Radiographic and histomorphometric comparison of two-stage maxillary sinus floor augmentation using different grafting materials: a systematic review and network meta-analyses of randomized controlled trials.

This study was performed to evaluate the various commercially available materials used in two-stage maxillary sinus floor augmentation (MSFA). Comprehensive searches were conducted across PubMed, Web of Science, Embase, and Scopus up to October 2, 2025. A manual search was also conducted to complement the electronic search. The analysis was restricted to randomized controlled trials (RCTs) that reported both radiographic and histological evaluations. Studies that did not incorporate graft materials were excluded. A frequentist network meta-analysis using a random-effects model was employed to compare the different materials. The certainty of the evidence was also evaluated. Out of 8148 studies initially identified, 17 studies involving 504 MSFA were included in the analysis. An allograft (Maxgraft, Botiss Biomaterials) demonstrated a significantly greater reduction in radiographic height compared to other materials; however, no significant differences were observed in radiographic volume changes. The results indicated that the addition of leukocyte- and platelet-rich fibrin (L-PRF) to xenograft (Bio-Oss, Geistlich Pharma) resulted in the highest percentage of newly formed bone and demonstrated a faster resorption rate, leading to less residual graft compared to other materials. Assessing materials with consideration of the variations arising from their distinct processing methods may provide additional clinical insights for clinicians. Additional RCTs are required to enable more precise comparisons among the available grafting materials.