Elnayef Basel, Monje Alberto, Gargallo-Albiol Jordi, Galindo-Moreno Pablo, Wang Hom-Lay, Hernández-Alfaro Federico
Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):291-312. doi: 10.11607/jomi.4861.
To systematically appraise the effectiveness/reliability of vertical ridge augmentation (VRA) in the atrophic mandible. Articles that addressed any one of the following four areas were included in this study: amount of VRA, implant survival (ISR) and success rates (SSR) in the area of newly regenerated bone, complication rate during the bone augmentation procedure, and bone resorption.
An electronic literature search was conducted by two independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases for articles reporting VRA in the atrophic mandible via distraction osteogenesis (DO), inlay block grafting (IBG), onlay block grafting (OBG), and guided bone regeneration (GBR). For meta-analysis, two primary (VRA and ISR [%]) and two secondary outcomes were studied (SSR [%] and vertical bone resorption [VBR] [%}). Additionally, for qualitative assessment, complications (ie, causes of failure) were further extracted and comprehensively described.
Overall, 73 full-text papers were evaluated. Of these, 52 articles fulfilled the inclusion criteria. The weight mean (WM) of VRA (± SD) was 4.49 ± 0.33 mm (95% CI: 3.85 to 5.14 mm). It was most notable that DO involved greater VRA than IBG, and thus, significantly higher than GBR and OBG. The technique significantly influenced the mean VRA obtained (P < .001). Nonetheless, no technique showed superiority in terms of ISR or SSR. VBR and complications were shown to be minimized for GBR.
If ~ 4 mm of VRA is needed, any technique in optimum local and systemic conditions should be equally reliable in the atrophic mandible. However, when greater VRA is needed, DO and IBG have demonstrated accuracy. By means of complication and VBR rates, GBR was shown to have the lowest. For ISR and SSR, no statistical differences existed among all techniques. Controlled studies are needed to examine the long-term peri-implant bone fate and the frequency of biologic complications in each technique applied for the vertical augmentation of the atrophied mandible.
系统评估垂直牙槽嵴增高术（VRA）用于萎缩性下颌骨的有效性/可靠性。本研究纳入涉及以下四个领域中任何一个领域的文章：VRA的量、新再生骨区域的种植体存活率（ISR）和成功率（SSR）、骨增量手术期间的并发症发生率以及骨吸收情况。
两名独立评审员在多个数据库中进行了电子文献检索，这些数据库包括MEDLINE、EMBASE、Cochrane对照试验中央注册库以及Cochrane口腔健康组试验注册数据库，以查找通过牵张成骨术（DO）、嵌体块状植骨术（IBG）、覆盖块状植骨术（OBG）和引导骨再生术（GBR）在萎缩性下颌骨中进行VRA的相关文章。对于荟萃分析，研究了两个主要结局（VRA和ISR [%]）以及两个次要结局（SSR [%]和垂直骨吸收 [VBR] [%]）。此外，为进行定性评估，进一步提取并全面描述了并发症（即失败原因）。
总体而言，共评估了73篇全文论文。其中，52篇文章符合纳入标准。VRA的加权均值（WM）（±标准差）为4.49±0.33 mm（95%CI：3.85至5.14 mm）。最值得注意的是，DO导致的VRA比IBG更大，因此显著高于GBR和OBG。该技术对获得的平均VRA有显著影响（P <.001）。尽管如此，在ISR或SSR方面，没有一种技术显示出优越性。对于GBR，VBR和并发症被证明降至最低。
如果需要约4 mm的VRA，在最佳局部和全身条件下，任何技术在萎缩性下颌骨中应该同样可靠。然而，当需要更大的VRA时，DO和IBG已证明具有准确性。就并发症和VBR发生率而言，GBR显示最低。对于ISR和SSR，所有技术之间不存在统计学差异。需要进行对照研究，以检查每种用于萎缩性下颌骨垂直增量技术的种植体周围骨的长期转归以及生物并发症的发生频率。
