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.