To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs)
with different biomaterials used for maxillary sinus augmentation (MSA).A search of
the existing medical literature until October 1, 2019 was performed. Inclusion criteria
were (1) RCTs assessing a two-stage MSA from the lateral approach using autologous
bone or biomaterials for grafting, (2) 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.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%.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.
