Major randomized clinical studies on the use of Bio-Oss® with fibrin-rich plasma in the activation of microRNAs for bone augmentation and dental implant: a systematic review

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Introduction: In the context of bone elevation and dental implants, there are several clinical studies with increasing expectations to establish treatment guidelines. In this aspect, Bio-Oss® is composed of inorganic bovine bone and is widely used in several bone regeneration procedures in oral surgery for dental implants. It was investigated miRNAs whose expression was significantly modified in an osteoblast-like cell line (MG63) cultured with Bio-Oss®, as well as in the presence of fibrin-rich plasma. Objective: It was analyzing the main randomized clinical studies of the use of Bio-Oss® with fibrinrich plasma in the activation of microRNAs for bone augmentation and dental implant. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 133 articles were found. 25 articles were fully evaluated and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 20 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=89.4%>50%. According to the aim of this study on bone regeneration processes with the use of biomaterials and the main molecular and cellular constituents for subsequent dental implantation, it was found that the search for a solution to large bone defects guided the studies for regeneration therapy tissue or bone regeneration. Bio-Oss® is composed of an organic bovine bone and has been widely used in various bone regeneration procedures. The upregulated miRNAs were mir-423, mir-492, mir-191, mir-23a, mir-377, mir-494, mir-214, mir-193b, mir-320), and 4 downregulated miRNAs (mir-27a, mir-24, mir-188, let-7c) were identified for translational regulation in an osteoblast-like cell line (MG63) exposed to Bio-Oss®. However, MiR-214 was positively correlated with osteonecrosis and upregulated in cells exposed to Bio-Oss®. Also, the main filler biomaterials can be fibrin-rich plasma (FRP), Bio-Oss®. However, it is necessary to understand the chemical, physical, and biological processes of both the biological material and the biological niche of the host. Crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization, regeneration, and bone filling for successful posterior dental implants.

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