Osteotome-mediated sinus floor elevation: a systematic review and meta-analysis.

PURPOSE: The objectives of this study were to systematically review the literature regarding sinus floor elevation using osteotomes with respect to the timing of implant placement, implant characteristics, grafting materials, and intraoperative and postoperative complications and to perform a meta-analysis to determine the influence of initial residual bone height (RBH) on implant success. MATERIALS AND METHODS: A systematic search of articles was conducted on MEDLINE and manually to identify studies of sinus floor elevation using osteotomes. Strict inclusion criteria were applied. The mean observation period was >/= 1 year after functional loading of implants. The quality of the included papers was assessed using the Newcastle-Ottawa Scale for observational studies and the PEDro Scale for randomized clinical trials, and the heterogeneity of the papers included in the meta-analysis was evaluated. The statistical accuracy was tested using the Cochran C test, and the relationship between initial RBH and implant success was analyzed using the Student t test Welch variant. RESULTS: Twenty-five studies published over a period of 13 years met the inclusion criteria; 15 were retrospective, 9 were prospective, and 1 was a randomized controlled trial. The included articles comprised 3,092 inserted implants with a failure rate of 3.85%. Of the 25 included studies, 8 were selected for the meta-analysis. RBH > 4 mm did not influence implant success/failure; however, there was a significant difference between the success/failure rates of implants, inserted in combination with sinus floor elevation using osteotomes, when the initial RBH was < 4 mm. CONCLUSION: Initial RBH of less than 4 mm influenced the success rates of implants inserted in combination with sinus floor elevation using osteotomes.