Efficacy of bone ring grafts for the reconstruction of alveolar ridge deficiencies: A systematic review. Part I: Clinical trials

Abstract

Background: Bone ring (BR) grafts have been introduced to reconstruct alveolar ridge defects with simultaneous implant placement, but its clinical effectiveness remains undetermined. This systematic review aimed to comprehensively investigate BR grafts in diverse scenarios of ridge defect with simultaneous or staged implant placement. Methods: Electronic retrieval of MEDLINE, Embase, Cochrane Library(CENTRAL), Web of Science, Scopus, and citation search until August 3, 2023, was used to identify relevant clinical articles that utilized BR grafts for ridge defect reconstruction. The quality of evidence in the studies reviewed was assessed with the Joanna Briggs Institute Critical Appraisal tool. The protocol was registered in Prospective Register of Systematic Reviews (CRD42023453943). Results: Fourteen studies with 251 BRs were identified, of which 8 studies were for alveolar ridge augmentation, 4 studies were for extraction socket augmentation, and 2 studies were for sinus floor elevation. Reported sources of BRs included autografts, allografts, and xenografts. The follow-up period ranged from 4 months to 4.7 years. Regarding the primary outcomes, the utilization of BR grafts demonstrated favorable bone gain along with acceptable graft absorption and marginal bone loss. Regarding the secondary outcomes, satisfactory bone mineral density and implant stability were confirmed, accompanied by a recorded incidence of postoperative complications (20 cases) and an implant failure rate of 5.58%. Conclusions: BR grafting with simultaneous or staged implant insertion is an effective approach for reconstructing alveolar ridge deficiencies. The BR grafts demonstrate favorable bone remodeling and osteointegration with the alveolar bone and implant; however, its success may be compromised by complications. Future studies should further investigate the clinical efficacy of BR grafting comparing to other bone augmentation techniques in diverse scenarios.