Clinical Applications of Cell‐Based Approaches in Alveolar Bone Augmentation: A Systematic Review

Shanbhag, Siddharth; Shanbhag, Vivek

doi:10.1111/cid.12103

Cited by 20 publications

(16 citation statements)

References 67 publications

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“…The results are also in line with other recent meta‐analyses on the effectiveness of BTE with regards to periodontal regeneration (Yan et al, ) and in terms of histological bone regeneration in all anatomical skeletal defects in large animal models (Liao et al, ). In context, a beneficial effect of BTE has been further described in systematic review (SR) of human clinical trials evaluating the effectiveness of this type of technology for alveolar bone regeneration (Padial‐Molina et al, 2015; Shanbhag and Shanbhag, ). Nevertheless, it has to be stressed that due to considerable variation among studies with regards to the nature of cells, biomaterial scaffolds and type/dimensions of defects used in the various reports, no conclusive statements regarding the clinical effectiveness of BTE can yet be made.…”

Section: Discussionmentioning

confidence: 99%

Bone tissue engineering in oral peri-implant defects in preclinicalin vivoresearch: A systematic review and meta-analysis

Shanbhag

Pandis

Mustafa

et al. 2017

J Tissue Eng Regen Med

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The regeneration and establishment of osseointegration within oral peri-implant bone defects remains a clinical challenge. Bone tissue engineering (BTE) is emerging as a promising alternative to autogenous and/or biomaterial-based bone grafting. The objective of this systematic review was to answer the focused question: in animal models, do cell-based BTE strategies enhance bone regeneration and/or implant osseointegration in experimental peri-implant defects, compared with grafting with autogenous bone or only biomaterial scaffolds? Electronic databases were searched for controlled animal studies reporting on peri-implant defects and implantation of mesenchymal stem cells (MSC) or other cells seeded on biomaterial scaffolds, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Random effects meta-analyses were performed for the outcomes histomorphometric bone area fraction (BA) and bone-to-implant contact (BIC). Nineteen studies reporting on large animal models (dogs and sheep) were included. Experimental defects were created surgically (16 studies) or via ligature-induced peri-implantitis (LIPI, three studies). In general, studies presented with an unclear to high risk of bias. In most studies, MSC were used in combination with alloplastic mineral phase or polymer scaffolds; no study directly compared cell-loaded scaffolds vs. autogenous bone. In three studies, cells were also modified by ex vivo gene transfer of osteoinductive factors. The meta-analyses indicated statistically significant benefits in favour of: (a) cell-loaded vs. cell-free scaffolds [weighted mean differences (WMD) of 10.73-12.30% BA and 11.77-15.15% BIC] in canine surgical defect and LIPI models; and (b) gene-modified vs. unmodified cells (WMD of 29.44% BA and 16.50% BIC) in canine LIPI models. Overall, heterogeneity in the meta-analyses was high (I 70-88%); considerable variation was observed among studies regarding the nature of cells and scaffolds used. In summary, bone regeneration and osseointegration in peri-implant defects are enhanced by the addition of osteogenic cells to biomaterial scaffolds. Although the direction of treatment outcome is clearly in favour of BTE strategies, due to the limited magnitude of treatment effect observed, no conclusive statements regarding the clinical benefit of such procedures for oral indications can yet be made. Copyright © 2017 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Bone tissue engineering in oral peri-implant defects in preclinicalin vivoresearch: A systematic review and meta-analysis

Shanbhag

Pandis

Mustafa

et al. 2017

J Tissue Eng Regen Med

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“…Other bone augmentation procedures used for implant-based rehabilitation are for the treatment of insufficient alveolar bone volume, which may occur as a result of periodontal disease and/or resorption atrophy. 51 In the last decades, the use of guided bone regeneration (GBR) in conjunction with the placement of dental implants has become a clinically well-documented and successful procedure for alveolar ridge augmentation. [52][53][54] The Glossary of Oral and Maxillofacial implants defines GBR as the "principle of GBR using barrier or resorbable membranes to exclude certain types of cells, such as rapidly proliferating epithelium and connective tissue, thus promoting the growth of slower-growing cells capable of forming bone.…”

Section: Discussionmentioning

confidence: 99%

Bioactive treatments in bone grafts for implant‐based rehabilitation: Systematic review and meta‐analysis

Rosa

Silva

et al. 2017

Clin Implant Dent Rel Res

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“…bone marrow, adipose tissue etc. ), their in vitro culture expansion and combination with an appropriate carrier scaffold for implantation in vivo (Shanbhag and Shanbhag, ). Thus, the ‘triad’ of osteogenic cells, osteoinductive signals (growth factors released by cells), and osteoconductive scaffolds, replicates the properties of autogenous bone, without the need for invasive harvesting (Oppenheimer et al ., ).…”

Section: Introductionmentioning

confidence: 99%

Alveolar bone tissue engineering in critical-size defects of experimental animal models: a systematic review and meta-analysis

Shanbhag

Pandis

Mustafa

et al. 2016

J Tissue Eng Regen Med

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Regeneration of large, 'critical-size' bone defects remains a clinical challenge. Bone tissue engineering (BTE) is emerging as a promising alternative to autogenous, allogeneic and biomaterial-based bone grafting. The objective of this systematic review was to answer the focused question: in animal models, do cell-based BTE strategies enhance regeneration in alveolar bone critical-size defects (CSDs), compared with grafting with only biomaterial scaffolds or autogenous bone? Following PRISMA guidelines, electronic databases were searched for controlled animal studies reporting maxillary or mandibular CSD and implantation of mesenchymal stem cells (MSCs) or osteoblasts (OBs) seeded on biomaterial scaffolds. A random effects meta-analysis was performed for the outcome histomorphometric new bone formation (%NBF). Thirty-six studies were included that reported on large- (monkeys, dogs, sheep, minipigs) and small-animal (rabbits, rats) models. On average, studies presented with an unclear-to-high risk of bias and short observation times. In most studies, MSCs or OBs were used in combination with alloplastic mineral-phase scaffolds. In five studies, cells were modified by ex vivo gene transfer of bone morphogenetic proteins (BMPs). The meta-analysis indicated statistically significant benefits in favour of: (1) cell-loaded vs. cell-free scaffolds [weighted mean difference (WMD) 15.59-49.15% and 8.60-13.85% NBF in large- and small-animal models, respectively]; and (2) BMP-gene-modified vs. unmodified cells (WMD 10.06-20.83% NBF in small-animal models). Results of cell-loaded scaffolds vs. autogenous bone were inconclusive. Overall, heterogeneity in the meta-analysis was high (I > 90%). In summary, alveolar bone regeneration is enhanced by addition of osteogenic cells to biomaterial scaffolds. The direction and estimates of treatment effect are useful to predict therapeutic efficacy and guide future clinical trials of BTE. Copyright © 2016 John Wiley & Sons, Ltd.

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Clinical Applications of Cell‐Based Approaches in Alveolar Bone Augmentation: A Systematic Review

Cited by 20 publications

References 67 publications

Bone tissue engineering in oral peri-implant defects in preclinicalin vivoresearch: A systematic review and meta-analysis

Bone tissue engineering in oral peri-implant defects in preclinicalin vivoresearch: A systematic review and meta-analysis

Bioactive treatments in bone grafts for implant‐based rehabilitation: Systematic review and meta‐analysis

Alveolar bone tissue engineering in critical-size defects of experimental animal models: a systematic review and meta-analysis

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