Al-Nawas Bilal, Schiegnitz Eik
Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S219-34.
Bone substitute materials (BSM) are described as a reasonable alternative to autologous bone (AB) to simplify the grafting procedure. In a systematic review and meta-analysis, the influence of BSM compared to AB on treatment success in augmentation procedures of the edentulous jaw was analysed.
Literature analysis resulted in only two studies addressing reconstruction of the totally edentulous jaw using BSM. Therefore the literature analysis was extended to partially and totally edentulous jaws. The following augmentation procedures were analysed: maxillary sinus floor augmentation (MSFA) and vertical and/or lateral alveolar ridge augmentation; guided bone regeneration (minor and contained defects) were excluded. Meta-analysis was implemented using the literature from the years 2000 to early 2014 and only studies with a mean follow-up of at least 10 months were included.
After screening 843 abstracts from the electronic database, 52 studies in qualitative and 14 in quantitative synthesis were included. In studies examining MSFA, the mean implant survival rate was 98.6% ± 2.6 for BSM, 88.6 ± 4.1% for BSM mixed with AB and 97.4 ± 2.2% for AB alone. For MSFA, meta-analysis showed a trend towards a higher implant survival when using BSM compared to AB, however the difference was not statistically significant ([OR], 0.59; [CI], 0.33-1.03). No statistically significant difference in implant survival for MSFA between BSM mixed with AB and AB was seen ([OR], 0.84; [CI], 0.5-1.42). Concerning ridge augmentation, the mean implant survival rate was 97.4 ± 2.5% for BSM, 100 ± 0% for BSM mixed with AB and 98.6 ± 2.9% for AB alone. Metaanalysis revealed no statistically significant difference in implant survival for ridge augmentation using BSM or AB ([OR], 1.85; [CI], 0.38 to 8.94). For BSM mixed with AB versus AB alone, a meta-analysis was not possible due to missing data.
Within the limitation of the meta-analytical approach taken, implant survival seems to be independent of the biomaterial used in MSFA and alveolar ridge augmentation. Therefore, based on the current literature, there is no evidence that AB is superior to BSM. The conclusions are limited by the fact that influence of defect size, augmented volume and regenerative capacity of the defects is not well described in the respective literature.
骨替代材料（BSM）被认为是自体骨（AB）的合理替代品，可简化植骨手术。在一项系统评价和荟萃分析中，分析了与自体骨相比，骨替代材料对无牙颌种植手术治疗成功率的影响。
文献分析仅得到两项关于使用骨替代材料重建全口无牙颌的研究。因此，文献分析范围扩大到部分无牙颌和全口无牙颌。分析了以下种植手术：上颌窦底提升术（MSFA）以及垂直和/或侧方牙槽嵴增高术；引导骨再生（微小和局限性缺损）被排除在外。使用2000年至2014年初的文献进行荟萃分析，仅纳入平均随访时间至少为10个月的研究。
在筛选了电子数据库中的843篇摘要后，纳入了52项定性研究和14项定量综合研究。在研究上颌窦底提升术的研究中，骨替代材料组的平均种植体存活率为98.6%±2.6%，骨替代材料与自体骨混合组为88.6%±4.1%，单纯自体骨组为97.4%±2.2%。对于上颌窦底提升术，荟萃分析显示，与自体骨相比，使用骨替代材料时种植体存活率有升高趋势，但差异无统计学意义（[OR]，0.59；[CI]，0.33 - 1.03）。骨替代材料与自体骨混合组和自体骨组在上颌窦底提升术的种植体存活率方面无统计学显著差异（[OR]，0.84；[CI]，0.5 - 1.42）。关于牙槽嵴增高术，骨替代材料组的平均种植体存活率为97.4%±2.5%，骨替代材料与自体骨混合组为100%±0%，单纯自体骨组为98.6%±2.9%。荟萃分析显示，使用骨替代材料或自体骨进行牙槽嵴增高术的种植体存活率无统计学显著差异（[OR]，1.85；[CI]，0.38至8.94）。由于数据缺失，无法对骨替代材料与自体骨混合组和单纯自体骨组进行荟萃分析。
在本次荟萃分析方法的局限性内，种植体存活率似乎与上颌窦底提升术和牙槽嵴增高术中使用的生物材料无关。因此，根据当前文献，没有证据表明自体骨优于骨替代材料。这些结论受到以下事实的限制：各文献中对缺损大小、增高体积和缺损再生能力的影响描述不足。
