Secondary alveolar bone grafting using autologous versus alloplastic material in the treatment of cleft lip and palate patients: systematic review and meta-analysis.
Bone grafting
Computerized tomography
Nonsyndromic clefting
Unilateral cleft lip and palate
Journal
Progress in orthodontics
ISSN: 2196-1042
Titre abrégé: Prog Orthod
Pays: Germany
ID NLM: 100936353
Informations de publication
Date de publication:
11 Feb 2019
11 Feb 2019
Historique:
received:
03
07
2018
accepted:
02
11
2018
entrez:
12
2
2019
pubmed:
12
2
2019
medline:
8
8
2019
Statut:
epublish
Résumé
A systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2). To perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate. An electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858. Only RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up. Bone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed. Four studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD - 14.410; 95% CI - 22.392 to - 6.428; p = 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI - 15.967 to 28.422; p = 0.582). No statistically significant difference in bone height was noted after 6-month (MD - 18.737; 95% CI - 43.560 to 6.087; p = 0.139) and 1-year follow-up (MD - 4.401; 95% CI - 30.636 to 21.834; p = 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD - 1.146; 95% CI - 2.147 to - 0.145; p = 0.025). The main limitation is the high risk of bias among included studies. Autologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).
Sections du résumé
BACKGROUND
BACKGROUND
A systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2).
OBJECTIVES
OBJECTIVE
To perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate.
DATA SOURCES
METHODS
An electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858.
ELIGIBILITY CRITERIA
METHODS
Only RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up.
MAIN OUTCOME MEASURES
METHODS
Bone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed.
RESULTS
RESULTS
Four studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD - 14.410; 95% CI - 22.392 to - 6.428; p = 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI - 15.967 to 28.422; p = 0.582). No statistically significant difference in bone height was noted after 6-month (MD - 18.737; 95% CI - 43.560 to 6.087; p = 0.139) and 1-year follow-up (MD - 4.401; 95% CI - 30.636 to 21.834; p = 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD - 1.146; 95% CI - 2.147 to - 0.145; p = 0.025).
LIMITATIONS
CONCLUSIONS
The main limitation is the high risk of bias among included studies.
CONCLUSION
CONCLUSIONS
Autologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).
Identifiants
pubmed: 30740615
doi: 10.1186/s40510-018-0252-y
pii: 10.1186/s40510-018-0252-y
pmc: PMC6369233
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Pagination
6Commentaires et corrections
Type : CommentIn
Références
Int Orthop. 2007 Dec;31(6):729-34
pubmed: 17639384
Plast Reconstr Surg. 2008 Jan;121(1):209-17
pubmed: 18176223
Br J Oral Maxillofac Surg. 2008 Dec;46(8):665-70
pubmed: 18760515
Can J Plast Surg. 2006 Fall;14(3):172-4
pubmed: 19554111
Cleft Palate Craniofac J. 2009 Sep;46(5):503-11
pubmed: 19929098
Tissue Eng Part C Methods. 2010 Oct;16(5):1183-9
pubmed: 20163243
Cleft Palate Craniofac J. 2010 Sep;47(5):454-68
pubmed: 20180704
J Clin Epidemiol. 2011 Apr;64(4):401-6
pubmed: 21208779
Clin Oral Investig. 2011 Jun;15(3):297-303
pubmed: 21465220
Cochrane Database Syst Rev. 2011 Jun 15;(6):CD008050
pubmed: 21678372
J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):37-42
pubmed: 22980542
J Craniofac Surg. 2012 Nov;23(6):1627-33
pubmed: 23147291
Ann Maxillofac Surg. 2013 Jan;3(1):46-50
pubmed: 23662259
J Clin Diagn Res. 2013 Nov;7(11):2627-30
pubmed: 24392424
J Maxillofac Oral Surg. 2014 Jun;13(2):195-207
pubmed: 24822013
J Plast Reconstr Aesthet Surg. 2014 Sep;67(9):1201-8
pubmed: 24909628
J Oral Maxillofac Surg. 2014 Dec;72(12):2531-8
pubmed: 25249173
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
J Craniomaxillofac Surg. 2015 Jul;43(6):790-5
pubmed: 25958096
J Plast Reconstr Aesthet Surg. 2016 Jan;69(1):101-7
pubmed: 26507862
Sci Rep. 2016 Apr 04;6:23597
pubmed: 27041697
J Craniofac Surg. 2016 Jun;27(4):913-8
pubmed: 27244210
Eur J Orthod. 2017 Nov 30;39(6):641-645
pubmed: 28371800
Plast Surg (Oakv). 2017 Aug;25(3):194-199
pubmed: 29026827
Cleft Palate Craniofac J. 2018 Mar;55(3):369-374
pubmed: 29437516
Oncotarget. 2018 Apr 10;9(27):18929-18938
pubmed: 29721173
Am J Orthod Dentofacial Orthop. 2018 Jun;153(6):883-894
pubmed: 29853246
J Oral Surg. 1972 Feb;30(2):87-92
pubmed: 4550446