Clinical outcomes of graftless implant rehabilitation strategies for the posterior atrophic maxilla: A systematic review and meta-analysis
5 affiliations
- 1Associate Professor, Department of Prosthodontics and Crown & Bridge, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar bypass road, Meerut, U.P., 250005, India; Corresponding author.
- 2Professor, Department of Prosthodontics and Crown & Bridge, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar bypass road, Meerut, U.P., 250005, India
- 3Associate Professor, Department of Oral Medicine and Radiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar bypass road, Meerut, Uttar Pradesh, 250005, India
- 4Associate Professor, Department of Prosthodontics and Crown & Bridge, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, NH-58, Delhi-Haridwar bypass road, Meerut, U.P., 250005, India
- 5AssociateProfessor, Department of Periodontology and Implantology, Kalka Dental College and Hospital, By pass, near Partapur Flyover, Royal Kunj, Partapur, Meerut, U.P., 250002, India
Abstract
Background: Rehabilitation of the posterior atrophic maxilla remains challenging because of inadequate residual bone volume and maxillary sinus pneumatization. Advanced graftless implant rehabilitation strategies, including osteotome/transcrestal sinus floor elevation without grafting (OSFE/TSFE), pterygoid implants (PI), and zygomatic implants (ZI), have emerged as alternatives to conventional augmentation procedures. Objective: To systematically evaluate the long-term clinical and prosthetic outcomes associated with OSFE/TSFE, PI, and ZI for graftless rehabilitation of the posterior atrophic maxilla. Materials and methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic searches of PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and LILACS were performed for studies published between January 2000 and January 2024. Randomized controlled trials (RCTs) and observational clinical studies with a minimum follow-up of 3 years reporting implant survival, prosthetic outcomes, biological complications, and/or marginal bone loss (MBL) were included. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was performed for implant survival, whereas other outcomes were synthesized descriptively. Results: Nine studies involving 883 implants met the inclusion criteria. Implant survival ranged from 94.7% to 100%. Meta-analysis demonstrated a pooled implant survival rate of 98% (95% CI: 97%–99%) with low heterogeneity (I² = 3.5%). Subgroup analyzes demonstrated pooled survival estimates of 96% for PI, 98% for OSFE/TSFE, and 99% for ZI. Because these estimates were derived from independent study cohorts, they should be interpreted descriptively rather than as comparative treatment effects. Prosthetic survival exceeded 95% in most studies, biological complications were uncommon, and MBL ranged from 0.51 ± 0.29 mm to 1.52 ± 1.08 mm. Conclusions: Within the limitations of the available evidence, graftless implant rehabilitation strategies appear to provide predictable long-term outcomes for the posterior atrophic maxilla. However, these findings should be interpreted cautiously because the evidence is derived predominantly from observational studies and should be used to inform individualized treatment planning rather than direct comparisons among rehabilitation strategies.
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BibTeX
@article{rawat2026clinical,
title = {{Clinical outcomes of graftless implant rehabilitation strategies for the posterior atrophic maxilla: A systematic review and meta-analysis}},
author = {Pragati Rawat and Deepesh Saxena and Abhinav Sharma and Sidhartha Tomar and Pratiksha A Srivastava and Aditya Sharma},
journal = {Dentistry Review},
year = {2026},
month = oct,
doi = {10.1016/j.dentre.2026.100441},
url = {https://doi.org/10.1016/j.dentre.2026.100441},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical outcomes of graftless implant rehabilitation strategies for the posterior atrophic maxilla: A systematic review and meta-analysis
AU - Pragati Rawat
AU - Deepesh Saxena
AU - Abhinav Sharma
AU - Sidhartha Tomar
AU - Pratiksha A Srivastava
AU - Aditya Sharma
PY - 2026
DA - 2026/10/30
JO - Dentistry Review
DO - 10.1016/j.dentre.2026.100441
UR - https://doi.org/10.1016/j.dentre.2026.100441
AB - Background: Rehabilitation of the posterior atrophic maxilla remains challenging because of inadequate residual bone volume and maxillary sinus pneumatization. Advanced graftless implant rehabilitation strategies, including osteotome/transcrestal sinus floor elevation without grafting (OSFE/TSFE), pterygoid implants (PI), and zygomatic implants (ZI), have emerged as alternatives to conventional augmentation procedures. Objective: To systematically evaluate the long-term clinical and prosthetic outcomes associated with OSFE/TSFE, PI, and ZI for graftless rehabilitation of the posterior atrophic maxilla. Materials and methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic searches of PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and LILACS were performed for studies published between January 2000 and January 2024. Randomized controlled trials (RCTs) and observational clinical studies with a minimum follow-up of 3 years reporting implant survival, prosthetic outcomes, biological complications, and/or marginal bone loss (MBL) were included. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was performed for implant survival, whereas other outcomes were synthesized descriptively. Results: Nine studies involving 883 implants met the inclusion criteria. Implant survival ranged from 94.7% to 100%. Meta-analysis demonstrated a pooled implant survival rate of 98% (95% CI: 97%–99%) with low heterogeneity (I² = 3.5%). Subgroup analyzes demonstrated pooled survival estimates of 96% for PI, 98% for OSFE/TSFE, and 99% for ZI. Because these estimates were derived from independent study cohorts, they should be interpreted descriptively rather than as comparative treatment effects. Prosthetic survival exceeded 95% in most studies, biological complications were uncommon, and MBL ranged from 0.51 ± 0.29 mm to 1.52 ± 1.08 mm. Conclusions: Within the limitations of the available evidence, graftless implant rehabilitation strategies appear to provide predictable long-term outcomes for the posterior atrophic maxilla. However, these findings should be interpreted cautiously because the evidence is derived predominantly from observational studies and should be used to inform individualized treatment planning rather than direct comparisons among rehabilitation strategies.
SN - 2772-5596
ER -