Does the adjunctive use of autologous platelet concentrate during secondary alveolar bone grafting reduce the risk of wound dehiscence? A systematic review and meta-analysis

Wound dehiscence is a common complication after secondary alveolar bone grafting (SABG), leading to unfavourable surgical outcomes. Studies have shown that autologous platelet concentrates (APC) may enhance wound healing and improve outcomes. Therefore, this review aimed to evaluate in patients with alveolar clefts, whether using APC and iliac crest bone graft can mitigate the likelihood of wound dehiscence formation compared with those who underwent iliac bone grafting only following SABG. A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, Scopus, Web of Science, EBSCOhost, Ovid MEDLINE, LILACS, Cochrane Library, and grey literature, to include studies until July 31, 2023, without any restriction to language and time of publication. Only randomized (RCT) and controlled (CCT) clinical trials were included. Two independent reviewers screened the studies based on the predefined criteria, after which a qualitative and quantitative analysis was conducted. The search yielded 821 studies, of which seven were deemed eligible for systematic review. The risk of bias assessment done using "The Cochrane collaboration tool for risk of bias assessment" for six RCTs and the "Risk of Bias in Non-randomized Studies - of Interventions" for one CCT revealed a moderate to high risk of bias. The meta-analysis of five studies showed that the overall risk of developing wound dehiscence was lower in the APC group (RR = 0.33; 95% CI: 0.16, 0.71; p = 0.005; χ2 = 0.82; I2 = 0%). Subgroup analyses based on study design further supported these findings. Although the adjuvant use of APC for alveolar cleft reconstruction reduces the risk of wound dehiscence, more studies with increased scientific rigour and fewer confounding variables are warranted.

Treatment of Unfavorable Intrabony Defects with Autogenous Bone Graft in Combination with Leukocyte- and Platelet-Rich Fibrin or Collagen Membranes: A Non-Inferiority Study

Background and Objectives: Unfavorable intrabony defects (IBDs) are associated with the progression of periodontal disease and tooth loss. Growing scientific evidence has demonstrated the effectiveness of platelet concentrations in periodontal treatment. The aim of our study was to demonstrate the non-inferiority of an autogenous bone graft (ABG) associated with leukocyte- and platelet-rich fibrin (L-PRF) compared to ABG + Collagen Membrane in the treatment of IBDs. Material and Methods: Sixty-four patients with at least one IBD were randomly assigned to two groups: ABG+L-PRF and CM+ABG. Clinical and radiographic evaluations were performed at baseline and 12-month follow-up. Clinical attachment level (CAL), gingival recession (GR), probing pocket depth (PPD), and radiograph defect bone level (DBL) were compared between the two treatments. To evaluate the effectiveness of ABG+L-PRF, a non-inferiority margin of =1 mm (-1 mm for GR) was chosen; a second non-inferiority margin of =0.5 mm (-0.5 mm for GR) was set for clinical relevance. Results: At 12-month follow up, both treatments showed clinical and radiographic improvements. The 90% confidence intervals of the CM+ABG-L-PRF+ABG mean difference for CAL gain (-0.0564 mm [-0.316 to 0.203]), DBL gain (-0.433 mm [-0.721 to -0.145]), and PPD reduction (0.232 mm [0.015 to 0.449]) were below the 0.5 mm non-inferiority margin; the GR increase (0.255 mm [0.0645 to 0.445]) stayed above the -0.5 mm. Conclusions: the L-PRF+ABG treatment of unfavorable IBDs is non-inferior with respect to the CM+ABG therapy for CAL gain, but with a lower GR, a slightly higher PPD, and DBL gain.

Effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF), in reconstruction of alveolar clefts: comparative study

PURPOSE

The aim of this study is to assess the effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF) in alveolar clefts.

PATIENTS AND METHODS

Seventy-two cleft patients were examined for their eligibility to be part in this comparative study; they were randomly divided into group A, thirty-six patients had received cancellous bone chips from iliac crest; group B, thirty-six had received cortical bone chips harvested from maxilla using a curved bone scraper, covered with PRF. The clinical success over the follow-up period was evaluated on the basis of elimination of the oronasal fistula, radiographic assessment of bone graft volume, achievement of the osseous continuity of the alveolar arch, and the extent of the vertical bone height.

RESULTS

The mean of volume gained in group A was 0.8053 ± 0.9682, while for group B was 0.7397 ± 0.7703. The amount of vertical bone loss between groups was registered, and the chi-square test revealed insignificant differences between study groups (p = 0.547). The result of the frequency of fistula development after grafting in both groups was insignificant (p = 0.074). Also, for the continuity of the maxilla as a one piece, the results were insignificant differences between study groups (p = 0.058).

CONCLUSION

In conclusion of our study, intraoral harvesting of maxillary cortical chips by bone scraper covered with PRF is able to achieve a valid functional and aesthetic support in alveolar cleft patients, meeting the reconstructive goals.

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis

OBJECTIVE

Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects.

DESIGN

Systematic review and meta-analysis.

PATIENTS/PARTICIPANTS

Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects.

INTERVENTIONS

Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group.

MAIN OUTCOME MEASURE(S)

Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis.

RESULTS

After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99).

CONCLUSIONS

There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

A meta-analysis of alveolar bone grafting using bone substitutes in cleft lip and palate patients

In individuals with cleft lip and palate (CLP), an alveolar bone graft (ABG) is carried out for alveolar cleft closure. Several sources for ABG include autologous bone, xenologous bone, and alloplastic substitutes. Autologous bone has been the preferred source for ABG. Alloplastic substitutes might serve as an alternative. This study aimed to compare the outcomes between autologous and alloplastic as sources for ABG. This study made use of eight web databases. Randomized control trials (RCTs) and non-RCTs were included. CLP patients with alveolar cleft with imaging studies, computed tomography (CT scan) and/or cone beam CT scan, and bone graft volume within 6-12 months postintervention were selected. Bone graft volume within 6-12 months postintervention was assessed. Three studies met the inclusion criteria. After 6-12 months of follow-up, there were no statistically significant differences in bone graft volume between autologous and alloplastic bone grafts (fixed-effect model estimate value = 0.21; confidence interval - 0.301-0.730; P = 0.414). The limitations include small research sample sizes, a high likelihood of bias among included studies, and different alloplastic materials from each included study. Autologous and alloplastic bone grafts showed similar effectiveness in alveolar bone grafting. Further clinical trial studies with bigger sample sizes and similar interventions are needed as evidence for future reviews.

Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis

OBJECTIVE

To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft.

METHODS

Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone.

RESULTS

Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ2  = 0.01; I2  = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ2  = 0.67; I2  = 0%).

CONCLUSION

Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.

The Effect of Platelet-Rich Plasma on Bone Volume in Secondary Alveolar Bone Grafting in Alveolar Cleft Patients: A Systematic Review

This systematic review aims to investigate the impact of platelet-rich plasma (PRP) in conjunction with bone grafting on bone volume outcomes in secondary alveolar bone grafting (SABG) procedures among alveolar cleft patients. An exhaustive search involving PubMed, Cochrane, and Google Scholar databases yielded 20 relevant titles, ultimately leading to the inclusion of four articles meeting all specified criteria. Based on the Cochrane risk of bias in systematic reviews (ROBIS) tool, the studies showed a high risk of bias. The primary outcome, bone volume assessment, was analyzed across these articles. While the Cochrane ROBIS tool deemed the included articles to have a high risk of bias, the comparison between PRP and Non-PRP groups did not reveal a significant difference in bone volume. Radiographic data illustrated an initial three-month period of bone resorption post-graft, regardless of PRP application, followed by a six-month phase of heightened bone density, particularly discernible in the PRP groups. To sum up, our findings indicate an absence of substantial bone density increase in cleft patients undergoing SABG with PRP augmentation. Nonetheless, there was a modest trend that suggests potential incremental bone density improvement with PRP usage, underscoring the need to conduct rigorously designed, randomized controlled trials (RCTs) with low bias to validate these observations.

Evaluation of the time-dependent osteogenic activity of glycerol incorporated magnesium oxide nanoparticles in induced calvarial defects

Introduction

Magnesium-based biomaterials have been explored for their potential as bone healing materials, as a result of their outstanding biodegradability and biocompatibility. These characteristics make magnesium oxide nanoparticles (MgO NPs) a promising material for treating bone disorders. The purpose of this investigation is to assess the osteogenic activity of newly-developed locally administered glycerol-incorporated MgO NPs (GIMgO NPs) in rabbits' calvarial defects.

Materials and methods

Characterization of GIMgO was done by X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Bilateral calvarial defects were created in eighteen New Zealand Rabbits, of which they were divided into 3 groups with time points corresponding to 2, 4, and 6 weeks postoperatively (n = 6). One defect was implanted with absorbable gel foam impregnated with GIMgO NPs while the other was implanted with gel foam soaked with glycerol (the control). The defects were assessed using histological, Micro-Computed Tomography (Micro-CT), and histometric evaluation.

Results

The characterization of the GIMgO nanogel revealed the presence of MgO NPs and glycerol as well as the formation of the crystalline phase of the MgO NPs within the nanogel sample. The histological and micro-CT analysis showed time-dependent improvement of healing activity in the calvarial defects implanted with GIMgO NPs when compared to the control. Furthermore, the histometric analysis demonstrated a marked increase in the total area of new bone, connective tissue, new bone area and volume in the GIMgO NPs implanted site. Statistically, the amount of new bone formation was more significant at 6 weeks than at 2 and 4 weeks postoperatively in the calvarial defects implanted with GIMgO NPs as compared to the control.

Conclusion

The locally applied GIMgO NPs demonstrated efficacy in promoting bone formation, with more significant effects observed over an extended period. These findings suggest its suitability for clinical use as a therapeutic alternative to enhance bone healing.

Can locally applied risedronate be an effective agent when combined with xenografts? An animal study

BACKGROUND

To examine the effects of local risedronate application with xenografts on healing of rabbit skull defects using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods.

METHODS

Two critical-sized defects with a diameter of 10 mm were created in 16 rabbits and filled with xenogenic bone graft and xenogenic bone graft + 5 mg risedronate in the control I and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups.

RESULTS

In both the 4- and 8-week samples, the RIS group samples had significantly higher mean new bone area values than the C group (p < 0.05). In both groups, the values for the new bone area were significantly higher in the 8-week-old samples than in the 4-week-old samples (p < 0.05). The h scores obtained for sialoprotein and osteopontin did not differ significantly between the groups at either time point (p > 0.05). The results of radiological evaluation showed that the bone density value was significantly higher in the C group than in the RIS group at either time point (p < 0.05).

CONCLUSIONS

Although this study aimed to demonstrate the effect of risedronate on the osteoconductive properties of xenografts when applied locally, targeted results could not be achieved.

Guide bone regeneration (GBR) reconstruction of extensive alveolar bone defect due to infected radicular cyst enucleation: 2 case reports

INTRODUCTION AND IMPORTANCE

Reconstruction of alveolar bone defects caused by radicular cysts is challenging for oral and maxillofacial surgeons.

CASE PRESENTATION

Two Indonesian females had similar complaint of swelling in the vestibule area of the right mandible. Panoramic radiography showed radiolucent lesions. Participants underwent guided bone regeneration (GBR) reconstruction, which used pericardium membrane in the first case and amnion membrane in the second case. Post-surgery condition showed an improved prognosis and histology showed a radicular cyst.

DISCUSSION

The use of pericardium membrane is easier compared to the amnion membrane, where success requires regular follow-up.

CONCLUSION

Alveolar bone defect reconstruction based on GBR requires meticulous preparation regarding patient condition, case selection and technical comprehension to ensure better treatment outcomes.

Effectiveness of Autogenous Chin Bone Graft in Reconstructive Surgery of Cleft Patients: A Systematic Review With Meta-Analysis and Algorithm of Treatment

PURPOSE

Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to evaluate the effectiveness of autogenous bone graft from the chin in the reconstruction of cleft alveolus.

METHODS

Searches were performed in six databases (PubMed, Scopus, Cochrane, LILACS, Embase, and Google Scholar) by two researchers individually until July 2022. This study was registered in the International Prospective Register of Systematic Reviews (CRD42021267954) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The predictor variable is reconstruction technique, grouped into three levels: autogenous genial grafts, other endochondral autogenous grafts, and bio- or tissue-engineered materials. The outcome variables were alveolar cleft healing rate and bone height. The secondary variables were complications that included infections, necrosis, paresthesia, and dehiscence. Data analysis included the risk of bias and assessment of the certainty of evidence by the risk of bias in nonrandomized studies of interventions and grading of recommendations, assessment, development, and evaluation tools, respectively. The meta-analysis was performed with heterogeneity based on random effects of I² and 95% confidence.

RESULTS

In the initial search, 4,833 articles were found, and 10 of them were included in this systematic review. The included studies were from six countries on three different continents, with a sample of 692 patients. It was observed that the chin bone graft (214 patients) when compared to the endochondral bone graft (386 patients) reduced by 0.42 [confidence interval 95% = 0.18, 0.95] times the prevalence of bone resorption (P = .040 and I² = 70%) analyzed in radiographic images. Two studies evaluated the bone filling through computed tomography, and there was no statistically significant difference between the groups (P = .340, I² = 0%). Only two studies had a low risk of bias.

CONCLUSION

Based on a low certainty of evidence, the chin autogenous bone graft proved to be similar to the endochondral graft in the reconstruction of the cleft alveolar; however, the limited number of studies with high heterogeneity and an uncertain risk of bias decreased the strength of the results found in this systematic review. New controlled primary studies should be carried out with the purpose of safely determining the effectiveness of chin bone grafts for the reconstruction of cleft alveolar.

Evaluation of decellularization process for developing osteogenic bovine cancellous bone scaffolds in-vitro

Current immunological issues in bone grafting regarding the transfer of xenogeneic donor bone cells into the recipient are challenging the industry to produce safer acellular natural matrices for bone regeneration. The aim of this study was to investigate the efficacy of a novel decellularization technique for producing bovine cancellous bone scaffold and compare its physicochemical, mechanical, and biological characteristics with demineralized cancellous bone scaffold in an in-vitro study. Cancellous bone blocks were harvested from a bovine femoral head (18-24 months old) subjected to physical cleansing and chemical defatting, and further processed in two ways. Group I was subjected to demineralization, while Group II underwent decellularization through physical, chemical, and enzymatic treatments. Both were then freeze-dried, and gamma radiated, finally producing a demineralized bovine cancellous bone (DMB) scaffold and decellularized bovine cancellous bone (DCC) scaffold. Both DMB and DCC scaffolds were subjected to histological evaluation, scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS), fourier-transform infrared spectroscopy (FTIR), quantification of lipid, collagen, and residual nucleic acid content, and mechanical testing. The osteogenic potential was investigated through the recellularization of scaffolds with human osteoblast cell seeding and examined for cell attachment, proliferation, and mineralization by Alizarin staining and gene expression. DCC produced a complete acellular extracellular matrix (ECM) with the absence of nucleic acid content, wider pores with extensive interconnectivity and partially retaining collagen fibrils. DCC demonstrated a higher cell proliferation rate, upregulation of osteogenic differentiation markers, and substantial mineralized nodules production. Our findings suggest that the decellularization technique produced an acellular DCC scaffold with minimal damage to ECM and possesses osteogenic potential through the mechanisms of osteoconduction, osteoinduction, and osteogenesis in-vitro.

Effects of a locally administered risedronate/autogenous bone graft combination on bone healing in a critical-size rabbit defect model

BACKGROUND

Risedronate is a bisphosphonate with poor oral absorption. An extremely hydrophilic molecule that has a high affinity for bone, risedronate also inhibits the farnesyl diphosphate synthase enzyme, inhibiting osteoclastic activity and reducing bone turnover and resorption. Autogenous bone grafts contain osteogenic cells and osteoinductive factors that are essential for bone regeneration and are therefore considered the gold standard. Thus, this study aimed to investigate the impact of local risedronate administered with autogenous bone grafts on the healing of defects in rabbit skulls using histological, histomorphometric, immunohistochemical, and three-dimensional radiological methods.

METHODS

Two 10-mm-diameter critical-size defects were created in 16 rabbits and filled with autogenous bone graft and autogenous bone graft + 5 mg risedronate in the control (C) and risedronate (RIS) groups, respectively. Residual graft, new bone, soft tissue areas, and bone volume were evaluated in the 4- and 8-week study groups.

RESULTS

There were no statistically significant differences in bone graft, new bone, or soft tissue area between the groups at 4 weeks (p > 0.05). At 8 weeks, the new bone area was significantly higher in the RIS group than in the C group (p < 0.05). The h scores obtained from sialoprotein and osteopontin did not differ significantly between the groups (p > 0.05). The radiologically measured total bone volume was significantly higher in the RIS group than in the C group at both time points (p < 0.05).

CONCLUSIONS

In this study, risedronate enhanced the osteoconductive properties of autogenous bone grafts and rapidly created better-quality bone. This could improve future patient outcomes.

The strategy of composite grafting with BMP2-Loaded calcium phosphate cements and autogenous bone for alveolar cleft reconstruction

Purpose: To remedy the drawbacks of traditional autogenous bone harvesting in alveolar bone grafting (ABG), a novel strategy of composite grafting with BMP2-loaded calcium phosphate cements (BMP2-CPC) and autogenous bone harvested by minimally invasive technique was developed and evaluated for its bone-repairing efficacy.

Materials and methods: A chart review was conducted for 19 patients with unilateral alveolar clefts who underwent secondary ABG from 2017 to 2020. Of the enrolled patients, 9 patients underwent grafting with autogenous bone harvested by traditional trap door technique (group I), and 10 patients underwent grafting with the composite graft comprising BMP2-CPC and autogenous bone harvested by minimally invasive technique at a ratio of 1:1 by volume (group II). The clinical performance of the composite graft was comprehensively evaluated in terms of clinical, radiographic and histological perspectives.

Results: The present results demonstrated that the composite graft exhibited satisfactory bone-repairing efficacy comparable to that of the autogenous bone graft on the premise of lower amount of harvested bone. The post-surgical resorption of bone volume and vertical height of grafted area was significantly slower in group II. The favourable resorption performance of BMP2-CPC contributed to preserving the post-surgical bony contour reconstructed with the composite graft.

Conclusion: The composite graft comprising BMP2-CPC and autogenous bone harvested by minimally invasive technique was demonstrated to be an eligible alternative for application in ABG, especially for its improved resorption performance in preserving post-surgical bony contour.

Effect of Locally Administered Denosumab on Bone Graft Healing in Rabbit Critical-Size Calvarial Defects

BACKGROUND/AIM

Denosumab is a human monoclonal immunoglobulin G2 antibody developed from the ovarian cells of Chinese hamsters. We aimed to histomorphometrically and radiologically evaluate the effects of xenografts used with local denosumab on the healing of defect sites using rabbit skulls.

MATERIALS AND METHODS

Two 10-mm diameter critical-size defects were created in 16 rabbits. The defect areas were filled with xenografts and xenograft + 3 mg denosumab in the control and denosumab groups (DEN), respectively. We evaluated new bone, residual graft, soft tissue areas, and bone volume in 4- and 8-week study groups.

RESULTS

Histomorphometrically, there were no statistically significant differences between groups at both 4 and 8 weeks regarding residual graft, new bone, and soft tissue area (p > 0.05). The 4-week residual graft control group values were significantly higher than the 8-week values (p < 0.05). The soft tissue area was significantly greater in the 4-week compared with the 8-week DEN group (p < 0.05). The radiologically measured total bone volume was significantly greater in the 8-week specimens than in the 4-week specimens (p < 0.05).

CONCLUSION

In this study, denosumab used locally with bone grafts, showed no direct effect on new and total bone volume.

Long-Term Outcomes of Implants Placed in Maxillary Sinus Floor Augmentation with Porous Fluorohydroxyapatite (Algipore® FRIOS®) in Comparison with Anorganic Bovine Bone (Bio-Oss®) and Platelet Rich Plasma (PRP): A Retrospective Study

Purpose: The objective of this retrospective study was to evaluate the long-term clinical outcomes of bone regeneration procedures using algae-derived plant hydroxyapatite (Algipore^® FRIOS^®) compared with demineralized anorganic bovine bone (Bio-Oss^®), in combination with autologous blood-derived PRP. Materials and Methods: Partially edentulous patients with severe atrophy of posterior maxillary treated by means of the split bone technique in a two-stage grafting procedures were observed for up to seven years after implants placement. After surgeries, the natural porous fluorohydroxyapatite (FHA) (Algipore^® FRIOS^®; Group, n = 29) or anorganic bovine bone (Bio-Oss^® Group, n = 28) with autogenous bone in a 50:50 composite ratio with PRP, were administered in a 2.8-mm critical-size defect (CSD). Four months later, implants were placed at second-stage surgery. Results: A sample of fifty-seven consecutive patients who required sinus augmentation was included in the study, and 57 implants were placed. There was no drop out or loss of follow-up of any case. Clinical and radiographic examinations revealed a comparable pattern of newly formed bone in both groups after seven years of functional loading for implants placed after sinus augmentation using porous fluorohydroxyapatite and anorganic bovine bone. No significant difference in marginal bone loss was found around implants in both groups. Conclusions: The favorable implant outcomes suggest both biomaterials are suitable for sinus grafting in severely atrophic maxillae.

Efficacy of regenerative medicine for alveolar cleft reconstruction: A systematic review and meta-analysis

Objective:

Objective: To analyze the efficacy and complications of regenerative medicine compared to autogenous bone graft for alveolar cleft reconstruction.

Method:

Method: Electronic search was done in PubMed, Scopus, Embase and Cochrane database for studies published until May 2021. No limitations were considered for the type of the included studies. The risk of bias (ROB) of the studies was assessed using the Cochrane Collaborations and NIH quality assessment tool. Meta-analyses were performed to assess the difference in the amount of bone formation and rate of complications. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for analyzing the level of the evidence.

Results:

Results: Among a total of 42 included studies, 21 studies used growth factors, 16 studies delivered cells, and five studies used biomaterials for bone regeneration of the alveolar cleft. Results showed no significant difference in the amount of bone formation between bone morphogenic protein-2 and iliac graft treated patients after six months (P=0.44) and 12 months (P=0.17) follow-up. Besides, higher swelling (OR=9.46,P<0.01) and less infection (OR=0.19,P=0.01) observed in BMP treated patients. Using stem cells can reduce the post-treatment pain (OR=0.04,P=0.01) but it has no significant impact on other complications (P>0.05). Using tissue engineering methods reduced the operation time (SD=1.06,P<0.01). GRADE assessment showed that results regarding the amount of bone formation volume after six and 12 months have low level of evidence.

Conclusion:

Conclusion: Tissue engineering methods can provide a comparable amount of bone formation as of the autogenous graft and reduce some of the complications, operation time and hospitalization duration.

Effectiveness of rhBMP-2 versus iliac autogenous bone graft in reconstructive surgery of cleft patients: an umbrella review

The objective of this umbrella review was to determine the effectiveness of rhBMP-2 in the reconstructive surgery of cleft patients through an evaluation of bone filling and volume of newly formed bone in the cleft area. A systematic search was carried out in PubMed/ Medline, Scopus, Cochrane Database of Abstracts of Reviews of Effects (DARE), Latin American and Caribbean Health Sciences Literature (LILACS), and the System for Information on Grey Literature in Europe (SIGLE) via Open Grey, until June 2020. Risk of bias was assessed using the ROBIS tool. A total of 2739 articles were identified and, based on the inclusion and exclusion criteria, six were included for final evaluation. The bone filling rate was 74.23% in the rhBMP-2 group and 72.38% in the autogenous group. Regarding the risk of bias, none of the articles had a low risk, four had an uncertain risk, and two a high risk. The results of this umbrella review show that the studies had high and uncertain risks of bias, and high heterogeneity. There was a lack of evidence regarding the possible complications offered by this therapy. The recommendation to use BMP-2 for alveolar cleft reconstruction, especially in a paediatric population, should be viewed with caution. New primary studies are needed to assess this variable and safely determine the use of rhBMP-2 in reconstructive surgery for cleft patients.

Assessment of Bone Formation After Secondary Alveolar Bone Grafting With and Without Platelet-Rich Plasma Using Computer-Aided Engineering Techniques

The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) × 100%. The mean BF% was 42.54 ± 9.32% in group A and 46.97 ± 18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.

Locally administrated single-dose teriparatide affects critical-size rabbit calvarial defects: A histological, histomorphometric and micro-CT study

OBJECTIVE

The aim of this study was to evaluate the effect of teriparatide (PTH 1-34, rhPTH) on a rabbit defect model with local xenogen grafts histomorphometrically and radiologically.

METHODS

For this purpose, two 10 mm diameter critical-size defects were created in the calvaria of 16 rabbits. In the control group, the defect area was filled with a xenogen graft, while in the teriparatide group (PTH 1-34), a xenogen graft combination with 20 mcg teriparatide was used. For both 4 - week and 8 - week study groups, new bone, residual graft, and soft tissue areas were evaluated as well as bone volume histomorphometrically and radiologically.

RESULTS

Histomorphometrically, there was a significant difference in new bone area values at the 8th week (p < 0.05), but there was no significant difference between the 4 - week values (p > 0.05). There was no statistically significant difference between the groups at both 4 and 8 weeks (p > 0.05). In the radiologically measured total bone volume values, PTH1-34 group values were found to be significantly higher for both 4 - and 8 - weeks values compared to the control groups (p < 0.05).

CONCLUSION

In this study, rhPTH, which is used locally in defect areas to be repaired with bone grafts, increases both new bone volume and total bone volume.