Evaluation of density, volume, height and rate of bone resorption of substitutes of autologous bone grafts for the repair of alveolar clefts in humans: A systematic review

Abstract

Objective To assess clinical studies that compare synthetic or enriched natural materials to autologous osseous grafts among individuals with cleft lip and palate to determine which would be the substitute to autologous bone graft for alveolar cleft repair in humans. Materials and methods Randomized and controlled clinical trials on alveolar clefts treated with synthetic bone substitutes and autogenous bone grafts combined with osteoinductive factors compared with autogenous bone grafts alone (with ≥4-month follow-up and reporting clinical/radiographic data) were considered eligible. MEDLINE, EMBASE, and Central databases were searched for articles published until February 2020. Results Of 73 eligible articles, 15 were included. Some inductive factors along with iliac crest bone decreased bone reabsorption, preserved the generated bone height/width, and reduced the required autologous bone graft volume. Bone morphogenetic protein (BMP2) as an autologous bone graft substitute, demonstrated satisfactory alveolar defect healing, by avoiding autograft use. Many materials did not yield better outcomes than did autologous grafts; however, hydroxyapatite and collagen complex, hydroxyapatite agarose composite gel, acellular dermal matrix film, fibrin glue, platelet-rich plasma, and deproteinized bovine bone showed similar bone healing outcomes, being an alternative alveolar defect treatment. Conclusions BMP2, as an osteoinductive factor along with a synthetic matrix, yields satisfactory bone healing and avoids the need for autologous bone grafts. However, high-quality RCTs are necessary to determine the most effective and safe concentration and protocol of BMP2 utilization as a substitute for the autologous iliac crest bone grafting.

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery

“…In this context, alternatives to autologous bone grafting have been sought [ 40 , 41 ]. Synthetic substitutes such as hydroxyapatite (HA), tricalcium phosphate (TCP), bioactive silicates (SiO 2 ), lactic or glycolic acid polymers (PLA and PGA), or biocomposites constructed from combinations can be used [ 42 ]. Bone substitutes such as bioactive silicates are already used in pediatric surgery to replace the iliac crest bone harvesting [ 6 , 43 , 44 ].…”

Multiple ways for the same destination: bone regeneration

“…As foreign proteins are considered as an immunogen, these ingredients may induce severe inflammation. To avoid any unwanted immune response, deproteinization is an important step for processing animal or human-originated bone as a bone graft [ 9 ]. If bone matrix proteins are removed from the bone, only inorganic components will remain.…”

Novel Approaches Guiding the Future of Spinal Biologics for Bone Regeneration

“…Iliac crest bone graft (ICBG), which has been utilized for over 50 years, is associated with complications such persistent pain and donor site morbidity postoperatively [ 2 , 3 ]. Moreover, autografts like ICBG vary in available amount and quality depending on the patient(s) they are harvested from [ 4 , 5 ]. Despite such associated costs, rates of non-union for ICBG can be up to 40% at 6 months and 20% at 12 months [ 6 •].…”