Lin Guo-Hao, Lim Glendale, Chan Hsun-Liang, Giannobile William V, Wang Hom-Lay
Graduate Periodontics, Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
Clin Oral Implants Res. 2016 Nov;27(11):1349-1359. doi: 10.1111/clr.12737. Epub 2015 Dec 1.
To study the effect of the recombinant human bone morphogenetic protein 2 (rhBMP-2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of non-biologic bone grafting materials.
An electronic search of 4 databases (January 1990-February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMP-2 in sinus grafting procedures, with ≥10 augmentation sites in each study group, and with a follow-up period of at least 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines.
Six randomized controlled trials (RCTs) were included. The results of the meta-analyses showed that the WMD of vertical bone height gain was -0.14 mm (95% CI = -1.91 to 1.62 mm, P = 0.87), the WMD of bone density was -142.42 mg/cm (95% CI = -310.62-25.78 mg/cm , P = 0.10), the WMD of the percentage of vital bone was -4.59% (95% CI = -11.73-2.56%, P = 0.21), and the WMD of the percentage of residual bone grafting materials was -9.90% (95% CI = -26.38-6.58%, P = 0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI = 0.94-1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures.
This systematic review revealed that the use of rhBMP-2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6-9 months. However, previous studies showed the morbidity and other patient-reported outcomes were improved in rhBMP-2 approaches as compared to bone autograft procedures (both intraoral and extraoral bone harvesting because no donor site is required). Long-term studies are required to determine the cost-benefit of sinus floor augmentation procedures for patients requiring implant reconstruction.
研究与传统非生物骨移植材料方法相比，重组人骨形态发生蛋白2（rhBMP - 2）对上颌窦底提升术后上颌窦容积和组织形态变化的影响。
对4个数据库（1990年1月至2015年2月）进行电子检索，包括PubMed/MEDLINE、EMBASE、科学网和考克兰中央对照试验注册库，并手动检索同行评审期刊以查找相关文章。纳入在鼻窦移植手术中使用和不使用rhBMP - 2进行鼻窦容积和/或组织形态学结果比较的数据的人体临床试验，每个研究组至少有10个提升部位，且随访期至少为6个月。根据PRISMA指南进行随机效应荟萃分析，以分析记录变量的加权平均差（WMD）和置信区间（CI）。
纳入6项随机对照试验（RCT）。荟萃分析结果显示，垂直骨高度增加的WMD为 - 0.14毫米（95%CI = - 1.91至1.62毫米，P = 0.87），骨密度的WMD为 - 142.42毫克/立方厘米（95%CI = - 310.62至25.78毫克/立方厘米，P = 0.10），活性骨百分比的WMD为 - 4.59%（95%CI = - 11.73至2.56%，P = 0.21），剩余骨移植材料百分比的WMD为 - 9.90%（95%CI = - 26.38至6.58%，P = 0.21）。种植体存活率的比较显示总体风险比为1.00（95%CI = 0.94至1.07）。两种方法（传统骨移植与骨形态发生蛋白相比）在临床和组织形态学测量方面均显示出相当的有效性。
该系统评价显示，与传统鼻窦移植手术相比，在6至9个月的愈合期后，在上颌窦底提升术中使用rhBMP - 2可获得相似的临床和组织形态学结果。然而，先前的研究表明，与自体骨移植手术（包括口腔内和口腔外取骨，因为无需供体部位）相比，rhBMP - 2方法的发病率和其他患者报告的结果有所改善。需要进行长期研究以确定上颌窦底提升手术对需要种植体重建的患者的成本效益。
