute bone; Xenografts; Xenotransplantation
• ISSN: 0905-7161; 1600-0501
• DOI: 10.1111/clr.13690

Objectives To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs) with different biomaterials used for maxillary sinus augmentation (MSA). Materials and Methods A search of the existing medical literature until October 1, 2019, was performed. Inclusion criteria were (a) RCTs assessing a two‐stage MSA from the lateral approach using autologous bone or biomaterials for grafting and (b) reported histomorphometric outcomes based on crestal bone core biopsy samples. The Bayesian method was used to perform pairwise meta‐analyses and network meta‐analysis (NMA). The primary outcome, the new bone percentage (NB %), was calculated as mean differences with 95% credible intervals. The interventions were ranked by their posterior probability by calculating the surface under the cumulative ranking curve values. Results Thirty‐four RCTs (842 MSAs) were included in the analysis with a normal healing period (5–8 months). All comparisons were presented in a league table. On the basis of the ranking probability, the most effective bone grafting material for NB% was bovine xenograft + bone marrow concentrate (BMC) (81%), followed by bovine xenograft + platelet‐rich plasma (PRP) (77%), bioactive glass ceramic + autologous bone 1:1 (70%), nanocrystalline hydroxyapatite in silica gel (70%), and bioactive glass ceramic (70%). Autologous bone graft alone took the twelfth position with 57%. Conclusion Within the limitations of the present NMA, the analysis did not confirm autologous bone alone as the gold standard for MSA and showed superiority of composite grafts such as bovine xenograft + BMC after 5–8 months of healing.