Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3 years after dental implant placement [3]. According to Pjetursson [4] in his systematic review on success of implants inserted in combination with sinus floor elevation, the implant survival increases to 98.3% after 3 years when compared to non-augmented jawbone.

Autogenous bone is still the gold standard, because of its osteoconductive and osteoinductive properties, due to the possible osteogenic capacity [5,6,7,8,9,10]. Moreover, the bone morphogenic proteins, present in autogenous bone grafts, can attract osteogenic cells from the surrounding tissues, in their turn containing other growth factors essential for the process of bone graft incorporation [4].

As the maxillary tuberosity, mandibular retromolar or chin region do not always supply enough bone graft volume, bone grafts can also be harvested from the anterior iliac crest, the tibia, the rib, and the calvarian bone. However, these harvesting procedures have disadvantages, such as prolonged operating time, donor site morbidity, hospitalization [9, 11,12,13], sensory disturbances [14], and unpredictable resorption rate of the bone grafts [5, 15]. Donor site morbidity may be a major reason to question the use of autogenous bone [16]. Therefore, several types and properties of bone substitutes (alloplast, xenograft, allograft, and mixtures of various materials) have been developed [16, 17] to overcome the disadvantages mentioned above.

Calcium phosphates, such as hydroxyapatite (HA), β-tricalcium phosphate (β-TCP), or biphasic calcium phosphate (BCP), a mixture of HA and β-TCP, are osteoconductive as they resemble the chemical composition of natural bone [18, 19]. Calcium phosphates are biocompatible and do not induce a sustained foreign body response or toxic reaction [20]. At a physiological pH, calcium phosphates are the least soluble of the naturally occurring calcium phosphates, which makes them relatively resistant to resorption [21,22,23].