Maxillary sinus lifts: with or without grafts?

shutterstock_119979133  - PA Skull x-ray

The use of dental implants has become a widely used to restore partially or wholly edentulous patients. The proximity of the maxillary sinus in the atrophic posterior maxilla can be challenging and a range of techniques are employed. These include maxillary sinus lift, guided bone regeneration, onlay or interpositional grafts, or the use of tilting or short implants.  The maxillary sinus lift is the most commonly used procedure and it is used both with and without bone grafts.

The aim of this review was to evaluate the efficacy of sinus lift without grafts in atrophic maxilla.


Searches were conducted in the PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. This was supplemented by hand searches of the journals, British Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, European Journal of Oral Implantology, Implant Dentistry, Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Journal of Dental Research, Journal of Clinical Periodontology, Journal of Periodontology, International Journal of Prosthodontics, International Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxillofacial Implants and the International Journal of Periodontics and Restorative Dentistry.

English languages studies providing data on the outcome of sinus lifts involving a minimum sample of 5 patients and 6 months follow up were considered. 2 reviewers independently selected studies, extracted data and assessed study quality using the Cochrane risk of bias tool. The overall quality of evidence was assessed using the GRADE approach


  • 5 studies involving a total of 127 patients (336 implants) were included.
  • 3 studies were considered to be at low risk of bias and 2 at unclear risk.
  • Follow up periods ranged from 6-60 months.
  • No significant differences were found between the two groups in
    • implant survivals (Risk Ratio= 1.00 [95%CI; 0.96 – 1.04) {5 studies}
    • marginal bone loss (Mean difference = 0.04 [95%CI; -0.18 – 0.26]) {2 studies} and
    • new bone density (Mean difference = 73.16 [95%CI; -160.32 -3.6.63) {2 studies}.
  • There was significantly more endosinus bone gain in the grafting group (Mean difference = -0.69[95%CI; -1.28 to – 0.11]) {3 studies}.
  • GRADE, the levels of evidence were assessed as moderate (implant survival and marginal bone loss), low (endosinus bone gain) and very low (new bone density).


 The authors concluded: –

there is no significant difference between sinus lift with and without grafts in the short‐term success rate, the changes in peri‐implant marginal bone level and the density of newly formed bone around implants. But the grafting group had more new bone formation than the no grafting group in the short‐term follow‐up.


This review has involved searches of a three major databases and hand searches on a range of relevant dental journals. However, restricting the inclusion criteria to English language article means that relevant papers may have been excluded. We have previously considered review on this topic (Dental Elf – 9th Dec 2016 & 27th Mar 2017) and none of the studies included in this review have been published since that time and other reviews of maxillary sinus floor augmentation have been published. The previous reviews have also shown little difference in outcomes between sinus lift with and without grafts. Implant survival was the only outcome that was assessed in all 5 studies and the longest follow up period was 5 years in one single trial. The number of patients involved in the studies was also small ranging from 14 to 45 patients.  So, while the review findings suggest no difference in outcomes with and without grafts the findings must be interpreted with caution as the studies are small and of short duration. Further studies should be well conducted and reported and of appropriate size and duration.


Primary Paper

Yang J, Xia T, Wang H, Cheng Z, Shi B. Outcomes of maxillary sinus floor augmentation without grafts in atrophic maxilla: A systematic review and meta-analysis based on randomised controlled trials. J Oral Rehabil. 2019 Mar;46(3):282-290. doi: 10.1111/joor.12753. Epub 2018 Dec 26. Review. PubMed PMID: 30537184.

Original review protocolon PROSPERO

Other references

Dental Elf – 9th Dec 2016

Maxillary sinus lift surgery: does grafting improve outcomes?


Dental Elf – 27th Mar 2017


Sinus lift with dental implants: to graft or not to graft



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