Augmentation procedures using bone substitute materials or autogenous bone - a systematic review and meta-analysis

Aims: Bone substitute materials (BSM) are described as a reasonable alternative to autologous bone (AB) to simplify the grafting procedure. In a systematic review and meta-analysis, the influence of BSM compared to AB on treatment success in augmentation procedures of the edentulous jaw was analysed. Material and methods: Literature analysis resulted in only two studies addressing reconstruction of the totally edentulous jaw using BSM. Therefore the literature analysis was extended to partially and totally edentulous jaws. The following augmentation procedures were analysed: maxillary sinus floor augmentation (MSFA) and vertical and/or lateral alveolar ridge augmentation; guided bone regeneration (minor and contained defects) were excluded. Meta-analysis was implemented using the literature from the years 2000 to early 2014 and only studies with a mean follow-up of at least 10 months were included. Results: After screening 843 abstracts from the electronic database, 52 studies in qualitative and 14 in quantitative synthesis were included. In studies examining MSFA, the mean implant survival rate was 98.6% +/- 2.6 for BSM, 88.6 +/- 4.1% for BSM mixed with AB and 97.4 +/- 2.2% for AB alone. For MSFA, meta-analysis showed a trend towards a higher implant survival when using BSM compared to AB, however the difference was not statistically significant ([OR], 0.59; [CI], 0.33-1.03). No statistically significant difference in implant survival for MSFA between BSM mixed with AB and AB was seen ([OR], 0.84; [CI], 0.5-1.42). Concerning ridge augmentation, the mean implant survival rate was 97.4 +/- 2.5% for BSM, 100 +/- 0% for BSM mixed with AB and 98.6 +/- 2.9% for AB alone. Meta-analysis revealed no statistically significant difference in implant survival for ridge augmentation using BSM or AB ([OR], 1.85; [CI], 0.38 to 8.94). For BSM mixed with AB versus AB alone, a meta-analysis was not possible due to missing data. Conclusions: Within the limitation of the meta-analytical approach taken, implant survival seems to be independent of the biomaterial used in MSFA and alveolar ridge augmentation. Therefore, based on the current literature, there is no evidence that AB is superior to BSM. The conclusions are limited by the fact that influence of defect size, augmented volume and regenerative capacity of the defects is not well described in the respective literature.