Cochrane · intervention · CD003607
Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment
Esposito, M, Grusovin, MG, Felice, P, et al. · Cochrane Database of Systematic Reviews · 2009 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
34
current version
GRADE rated
0
No studies
1
Included studies
13
as reported
No studies 1 · 2.9%Ungraded 33 · 97.1%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with missing teeth who may require horizontal and/or vertical alveolar bone augmentation prior to or during dental implant placement procedures | 224 patients in 13 trials; 3 RCTs (106 patients) horizontal and 10 trials (218 patients) vertical augmentation; 9 parallel-group and 4 split-mouth; 8 in Italy and 5 in the Netherlands |
| Intervention | Any horizontal or vertical bone augmentation technique, active agent (e.g. bone morphogenetic proteins, platelet-rich plasma) or biomaterials used with osseointegrated root-formed dental implants | Inlay/interposed graft + longer implants (n=50 across 2 trials); autogenous bone block from chin (n=31/31); sinus + buccal onlay grafts with PRP (n=5); buccal onlay grafts, titanium screws (n=8); vertical distraction osteogenesis (n=11/9/5); vertical GBR autogenous bone (n=5); GBR non-resorbable barrier (n=11); inlay autogenous bone (n=10); ultrasound during distraction (n=5); autogenous inlay graft (n=10) |
| Comparison | Different bone augmentation techniques; No augmentation; Barrier membrane | Short implants (n=48 across 2 trials); 100% Bio-Oss + resorbable barrier (n=31); grafts without PRP (n=5); resorbable screws (n=8); autogenous inlay/onlay bone graft (n=6/8/13); GBR / bone substitute; resorbable barriers + osteosynthesis plates (n=11); placebo ultrasound (n=4) |
| Outcomes | Prosthesis failure; Implant failure; Augmentation procedure failure; Major complications at augmented sites; Major complications at bone donor sites; Patient satisfaction including aesthetics; Patient preference including aesthetics; Bone gain vertically or horizontally or both; Aesthetics evaluated by dentist; Duration of the treatment time; Treatment costs; Bone level changes over time | Prosthesis failure (n=224); Implant failure (n=224); Augmentation procedure failure; Major complications at augmented/donor sites; Patient satisfaction/preference (n=40); Bone gain vertically/horizontally; Perimplant bone level changes; Aesthetics by dentist (n=31); Treatment time |
| Study designs | Randomised controlled clinical trials including split-mouth studies | All 13 included studies were RCTs (9 parallel-group, 4 split-mouth) at university, hospital or specialist clinics and 2 in private practice |
| Timing | Abutment connection, 1, 3 and 5 years after loading | Follow-up ranged from 4 months post-loading to 3 years post-loading: 4 months (1 trial), 1 year (4), 1.5 years (1), 2 years (4), 3 years (3) |
Search date: 2009-06. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE
Questions and results
Show all 4 versionsInlay/interposed bone graft (iliac or Bio-Oss block) + longer implants (vertical augmentation) vs Short implants (8 to 11 mm) without augmentation
Population: Patients with atrophic (resorbed) mandibles (anterior 6 to 12 mm; posterior 7 to 8 mm) needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severe pain for > 1 week 3 weeks post-surgery | OR 22.67 [4.37, 117.47] | 1 study · 40 participants | Ungraded |
Implant failure Up to 2 years post-loading | OR 5.74 [0.92, 35.82] | 2 studies · 98 participants | Ungraded |
Experienced the operation negatively 3 weeks post-surgery | OR 3.0 [0.79, 11.44] | 1 study · 40 participants | Ungraded |
Major complications Up to 2 years post-loading | OR 4.97 [1.10, 22.40] | 2 studies · 100 participants | Ungraded |
Prosthetic failure Up to 2 years post-loading | OR 3.20 [0.48, 21.25] | 2 studies · 98 participants | Ungraded |
No improvement of facial appearance (3 weeks) 3 weeks post-surgery | OR 0.11 [0.03, 0.46] | 1 study · 40 participants | Ungraded |
Vertical distraction osteogenesis vs Vertical GBR with non-resorbable barriers + particulate autogenous bone
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complication at augmentation + donor site Up to 3 years post-loading | OR 0.3 [0.04, 2.11] | 1 study · 21 participants | Ungraded |
Vertical GBR with non-resorbable titanium-reinforced barriers vs Vertical GBR with resorbable barriers supported by osteosynthesis plates
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Complication at augmented site About 4.5 months | OR 1.46 [0.26, 8.05] | 1 study · 22 participants | Ungraded |
Perimplant bone loss (3 years) 3 years post-loading | MD 0.02 [-0.50, 0.54] | 1 study · 22 participants | Ungraded |
Augmentation procedure failure About 4.5 months | OR 2.22 [0.17, 28.86] | 1 study · 22 participants | Ungraded |
Vertical bone gain About 4.5 months | MD 0.32 [-0.79, 1.43] | 1 study · 22 participants | Ungraded |
Two-stage sinus lift + buccal onlay iliac grafts WITH platelet-rich plasma (PRP) vs Same grafts WITHOUT PRP (split-mouth)
Population: Patients with resorbed maxillae (incl. atrophic sinuses) needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant/prosthesis failure and complications 2 years post-loading | No statistically significant difference for any outcome; data not shown (Raghoebar 2005) | 1 study · 5 participants | Ungraded |
Buccal onlay iliac grafts fixed with titanium screws vs Buccal onlay iliac grafts fixed with resorbable screws (split-mouth)
Population: Patients with resorbed maxillae (incl. atrophic sinuses) needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Implant/prosthesis failure and complications 2 years post-loading | No statistically significant difference for any outcome; data not shown (Raghoebar 2006) | 1 study · 8 participants | Ungraded |
Vertical distraction osteogenesis vs Autogenous onlay bone graft (mandibular ramus)
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
1-year post-loading bone level changes 1 year post-loading | MD 0.09 [-0.26, 0.44] | 1 study · 17 participants | Ungraded |
Augmentation procedure (partial) failure Up to 3 years post-loading | OR 0.88 [0.05, 16.74] | 1 study · 17 participants | Ungraded |
3-year post-loading bone level changes 3 years post-loading | MD 0.29 [-0.14, 0.72] | 1 study · 17 participants | Ungraded |
Vertical bone gain Up to 3 years post-loading | MD 0.30 [-0.97, 1.57] | 1 study · 17 participants | Ungraded |
Complication at augmented + donor site Up to 3 years post-loading | OR 0.5 [0.07, 3.55] | 1 study · 17 participants | Ungraded |
Autogenous bone block from the chin vs 100% Bio-Oss + resorbable barrier
Population: Patients with horizontally resorbed maxillary sites needing single implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prosthesis/implant failure (1 year) Up to 1 year post-loading | OR 0.19 [0.01, 4.07] | 1 study · 62 participants | Ungraded |
Autogenous bone block from the chin + resorbable barrier vs 100% Bio-Oss + resorbable barrier
Population: Patients with horizontally resorbed maxillary sites needing single implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prosthesis/implant failure (1 year) Up to 1 year post-loading | OR 0.19 [0.01, 4.07] | 1 study · 62 participants | Ungraded |
Vertical distraction osteogenesis vs Autogenous inlay bone graft (iliac crest)
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vertical bone gain At least 1.5 years post-loading | MD 3.25 [1.66, 4.84] | 1 study · 11 participants | Ungraded |
Complications At least 1.5 years post-loading | OR 7.50 [0.46, 122.70] | 1 study · 11 participants | Ungraded |
Inlay autogenous bone graft (iliac crest) vs Inlay bone substitute (Bio-Oss block)
Population: Patients with atrophic posterior mandibles (5 to 7 mm above the mandibular canal) needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perimplant bone loss 1 year post-loading | MD -0.21 [-0.76, 0.34] | 1 study · 10 participants | Ungraded |
Vertical bone gain Up to 1 year post-loading | MD -1.1 [-2.61, 0.41] | 1 study · 10 participants | Ungraded |
Implant failure Up to 1 year post-loading | OR 1.0 [0.01, 82.26] | 1 study · 10 participants | Ungraded |
Patient preference 1 month after definitive prostheses | OR 0.03 [0.00, 0.64] | 1 study · 10 participants | Ungraded |
Major complications Up to 1 year post-loading | OR 2.00 [0.11, 37.83] | 1 study · 10 participants | Ungraded |
Prosthesis failure Up to 1 year post-loading | OR 1.0 [0.01, 82.26] | 1 study · 10 participants | Ungraded |
Vertical GBR with autogenous bone (retromolar) vs Vertical GBR with bone substitute (Regenaform)
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Vertical bone gain Up to 1 year post-loading | MD 0.6 [0.21, 0.99] | 1 study · 5 participants | Ungraded |
Ultrasound during vertical distraction osteogenesis vs Placebo (no ultrasound) during vertical distraction
Population: Patients with vertically deficient posterior/anterior mandibular ridges needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Distraction distance (bone gain, mm) 2 years post-loading | Distraction distance 4.6 mm (ultrasound) vs 5.8 mm (placebo); difference 1.2 mm not statistically significant, in favour of placebo; data not shown (Schortinghuis 2008) | 1 study · 9 participants | Ungraded |
Autogenous inlay bone graft (iliac crest) vs Autogenous onlay bone graft (iliac crest)
Population: Patients with deficient posterior mandibles (4.5 to 10 mm above the mandibular canal) needing implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Graft failure Up to 1 year post-loading | OR 1.33 [0.07, 24.32] | 1 study · 23 participants | Ungraded |
Major complications Up to 1 year post-loading | OR 1.07 [0.20, 5.77] | 1 study · 23 participants | Ungraded |
Vertical bone gain Up to 1 year post-loading | MD 0.97 [-0.07, 2.01] | 1 study · 23 participants | Ungraded |
Horizontal bone augmentation (any technique) vs No augmentation
Population: Patients with horizontally resorbed maxillary sites needing single implants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR At least to abutment connection (planned) | No trial evaluated whether horizontal bone augmentation is necessary (explicit gap) | 0 studies | No studies |