Sinus Augmentation versus Short Implants in the Atrophic Posterior Maxilla: A Systematic Review of Patient Related Risk Factors

Aim

This systematic review was performed in an attempt to identify individual patient risk factors when deciding between these treatment modalities for the atrophic maxilla. The objective of this study was to provide complication-based treatment recommendations to help clinicians to make this decision by comparing the use of short implants or sinus augmentation procedures in conjunction with standard length implants.

Methods

Online databases (Google Scholar, PubMed, Medline, Embase and the Cochrane library) were searched to identify Level 1 English language studies published since 2005 that assessed short and long term clinically assessed complications following surgery for implant placement in the posterior maxilla, involving sinus augmentation procedures in conjunction with standard length implants or short implants.

Results

Of 76 articles identified, 20 were included. The complications identified were failure to integrate/loss of osseointegration, biological and technical complications. Patient related risk factors were identified for some biological and technical complications. Short implants lead to fewer biological complications but carry a higher risk of technical complications.

 Conclusions

The available evidence does not allow for definitive treatment recommendations; however, several patient related risk factors have been identified which should be considered when choosing a treatment modality. For sinus augmentation procedures these include amoxicillin allergy, sinus anatomy, preoperative sinus pathology, smoking, uncontrolled diabetes, and the use of anticoagulant medications in the presence of cardiovascular disease.  Where short implants are used, a crown-to-implant ratio ≥ 2 and the use of implants with a diameter <4mm could lead to technical complications. Although these findings provide useful information for clinicians, much more research is needed in the future to formulate definitive clinical guidelines.