Emerging Biomaterials for Maxillary Sinus Augmentation: From In Vitro Insights to In Vivo Clinical Translation

Maxillary sinus augmentation is a key procedure for rehabilitating the atrophic poste-rior maxilla and enabling predictable implant-supported restorations. Although au-togenous bone remains the biological gold standard due to its superior osteogenic properties, its clinical use has declined because of donor-site morbidity, limited availa-bility, and increased operative time. Deproteinized bovine bone mineral (DBBM) is now the most widely used substitute, offering biocompatibility and long-term volumetric stability. However, as an inert osteoconductive scaffold with limited bioactivity and slow resorption, DBBM has stimulated interest in next-generation graft materials. Re-cent biomaterial innovations aim to enhance vascularization, accelerate osteogenesis, modulate immune responses, and achieve controlled resorption while preserving han-dling characteristics. These advances include ion-releasing bioactive ceramics, growth factor–enhanced allografts, polysaccharide–hydroxyapatite composites, smart hydro-gels, and synthetic scaffolds with tunable degradation. Because bone regeneration is highly complex, a robust translational framework integrating in vitro assays, animal models, and human clinical studies is essential. In vitro systems enable rapid cyto-compatibility and cell-interaction screening, while animal models provide insights into vascularization, immune behavior, and spatial bone formation. Human studies ulti-mately confirm clinical performance and implant success. This review synthesizes ev-idence from 2018 onward on emerging biomaterials for sinus floor elevation, evaluating their ability to overcome the limitations of DBBM and emphasizing the importance of a coordinated preclinical-to-clinical research continuum for safe and effective clinical translation.