Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta‐analysis

Abstract

AimTo systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment‐based ranking on the incidence of complications as well as their clinical effectiveness.Materials and MethodsSearches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra‐operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient‐reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair‐wise and network meta‐analysis (NMA) models.ResultsThirty‐two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense‐polytetrafluoroethylene, expanded‐polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92–29.14). The latter group, however, ranked last in clinical VBG.ConclusionsVRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non‐resorbable membranes yield the most favourable results in relation to VBG and complications.

Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review

“…Indeed, when large vertical alveolar ridge defects are present, bone grafting techniques seem to have a higher incidence of complications. Alotaibi et al [22] performed a network meta-analysis to compare the results associated with the use of onlay and inlay grafts, several types of membranes (resorbable and nonresorbable), distraction osteogenesis, tissue expansion, and short implants. These authors concluded that all grafting options (except the use of resorbable membranes) were associated with a statistically significant higher odds ratio of complications [22].…”

“…Alotaibi et al [22] performed a network meta-analysis to compare the results associated with the use of onlay and inlay grafts, several types of membranes (resorbable and nonresorbable), distraction osteogenesis, tissue expansion, and short implants. These authors concluded that all grafting options (except the use of resorbable membranes) were associated with a statistically significant higher odds ratio of complications [22]. It is also important to stress that when extraoral bone harvesting is required, patients might experience pain in the donor site area and gait and sensory disturbances if the iliac crest is involved [23].…”

Advances in biomaterials for oral-maxillofacial bone regeneration: spotlight on periodontal and alveolar bone strategies

“…Non-resorbable membranes demonstrate good mechanical properties, enabling them to retain their shape and provide space for new tissue formation [ 62 ], thus allowing for precise control over their barrier function [ 11 ]. A systematic review concerning vertical bone gain revealed that GTR techniques using non-resorbable membranes yield the most favorable results [ 63 ]. However, it is subject to certain limitations.…”

Does diabetes mellitus affect guided bone regeneration outcomes in individuals undergoing dental implants? A systematic review and meta-analysis

“…To enhance dental implant therapy by reconstructing deficient alveolar ridges, various bone regenerative techniques have been assessed (9)(10)(11)(12)(13). Guided bone regeneration (GBR) is one such technique, which involves a membrane application to prevent non-osteogenic tissues interference in bone regeneration, closely mimicking the natural osteogenesis process (14).…”