Replacing Autogenous Bone in Sinus Lift Procedures: Toward a New Biomaterial Approach?

Replacing Autogenous Bone in Sinus Lift Procedures: Toward a New Biomaterial Approach?

Sinus floor elevation is a cornerstone technique in posterior maxillary implantology, particularly when residual bone height is insufficient. Historically, autogenous bone—harvested directly from the patient—has long been considered the gold standard due to its osteogenic, osteoinductive, and osteoconductive properties. However, this solution is not without drawbacks: donor site morbidity, prolonged surgical time, and patient discomfort. As a result, the search for effective and safe substitutes has become increasingly important.

Why Seek an Alternative to Autogenous Bone?

Several factors are driving the gradual move away from autogenous bone for sinus augmentation:

Donor site morbidity (chin, mandibular ramus, iliac crest, etc.): postoperative pain, infection risk, paresthesia.

Limited resources: available bone quantity is often insufficient, particularly in elderly or long-term edentulous patients.

Increased surgical complexity: two surgical sites, longer procedure time.

Rapid resorption of autogenous bone post-graft, potentially compromising long-term bone volume.

Given these limitations, xenogeneic, allogeneic, and synthetic biomaterials have progressively become widely accepted.

What Do Clinical Studies Say?

Scientific literature has extensively compared autogenous grafts and biomaterials in sinus lift procedures. Several systematic reviews and meta-analyses (Aghaloo & Moy, 2007; Starch-Jensen et al., 2018) conclude that implant survival rates are equivalent between both approaches.

Key findings include:

Osteoconductive biomaterials, especially deproteinized bovine bone mineral (DBBM), provide excellent long-term volume stability.

New bone formation rates are often slightly lower compared to pure autogenous bone but are sufficient to support reliable osseointegration.

Composite materials, combining autogenous bone (20–30%) with DBBM (70–80%), appear to offer a compelling balance between regeneration potential and volume maintenance.

Which Strategy to Adopt in Clinical Practice Today?

Depending on the clinical situation, residual anatomy, and practitioner preference, several options are available:

Xenogeneic biomaterials (e.g., DBBM): excellent volume maintenance, slow resorption, high biocompatibility. Indicated for sinus lifts using the Summers technique or lateral window approach.

Allogeneic biomaterials: lyophilized demineralized bone (DFDBA) or cortical bone, offering osteoinductive properties. Faster resorption, but good regenerative potential.

Synthetic biomaterials (calcium phosphates, bioceramics, etc.): high infectious safety, but sometimes less predictable volume stability.

Autograft/xenograft composites: a combination strategy to blend the cellular vitality of autogenous bone with the stability of a xenograft.

Implant placement may be performed simultaneously or delayed (6 to 9 months post-augmentation) depending on initial bone height and achieved primary stability.

Conclusion

Replacing autogenous bone in sinus lift procedures is now not only possible but often desirable, depending on the case. Modern biomaterials offer comparable results in terms of implant survival while simplifying surgical protocols and improving patient comfort.

HYGITECH Recommendations

For your sinus lift procedures, HYGITECH offers:

Collagen membrane: for graft protection and stabilization,

Surgical kits: sterile, single-use kits for sinus augmentation.

Sur le sujet

PARASORB® Fleece HD

Haemostatic Sponges