Background and Objectives: Alkaline phosphatase activity, mineralized matrix, and osteogenic-related gene expression have been shown to increase in response to bone morphogenetic protein-9 (BMP-9). In this study, spheroids derived from human gingival stem cells were used to determine the effects of BMP-9 on cell survival, osteogenesis, and mineralization. Materials and Methods: Human gingival stem cells were used to produce spheroids and then grown to concentrations of 0, 0.1, 1, 10, and 100 ng/mL with BMP-9. On days 1, 3, 5, and 7, morphological examination was carried out. A live/dead assay and Cell Counting Kit-8 was used to assess the vitality of cells. On days 7 and 14, alkaline phosphatase activity assays were carried out using a commercially available kit to examine the osteogenic differentiation of cell spheroids. Alizarin Red Staining was performed on the 7th and 14th days to evaluate mineralization, and RUNX2 and COL1A1 expression levels were evaluated on the 7th and 14th days using real-time polymerase chain reactions. Results: The BMP-9 added at the measured quantities did not appear to alter the shape of the well-formed spheroids produced by stem cells on day 1. In addition, treatment with BMP-9 at doses of 0, 0.1, 1, 10, or 100 ng/mL did not significantly alter cell diameter. Throughout the whole experimental process, viability was maintained. On day 14, the alkaline phosphatase activity in the groups dosed with 0.1, 1, 10, or 100 ng/mL was statistically higher than that in the unloaded control group (p < 0.05). According to qPCR data, the mRNA expression level of RUNX2 with 1 ng/mL dosing was higher on day 7 compared to that of the unloaded control group (p < 0.05). Conclusions: These findings suggest that BMP-9 can be employed to stimulate early osteogenic differentiation in stem cell spheroids.

Background and Objectives: Evidence directly comparing crestal and lateral approaches for maxillary sinus floor augmentation remains uncertain. We compared their outcomes and assessed certainty of evidence. Materials and Methods: Randomized trials directly comparing both approaches were included. MEDLINE/PubMed, Embase, and the Cochrane Library were searched from inception to 30 July 2026, supplemented by non-systematic Google Scholar searches. Risk of bias and evidence certainty were assessed using RoB 2 and GRADE. Outcomes were pooled as risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs), with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD420261447905). Results: Thirteen randomized trials (17 reports) were included. No statistically significant differences were found for implant failure (RR 0.50, 95% CI 0.10–2.61), membrane perforation (RR 0.63, 95% CI 0.29–1.38), marginal bone loss at 12 months (MD −0.08 mm, 95% CI −0.31–0.15), vertical bone gain at 12 months (MD −0.81 mm, 95% CI −1.94–0.33) or 6 months (MD −1.07 mm, 95% CI −2.50–0.36), or postoperative pain (SMD −1.56, 95% CI −3.31–0.20). Certainty was low to very low. Conclusions: Current evidence does not establish superiority of either approach. Selection should reflect residual bone height, sinus anatomy, treatment objectives, and operator experience.