Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment

Marco Esposito; Maria Gabriella Grusovin; Pietro Felice; Georgios Karatzopoulos; Helen V Worthington; Paul Coulthard

doi:10.1002/14651858.CD003607.pub4

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Analysis 1.1

Comparison 1 Vertical augmentation versus no augmentation, Outcome 1 Inlay bone grafts versus short implants in atrophic mandibles.

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Analysis 2.1

Comparison 2 Horizontal augmentation versus horizontal augmentation, Outcome 1 Horizontal augmentation: bone versus 100% Bio‐Oss + barrier.

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Analysis 2.2

Comparison 2 Horizontal augmentation versus horizontal augmentation, Outcome 2 Horizontal augmentation: bone + barrier versus 100% Bio‐Oss + barrier.

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Analysis 3.1

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 1 Osteodistraction versus inlay bone graft (binary).

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Analysis 3.2

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 2 Osteodistraction versus inlay bone graft (continuous).

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Analysis 3.3

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 3 Osteodistraction versus onlay bone graft (binary).

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Analysis 3.4

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 4 Osteodistraction versus onlay bone graft (continuous).

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Analysis 3.5

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 5 Osteodistraction versus GBR (binary).

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Analysis 3.6

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 6 GBR: autogenous bone versus bone substitute (continuous).

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Analysis 3.7

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 7 GBR: non‐resorbable versus resorbable barriers (binary).

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Analysis 3.8

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 8 GBR: non‐resorbable versus resorbable barriers (continuous).

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Analysis 3.9

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 9 Inlay graft: autogenous bone versus bone substitute (continuous).

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Analysis 3.10

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 10 Inlay graft: autogenous bone versus bone substitute (binary).

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Analysis 3.11

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 11 Autogenous bone: inlay versus onlay (binary).

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Analysis 3.12

Comparison 3 Vertical augmentation versus vertical augmentation, Outcome 12 Autogenous bone: inlay versus onlay (continuous).

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Table 1. Quality assessment

Study	Allocation concealment	Outcome assessor blinded	Withdrawals	Risk of bias
Stellingsma 2003	Unclear	No	Yes, reasons given	High
Chiapasco 2004	No	No	None	High
Raghoebar 2005	Unclear	Yes	None	High
Raghoebar 2006	Unclear	No	None	High
Chiapasco 2007	Yes	Yes, when possible	None	Low
Meijndert 2007	Unclear	Yes	None	High
Merli 2007	Yes	Yes, when possible	None	Low
Bianchi 2008	Yes	Yes, when possible	None	Low
Felice 2008	No	Yes, when possible	None	High
Fontana 2008	Yes	Yes	None	Low
Schortinghuis 2008	Yes	Yes	None	Low
Felice 2009a	Yes	Yes, when possible	None	Low
Felice 2009b	Yes	Yes	None	Low

Table 1. Quality assessment

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Comparison 1. Vertical augmentation versus no augmentation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Inlay bone grafts versus short implants in atrophic mandibles Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Prosthetic failure	2	98	Odds Ratio (M‐H, Random, 95% CI)	3.20 [0.48, 21.25]
1.2 Implant failure	2	98	Odds Ratio (M‐H, Random, 95% CI)	5.74 [0.92, 35.82]
1.3 Major complications	2	100	Odds Ratio (M‐H, Random, 95% CI)	4.97 [1.10, 22.40]
1.4 Experienced the operation negatively	1	40	Odds Ratio (M‐H, Random, 95% CI)	3.0 [0.79, 11.44]
1.5 Severe pain for > 1 week	1	40	Odds Ratio (M‐H, Random, 95% CI)	22.67 [4.37, 117.47]
1.6 No improvement of facial appearance (3 weeks)	1	40	Odds Ratio (M‐H, Random, 95% CI)	0.11 [0.03, 0.46]

Comparison 1. Vertical augmentation versus no augmentation

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Comparison 2. Horizontal augmentation versus horizontal augmentation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Horizontal augmentation: bone versus 100% Bio‐Oss + barrier Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Prosthesis/implant failure (1 year)	1	62	Odds Ratio (M‐H, Random, 95% CI)	0.19 [0.01, 4.07]
2 Horizontal augmentation: bone + barrier versus 100% Bio‐Oss + barrier Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Prosthesis/implant failure (1 year)	1	62	Odds Ratio (M‐H, Fixed, 95% CI)	0.19 [0.01, 4.07]

Comparison 2. Horizontal augmentation versus horizontal augmentation

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Comparison 3. Vertical augmentation versus vertical augmentation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Osteodistraction versus inlay bone graft (binary) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Complications	1	11	Odds Ratio (M‐H, Fixed, 95% CI)	7.50 [0.46, 122.70]
2 Osteodistraction versus inlay bone graft (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Bone gain	1	11	Mean Difference (IV, Fixed, 95% CI)	3.25 [1.66, 4.84]
3 Osteodistraction versus onlay bone graft (binary) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Augmentation procedure (partial) failure	1	17	Odds Ratio (M‐H, Fixed, 95% CI)	0.88 [0.05, 16.74]
3.2 Complication at augmented + donor site	1	17	Odds Ratio (M‐H, Fixed, 95% CI)	0.5 [0.07, 3.55]
4 Osteodistraction versus onlay bone graft (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Vertical bone gain	1	17	Mean Difference (IV, Fixed, 95% CI)	0.30 [‐0.97, 1.57]
4.2 1‐year post‐loading bone level changes	1	17	Mean Difference (IV, Fixed, 95% CI)	0.09 [‐0.26, 0.44]
4.3 3‐year post‐loading bone level changes	1	17	Mean Difference (IV, Fixed, 95% CI)	0.29 [‐0.14, 0.72]
5 Osteodistraction versus GBR (binary) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1 Complication at augmentation + donor site	1	21	Odds Ratio (M‐H, Fixed, 95% CI)	0.3 [0.04, 2.11]
6 GBR: autogenous bone versus bone substitute (continuous) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Subtotals only

6.1 Vertical bone gain	1		Mean Difference (Fixed, 95% CI)	0.6 [0.21, 0.99]
7 GBR: non‐resorbable versus resorbable barriers (binary) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7.1 Augmentation procedure failure	1	22	Odds Ratio (M‐H, Fixed, 95% CI)	2.22 [0.17, 28.86]
7.2 Complication at augmented site	1	22	Odds Ratio (M‐H, Fixed, 95% CI)	1.46 [0.26, 8.05]
8 GBR: non‐resorbable versus resorbable barriers (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.1 Vertical bone gain	1	22	Mean Difference (IV, Fixed, 95% CI)	0.32 [‐0.79, 1.43]
8.2 Perimplant bone loss (3 years)	1	22	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.50, 0.54]
9 Inlay graft: autogenous bone versus bone substitute (continuous) Show forest plot	1		Mean Difference (Fixed, 95% CI)	Subtotals only

9.1 Bone gain	1		Mean Difference (Fixed, 95% CI)	‐1.1 [‐2.61, 0.41]
9.2 Perimplant bone loss	1		Mean Difference (Fixed, 95% CI)	‐0.21 [‐0.76, 0.34]
10 Inlay graft: autogenous bone versus bone substitute (binary) Show forest plot	1		Odds Ratio (Fixed, 95% CI)	Subtotals only

10.1 Prosthesis failure	1		Odds Ratio (Fixed, 95% CI)	1.0 [0.01, 82.26]
10.2 Implant failure	1		Odds Ratio (Fixed, 95% CI)	1.0 [0.01, 82.26]
10.3 Major complications	1		Odds Ratio (Fixed, 95% CI)	2.00 [0.11, 37.83]
11 Autogenous bone: inlay versus onlay (binary) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

11.1 Graft failure	1	23	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.07, 24.32]
11.2 Major complications	1	23	Odds Ratio (M‐H, Fixed, 95% CI)	1.07 [0.20, 5.77]
12 Autogenous bone: inlay versus onlay (continuous) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.1 Vertical bone gain	1	23	Mean Difference (IV, Fixed, 95% CI)	0.97 [‐0.07, 2.01]

Comparison 3. Vertical augmentation versus vertical augmentation

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