Histological outcomes of sinus augmentation for dental implants with calcium phosphate or deproteinized bovine bone: a systematic review and meta-analysis

This study compared the histological outcomes of deproteinized bovine bone (DBB) and technically derived calcium phosphate for sinus floor augmentation. MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until April 2015 with the following key words: dental implants, augmentation/augmented, calcium phosphate/ceramic/tricalcium phosphate, bovine bone/Bio-Oss, deproteinized/anorganic. Randomized controlled trials (RCTs) and two-arm prospective/retrospective studies that used DBB or biphasic calcium phosphate/tricalcium phosphate (BCP/TCP) for sinus augmentation with quantitative results were included. Outcomes were the percentage of new bone formed and percentage of surface contact between the graft material and new bone (bone-to-graft contact). Four RCTs and one prospective study were included, with a total of 110 patients and 145 implants. All studies reported the percentage of new vital bone; however, large heterogeneity was present (Q = 15.23, P = 0.004, I2 = 73.8%). BCP/TCP was associated with a higher percentage of new bone, but the pooled results did not reach significance (pooled standardized mean difference (SMD) = 0.145, 95% confidence interval (CI) −0.488 to 0.778, P = 0.654). Only two studies reported bone-to-graft contact, and BCP/TCP was associated with significantly lower bone-to-graft contact (pooled SMD = −0.807, 95% CI −1.276 to −0.337, P = 0.001). This meta-analysis does not allow us to conclude superiority of one particular material with respect to histological outcomes.