Efficacy of engineered scaffolds for horizontal and vertical ridge augmentation: A systematic review and meta-analysis.

چکیده اصلی

BACKGROUND: Engineered scaffolds hold promise for personalizing surgical therapy and are being increasingly applied in clinical practice. Therefore, a comprehensive synthesis of existing data on ridge augmentation is warranted. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO: CRD42024611887). Four databases (MEDLINE, EMBASE, Cochrane Central, Scopus) and the grey literature were searched. Eligible studies included randomized clinical trials and prospective case series. The primary outcomes were horizontal, vertical, and volumetric bone gains. A meta-analysis was performed to obtain pooled estimates for vertical bone gain (mm), horizontal bone gain (mm), volumetric bone gain (mm3), and early and late complication rates (%). The certainty of evidence was evaluated using the GRADE approach. RESULTS: Thirteen studies (n = 241 patients, mean age 47.1 years) and 202 defects (12.4% horizontal, 27.2% vertical, and 60.4% combined) were included. Risk of bias was significant, with three of six randomized clinical trials showing low risk and all non-randomized studies showing moderate-to-serious risk of bias. Nine studies used customized computer-aided design and manufacturing (CAD/CAM) titanium mesh devices, while the remaining studies used materials like polyether ether-ketone scaffolds (two studies), three-dimensional hydroxyapatite blocks (one study), or customized allogeneic bone blocks (one study). Pooled horizontal bone gain was 4.96 mm (95% CI: 4.48-5.44 mm), vertical gain 5.64 mm (95% CI: 5.26-6.02 mm), and volumetric gain 1307 mm3 (95% CI: 1000-1700 mm3) over a 6 to 9-month follow-up period. The overall complication rate, irrespective of timing and resorbable membrane use, was 21.7% [16.4-27.0]. The pooled early and late (<4 or ≥4 weeks) complication rates were 24.3% and 16.5%, respectively. Based on six studies, the early complications were 25.6% without versus 21.4% with resorbable membranes. Meta-regression identified smoking status, surgical experience of the operator, and the defect type as significant factors influencing bone gain. CONCLUSIONS: Engineered scaffolds show promise in managing complex alveolar defects, achieving significant bone gains in all dimensions. However, a high complication rate makes the outcomes unpredictable and limits their use to selective cases. PLAIN LANGUAGE SUMMARY: This review investigated the usefulness of patient-specific scaffolds in improving our ability to rebuild lost jawbone. Researchers included 13 studies using different scaffolds, such as custom-made titanium meshes, polyether ether-ketone scaffolds, three-dimensionally printed bone-like blocks, or customized donated bone blocks. On average, patients gained about 5 mm of new bone in both width and height, and a significant increase in overall bone volume after 6 to 9 months. However, complications were common, affecting about one in five patients. Using a resorbable membrane helped reduce early problems. Key factors such as the surgeon's experience, the type of bone defect (combined horizontal and vertical defects vs. purely vertical), and whether the patient smoked had a strong impact on both bone gain and complications. These findings demonstrated that engineered scaffolds can successfully rebuild missing jawbone, but because complications are relatively frequent, they should be used only in carefully selected patients by highly experienced surgeons.

متن کامل اصلی