Graduate Periodontics, University of Washington School of Dentistry, Seattle, WA.
Clarus Dental Specialities, Pune, India.
Implant Dent. 2018 Feb;27(1):119-134. doi: 10.1097/ID.0000000000000687.
The objective of this systematic review was to assess the clinical efficacy of the tooth-bone graft as a bone substitute in the oral and maxillofacial region in humans as compared to ungrafted sites and other bone substitutes.
Databases were electronically and manually searched up to January 2017 to identify animal and human studies and a risk of bias analysis and descriptive statistics was performed.
Eighteen animal controlled trials (401 animals), 4 human randomized controlled trials, 1 cohort study, and 3 controlled trials (184 patients) were included. Graft processing was highly heterogeneous. 71.42% clinical and 55.56% animal studies reported no significant difference between tooth-bone graft and controls. Histologically, a dentin-bone complex was reported. A low risk of bias was noted in only 50% of the randomized controlled trials and 63.33% animal study entries. An independent analysis of 6 high-quality case reports (350 patients) revealed complications in 18.86% cases.
Tooth-bone graft demonstrated no added benefits over conventional graft materials. Absence of standardized processing and heterogeneous study results limit its use in clinical practice. Until long-term studies determine its success, clinicians are recommended to use it with caution because of high variability in resorption time (2-24 weeks) and a risk of graft dehiscence (12.96%-34.38%).
本系统评价的目的是评估牙-骨移植物作为口腔颌面部骨替代物与未植骨部位和其他骨替代物相比的临床疗效。
电子检索和手工检索数据库，截至 2017 年 1 月，以识别动物和人类研究，并进行偏倚风险分析和描述性统计分析。
纳入了 18 项动物对照试验（401 只动物）、4 项人类随机对照试验、1 项队列研究和 3 项对照试验（184 例患者）。移植物处理高度异质。71.42%的临床研究和 55.56%的动物研究报告牙-骨移植物与对照组之间无显著差异。组织学上，报告了牙本质-骨复合物。仅 50%的随机对照试验和 63.33%的动物研究报告存在低偏倚风险。对 6 份高质量病例报告（350 例患者）的独立分析显示，18.86%的病例存在并发症。
牙-骨移植物与传统移植物材料相比没有额外的益处。缺乏标准化的处理和研究结果的异质性限制了其在临床实践中的应用。在长期研究确定其成功之前，建议临床医生谨慎使用，因为吸收率（2-24 周）和移植物裂开的风险（12.96%-34.38%）变化较大。
