This umbrella review aims to evaluate systematic/meta-analysis studies containing clinical evidence on tooth grafts as bone substitutes in the oral and maxillofacial regions. Using language restrictions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic database search of PubMed, MEDLINE, Embase, Cochrane library, and Google Scholar was conducted, featuring published studies up until August 2022. All systematic/meta-analysis review articles relating to tooth graft materials were matched against the inclusion criteria. Two qualified researchers independently assessed the studies' inclusion or exclusion criteria and risk of bias, and a third investigator assisted in resolving ambiguities. A total of 81 systematic/meta-analysis studies, comprising 21 animal-controlled trials, 23 randomized controlled human trials, 23 prospective studies, and 14 retrospective studies, were selected for this study. A small risk of bias was observed in systematic studies/meta-analyses. In addition, the clinical evidence from the analysis of these studies revealed a low incidence of side effects. According to the current review, two systematic reviews indicated that autogenous bone grafting of prepared teeth might be as effective as other bone grafting materials. Four studies also mentioned autologous grafts as potential alternatives to autologous grafts, autogenous demineralized dentin (ADDM), engineered grafts, root blocks, and dental matrix. On the other hand, three systematic studies stated that more long-term research is needed to confirm their findings. Finally, given the importance of standardization and homogeneity of studies for clinical cases, it is advised to be used cautiously due to the risks of transplant rejection.
Objectives. This study aimed to assess stress distribution in 5-unit fixed partial dentures (FPDs) with a pier abutment and rigid (RC) and nonrigid connectors (NRCs) with the canine rise and group function occlusal schemes by finite element analysis (FEA). Materials and Methods. In this FEA study, a geometrical model of the maxilla with natural teeth and periodontal ligament (PDL) was three-dimensionally designed and meshed by ANSYS and Pro/Engineer software programs. A 5-unit FPD was then designed to replace the lost first premolar and first molar teeth; the second premolar served as a pier abutment, and the canine and second molar served as terminal abutments. Two FPDs were designed with RC and NRC. Each FPD was analyzed with the canine rise and group function occlusal schemes (a total of 4 models). The first and second molars (180 N), premolars (120 N), and canine (80 N) teeth were subjected to progressive vertical and oblique (12-degree) loads, and maximum von Mises stress and strain in teeth and connectors were calculated for each model. Results. The models had 73704 elements and 137732 nodes. The connector design and occlusal scheme had significant effects on stress distribution in FPDs. The highest von Mises stress (73.035 MPa) was recorded in FPD with RC and group function occlusal scheme. The lowest von Mises stress (0.004 MPa) was recorded in FPD with NRC and canine rise occlusal scheme. Conclusion. Oblique forces created greater stress, and FPD with NRC and canine rise occlusal scheme decreased stress in FPD and increased stress in the tooth crown.
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