| Objective:After the loss of maxillary posterior teeth,due to the combined effect of maxillary sinus gasification and loss of functional load stimulation,the alveolar ridge height often has more serious absorption than the rest of the oral cavity,which often cannot meet the needs of conventional length implant implantation.Sinus floor elevation(SFE)is the most commonly used method of bone augmentation in the maxillary posterior region in clinical practice.It can safely and effectively increase the bone height of the maxillary posterior region without changing the repair space.The key to its success is the complete separation of the maxillary sinus membrane and the bone wall of the sinus floor to form a stable osteogenic space.However,due to the complex anatomy of the maxillary sinus and the fragile texture of the maxillary sinus membrane itself,it is unable to withstand excessive tension.Its perforation is the most common complication in the maxillary sinus floor elevation surgery,which is easy to lead to the loss of bone graft materials and acute and chronic inflammation in the maxillary sinus after surgery.At present,there is no consensus on whether the perforation of maxillary sinus membrane will affect the retention rate of the lower implant and the process of bone regeneration around it.This study intends to provide high-quality evidence-based medical evidence for the clinical decision of this problem through systematic evaluation and meta-analysis.Methods:The content of the study was determined according to the PICOS principle,and a comprehensive search was conducted in PubMed/Medline,EMBASE,Web of Science and Cochrane Library databases by using the search method of subject words combined with free words.In addition,the reference documents included in the study were retrieved as a supplement to manual search.The last search was conducted on November 1,2022.Two researchers screened all the documents according to the preset inclusion and exclusion criteria.The quality of the included studies was evaluated according to the Newcastle-Ottawa Scale(NOS).After data extraction and heterogeneity evaluation of the included study,subgroup analysis was performed,and the extracted data were meta-analyzed using the appropriate effect model according to the heterogeneity evaluation results.Then,sensitivity analysis,cumulative meta-analysis and publication bias evaluation were performed to verify the reliability of the meta-analysis results.Results:A total of 1056 articles were obtained by searching PubMed,Embase,Web of Science and Cochrane Library databases and manual searching.After screening,13 articles were finally included for systematic evaluation of implant retention rate and meta-analysis.Among them,3 articles were included in the systematic evaluation and meta-analysis of new bone formation in maxillary sinus.The quality of the included studies was evaluated according to the NOS scoring scale.Ten studies were rated as high quality and three were rated as medium quality.The meta-analysis results of implant retention rate showed that the perforation of maxillary sinus membrane had no significant effect on the early failure and long-term retention rate of the implant,and the perforation of maxillary sinus membrane during the lateral fenestration of the maxillary sinus floor elevation and the elevation of the maxillary sinus floor through the top of the alveolar ridge would not significantly reduce the implant retention rate,but the perforation of maxillary sinus membrane would significantly reduce the height of new bone in the maxillary sinus.The funnel map was drawn and the Egger’s test and Begg’s test were performed.The results showed that there was no significant publication bias in the included study.The sensitivity analysis showed that the overall results of the meta-analysis were not affected by individual studies.The cumulative meta-analysis showed that the OR value and confidence interval of the meta-analysis tended to be stable with the increase of included studies.Conclusion:The perforation of the maxillary sinus membrane during the maxillary sinus floor elevation has no significant effect on the implant retention rate,but the influence of the perforation of the maxillary sinus membrane during the maxillary sinus floor elevation through the crest of the alveolar ridge on the implant retention rate should be carefully considered,especially the influence on its early osseointegration process still needs further basic and clinical research verification.Perforation of the maxillary sinus membrane will significantly reduce the height and proportion of new bone in the maxillary sinus,and may increase the amount of bone loss around the edge of the implant.Therefore,for the implant implanted under the perforated sinus membrane,more strict occlusion control and regular follow-up should be carried out to ensure the long-term health of the soft and hard tissues around the implant. |
PDF Full Text Request