Efficacy of lateral bone augmentation prior to implant placement: A systematic review and meta‐analysis

Abstract

Aim The aim of the current systematic review was to critically appraise evidence from randomized and prospective non‐randomized comparative clinical trials about the efficacy of lateral bone augmentation prior to implant placement and their outcome regarding bone width gain. Materials and Methods Eight databases were searched until May 2018 for randomized and prospective non‐randomized comparative trials on lateral bone augmentation prior to implant placement. After elimination of duplicate studies, data extraction and risk‐of‐bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of mean differences (MD) or relative risks (RR) and their 95% CIs were performed, followed by subgroup, meta‐regression and sensitivity analyses. Results Overall, 25 trials (16 randomized/9 non‐randomized) were identified, which included a total of 553 patients (42.2% male; mean age of 43.9 years). In these included studies and populations, various modalities for primary lateral bone augmentation rendered implant placement feasible. Small discrepancies were found between overall clinical and radiographic gain (pooled gains of 3.45 ± 1.18 mm versus 2.90 ± 0.83 mm, respectively), but were not statistically significant. Bone width gain was significantly inversely associated with baseline bone width (pooled effect: −0.35 mm/mm; 95% CI: −0.63 to −0.07 mm; p = 0.01). Additionally, % graft resorption was associated with patient age (36%/year, 95% CI: −0.62 to −0.11 mm; p = 0.01). The presence of xenograft added to autologous graft led to less resorption compared to autologous graft alone (MD: 1.06 mm; 95% CI: 0.21 to 1.92 mm; p = 0.01). Barrier membrane did not yield significant difference in terms of bone width gain (MD: −0.33 mm; 95% CI: −2.24 to 1.58 mm; p > 0.05) and graft resorption (MD: 0.84 mm; 95% CI: −1.42 to 3.09 mm; p > 0.05). However, the quality of evidence ranged from very low to moderate due to bias and imprecision. Conclusions Initially smaller bone dimensions are associated with favours larger bone width gain, which indicates that a severe lateral bone deficiency can be effectively augmented applying primary lateral bone augmentation. Both Patients’ age and recipient site (maxilla or mandible) seem to influence graft resorption. The addition of a xenograft can be helpful in reducing graft resorption. Existing evidence from randomized and prospective non‐randomized trials on humans indicates that lateral bone augmentation prior to implant placement can successfully increase bone width. There are some indications that patient‐related, site‐related, and technique‐related characteristics might influence the amount of gained bone width, but the quality of evidence is for the most part hampered by the small number of existing studies and methodological limitations that might lead to bias.

The positive effect of tenting screws for primary horizontal guided bone regeneration: A retrospective study based on cone‐beam computed tomography data

“…A recent systematic review (Naenni, Lim, Papageorgiou, & Hammerle, 2019) analyzed and compiled the results of prospective studies that compared techniques for primary bone augmentation. The pooled average gain reported for studies that employed radiographic analysis for horizontal bone augmentation was 2.90 ± 0.83 mm.…”

“…The greater frequency of cases exhibiting crestal resorption in the control group may have favored the detection of a significant difference between the groups at 1 mm below the crest. Most of the existing literature reports on measurements performed the level of 3 mm below the crest (Naenni et al., 2019). Also, a possible explanation for this finding is that, during surgical procedure, particles were usually placed on top of the ridge as an attempt to correct minor vertical defects and lingual/palatal bone deficiencies.…”

Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on Bone Regeneration

“…The focused question of this systematic review was to assess whether primary lateral bone augmentation prior to implant placement leads to sufficient bone width in patients presenting with insufficient alveolar ridge width for implant placement (Naenni et al., ).…”

“…A complete list of the treatment protocols included in the systematic review is summarized in Table 1a (Naenni et al., ). Regarding graft materials, most studies investigated autologous bone (17 studies), followed by xenografts (10), allografts (6), alloplasts (2), or combinations of these (15).…”

“…The group discussions and consensus were based on four systematic reviews focusing on lateral bone augmentation staged with implant placement (Naenni, Lim, Papageorgiou, & Hämmerle, ), vertical bone augmentation (Urban, Montero, Monje, & Sanz‐Sanchez, ), reconstructive treatment of peri‐implantitis associated defects (Tomasi, Regidor, Ortiz‐Vigon, & Derks, ), and lateral window sinus grafting procedures (Raghoebar, Onclin, Boven, Vissink, & Meijer, ).…”