Maxillary sinus augmentation using chairside bone marrow aspirate concentrates for implant site development: a systematic review of histomorphometric studies

Maxillary sinus pneumatization following dental tooth extractions and maxillary alveolar bone resorption frequently leaves inadequate bone levels for implant placement. The objectives of this systematic review are to evaluate the effects of bone marrow aspirate concentrates (BMACs) used in maxillary sinus augmentation for implant site development. A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar for studies which histomorphometrically evaluated the efficacy of BMACs and BMAC-enriched biomaterials in sinus floor elevation. Six studies were selected, and the risk of bias was evaluated. Reported ranges of vital mineralized tissue for the BMAC groups for the selected studies were 34.63–55.15% compared to 27.30% for control groups. For vital mineralized bone, these studies reported variable statistical significance. At 3–4 months, new bone formation for BMAC groups with controls using no BMAC was 7.4–12.6% and for the control groups was 9.45–14.3%. At 6 months, new bone formation for BMAC groups was 13.5–14.12% and for control groups was 10.41–13.9%. For new bone formation, these studies reported no significant difference between test and control and between 3 and 6 months histologic evaluation. Within the limits of this systematic review, the chairside method to harvest BMAC produced similar implant survival and new bone formation compared to the laboratory FICOLL group, without the additional cost and time of laboratory cell isolation techniques. The iliac crest or tibia origins, single or double centrifugation, for BMAC do not appear to be a factor for implant survival or bone formation. Although some favorable outcomes were reported, the increase in new bone formation using chairside-harvested BMAC compared to control is not predictably more significant across studies. Clinically, new bone formation in the maxillary sinus is not always contingent on the presence of BMAC. The novelty of this method requires more future studies.