Abstract
Selection Criteria
Besides manual search, an electronic search was conducted in 4 databases: MED-LINE, Web of Science, Scopus, and Cochrane; the last search was performed on August 2022. The eligibility criteria included clinical trials investigating the effect of autogenous dentine graft (ADG) vs other grafting materials on marginal bone loss (MBL), implant stability, and complication rate when a dental implant is required to be placed in an area with an alveolar bone defect such as horizon-tal or vertical ridge defect, fresh extraction socket, or insufficient maxillary sinus floor height. On the other hand, animal, In Vitro studies, and case reports were excluded.
Two reviewers separately screened the title and abstract, extracted data, and assessed the risk of bias in relevant papers; any disagreements were discussed with the third reviewer.
For randomized controlled trials (RCTs), the Cochrane risk-of-bias tool (RoB 2) was used, and for non-randomized studies, the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was utilized.
Key Study Factor
A review of studies compared an autogenous dentin graft to other graft types (eg, demineralized or mineralized whole tooth, Bio-Oss, or autogenous bone graft). The bone augmentation procedure could be performed before or during dental implant placement. Types of bone defect augmented include the low height of the maxillary sinus floor, reduced horizontal ridge width, vertical bone defect, and fresh extraction socket.
Main Outcome Measure
Implant stability and MBL were defined as primary outcomes; implant-related complications and failure rate wear secondary outcomes.
Main Results
A total of 9 articles were included in the review: 5 RCTs, 3 retrospective studies, and one controlled clinical trial. Implant placement was immediate in 2 investigations, delayed in 4, and done simultaneously with grafting and maxillary sinus floor augmentation in 3.
One of the 6 RCTs/CCTs had a low risk of bias, one had a high risk, and 4 had some concerns. Two retrospective studies were deemed at high risk of bias, while the third was considered moderate. The meta-analyses included 5 RCTs, and no significant differences were detected between ADG and bone grafts regarding Implant stability, preimplant MBL, and complication rates.
Compared to Bio-Oss, ADG demonstrated equal primary and secondary implant stability (primary: mean difference (MD) 0.74, 95% confidence interval (CI) 3.36-1.88, P = .58; secondary: MD 1.29, 95% CI 5.69-3.11, P = .57).
The standardized mean difference (SMD) of MBL at 6 months and 18 months revealed that the 2 grafts were similar (6 months: SMD 0.26, 95% CI 0.64-0.12, P = .18; final follow-up: SMD 0.12, 95% CI 0.50-0.26, P = .53), and the overall implant survival rate for the ADG group was 97.37%, whereas the bone-grafted group had a rate of 97.30%. Complication rates with ADG were comparable to those with Bio-Oss or autogenous bone blocks, respectively.
Conclusion
Autogenous dentin graft is a viable material that augments the defected bone and has comparable results to other graft materials concerning implant stability, MBL, and complications and failure rates.