IADR Abstract Archives
Premature Resorption in Vertical Augmentation; Systematic Review and Network Meta-Analysis
Objectives: To systematically appraise the available evidence on premature bone resorption (PBR) following several vertical ridge augmentation (VRA) techniques and to compare/rank them using a Bayesian Network Meta-analysis (NM) model.
Methods: Hand and electronic evidence searches were conducted in six databases to identify randomised clinical trials (RCT) comparing staged VRA techniques up to November 2022. Relative premature bone resorption (PBR%) overall (primary) and in sites with uneventful versus complicated healing and need for additional bone grafting (NAG) (secondary) were chosen as outcomes. Risk of bias (RoB) and certainty in evidence were assessed using Cochrane RoB 2.0 and GRADE tools, respectively. Direct and indirect treatment effects and treatments’ ranking were estimated using Bayesian pair-wise and NM models.
Results: Nine RCTs with a total of 191 participants and 207 defects were included. NM model involving seven treatment groups were created including onlay, onlay + barrier, inlay, guided bone regeneration distraction osteogenesis (DO), tissue expansion + tunnelling (TET) and cortical tenting (CT). Eight RCTs reported mean PBR%, with a range from 6%-44% and an average of 19%. When compared to onlay, lower mean difference (MD) of PBR% were confirmed for all groups except CT (MD 7.9, 95%CrI -34.6-50.3), Inlay had the best probability (Pr) to be ranked one (Pr=0.54) followed by DO (Pr=0.29) and TE (Pr=0.13). Healing complications resulted in substantial higher PBR% (MD 10, 95%CrI 4.4-15.7). Use of barrier with Onaly grafting resulted in less incidence of NAG (16.7% Vs. 41.7%).
Conclusions: VRA techniques preserving the periosteum exhibit less PBR when compared with other techniques. When surgical techniques involve full flap elevation, clinicians should be aware of possible loss of volume at re-entry and should consider greater grafting volumes to compensate for PBR at implant placement. Authors should aim to include data on PBR to inform future research and improve clinical evidence.
Methods: Hand and electronic evidence searches were conducted in six databases to identify randomised clinical trials (RCT) comparing staged VRA techniques up to November 2022. Relative premature bone resorption (PBR%) overall (primary) and in sites with uneventful versus complicated healing and need for additional bone grafting (NAG) (secondary) were chosen as outcomes. Risk of bias (RoB) and certainty in evidence were assessed using Cochrane RoB 2.0 and GRADE tools, respectively. Direct and indirect treatment effects and treatments’ ranking were estimated using Bayesian pair-wise and NM models.
Results: Nine RCTs with a total of 191 participants and 207 defects were included. NM model involving seven treatment groups were created including onlay, onlay + barrier, inlay, guided bone regeneration distraction osteogenesis (DO), tissue expansion + tunnelling (TET) and cortical tenting (CT). Eight RCTs reported mean PBR%, with a range from 6%-44% and an average of 19%. When compared to onlay, lower mean difference (MD) of PBR% were confirmed for all groups except CT (MD 7.9, 95%CrI -34.6-50.3), Inlay had the best probability (Pr) to be ranked one (Pr=0.54) followed by DO (Pr=0.29) and TE (Pr=0.13). Healing complications resulted in substantial higher PBR% (MD 10, 95%CrI 4.4-15.7). Use of barrier with Onaly grafting resulted in less incidence of NAG (16.7% Vs. 41.7%).
Conclusions: VRA techniques preserving the periosteum exhibit less PBR when compared with other techniques. When surgical techniques involve full flap elevation, clinicians should be aware of possible loss of volume at re-entry and should consider greater grafting volumes to compensate for PBR at implant placement. Authors should aim to include data on PBR to inform future research and improve clinical evidence.
IMAGES
3896075_File000000.jpg
3896075_File000000.jpg