Use of cells and/or biologics combined with scaffolds in alveolar bone augmentation for implant site development

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BACKGROUND: The impact of adjunctive biologics and the use of cell-therapy has been sparsely explored. The objective of this systematic review is to evaluate the effectiveness/efficacy of these therapeutic modalities combined with scaffolds in alveolar bone augmentation for implant site development. METHODS: An electronic and manual was conducted. Clinical trials evaluating the effectiveness/efficacy and safety of biologics and cell-therapy combined with scaffolds used for bone alveolar augmentation procedures aiming at implant site development were eligible. The primary outcome was to assess the dimensional bone changes/gain, while the and secondary outcomes included histologic outcomes, patient-reported outcomes, complications and adverse effects. Meta-analysis was conducted only based on randomized clinical trials (RCTs). Moreover, risk of bias assessment of the selected investigations was also reported. RESULTS: = 451) for sinus floor elevation. All 23 RCTs explored the effectiveness/efficacy of adjunctive biologics. For ridge augmentation, the use of biologics resulted in superior outcomes in ridge width (RW) gain, especially the use of platelet rich plasma (p < 0.001), but not in ridge height (RH). For ridge preservation procedures, the adjunctive use of biologics rendered an added therapeutic benefit to maintain ridge dimensions, especially the use of bone morphogenetic protein-2 for RW (p = 0.02) and RH (p = 0.09). Less non-mineralized tissue was found based on histologic analysis for the use of biologics compared to control groups (p = 0.009). For sinus floor elevation, no benefit was shown in terms of RH gain (p = 0.87). However, upon histomorphometric analysis statistically less residual graft material was noted when biologics were used in combination with scaffolds (p < 0.001) compared to treatments without biologics. No complications or adverse events were found when using biologics or cell-therapy in these applications. Use of the assessed adjunctive biologics generally did not have an influence on patient-reported outcomes. Low risk of bias was demonstrated in the included studies. CONCLUSION: Findings from this review may suggest that biologics combined with scaffolds in alveolar ridge augmentation procedures may elicit superior outcomes in terms of dimensional bone gain and histological new bone formation compared to the use of grafts without applying biologics. Biologics and cell-therapy are suggested to be safe and effective in alveolar bone augmentation interventions pursuing implant site development. PLAIN LANGUAGE SUMMARY: In recent years, researchers have been studying special biological products, called biologics, to help improve bone growth before placing dental implants. These products include things like growth factors or cells that can speed up healing and help new bone form. Our review demonstrates that when biologics are used together with bone graft materials, they appear to be safe and may lead to better bone growth and shape compared to traditional treatments. Patients also seem to prefer biologics especially when they come from their own blood because they may reduce pain and swelling after surgery. For procedures that lift the sinus to create more space for implants, using biologics did not show clear differences in bone height or appearance on X-rays, although the bone healing process may change slightly when these products are used. Cell-based therapies also seem safe and may work well, but there are not yet enough studies to prove they are better than traditional bone grafting methods.

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