Esposito Marco, Grusovin Maria Gabriella, Coulthard Paul, Worthington Helen V
Oral and Maxillofacial Surgery, Cochrane Oral Health Group, School of Dentistry, The University of Manchester, United Kingdom.
Int J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):696-710.
To test (a) whether and when bone augmentation procedures are necessary and (b) which is the most effective augmentation technique for specific clinical indications. Trials were divided into 3 categories: (1) major vertical or horizontal bone augmentation (or both); (2) implants placed in extraction sockets; (3) fenestrated implants.
An exhaustive search was conducted for all randomized controlled clinical trials (RCTs) comparing different techniques and materials for augmenting bone for implant treatment reporting the outcome of implant therapy at least to abutment connection. No language restriction was applied. The last electronic search was conducted on October 1, 2005.
Thirteen RCTs of 30 potentially eligible trials reporting the outcome of 332 patients were suitable for inclusion. Six trials evaluated techniques for vertical and/or horizontal bone augmentation. Four trials evaluated techniques of bone grafting for implants placed in extraction sockets, and 3 trials evaluated techniques to treat fenestrated implants.
Major bone grafting procedures of extremely resorbed mandibles may not be justified. Bone substitutes may replace autogenous bone for sinus lift procedures of extremely atrophic sinuses. Both guided bone regeneration procedures and distraction osteogenesis can be used to augment bone vertically, but it is unclear which is the most efficient. It is unclear whether augmentation procedures are needed at immediate single implants placed in fresh extraction sockets; however, sites treated with barrier + Bio-Oss showed a higher position of the gingival margin than sites treated with barriers alone. More bone was regenerated around fenestrated implants with nonresorbable barriers than without barriers; however, it remains unclear whether such bone is of benefit to the patient. Bone morphogenetic proteins may enhance bone formation around implants grafted with Bio-Oss, but there was no reliable evidence supporting the efficacy of other active agents, such as platelet-rich plasma, in conjunction with implant treatment.
测试（a）植骨手术是否必要以及何时必要，（b）针对特定临床指征哪种植骨技术最有效。试验分为3类：（1）主要的垂直或水平骨增量（或两者皆有）；（2）植入拔牙窝的种植体；（3）骨开窗种植体。
全面检索了所有比较不同植骨技术和材料用于种植治疗的随机对照临床试验（RCT），这些试验至少报告了种植治疗至基台连接阶段的结果。不设语言限制。最后一次电子检索于2005年10月1日进行。
30项潜在符合条件的试验中有13项RCT报告了332例患者的结果，适合纳入研究。6项试验评估了垂直和/或水平骨增量技术。4项试验评估了植入拔牙窝种植体的骨移植技术，3项试验评估了治疗骨开窗种植体的技术。
极度吸收的下颌骨进行主要的骨移植手术可能不合理。骨替代材料可在极度萎缩的上颌窦提升手术中替代自体骨。引导骨再生手术和牵张成骨均可用于垂直骨增量，但哪种最有效尚不清楚。对于即刻植入新鲜拔牙窝的单颗种植体是否需要进行增量手术尚不清楚；然而，使用屏障膜+Bio-Oss治疗的位点牙龈边缘位置高于仅使用屏障膜治疗的位点。与不使用屏障膜相比，使用不可吸收屏障膜的骨开窗种植体周围再生的骨更多；然而，这种骨对患者是否有益仍不清楚。骨形态发生蛋白可能会增强Bio-Oss种植体周围的骨形成，但没有可靠证据支持其他活性剂（如富血小板血浆）联合种植治疗的疗效。
