Summary of findings 2. Different grafting materials for alveolar ridge preservation.
| Different grafting materials for alveolar ridge preservation | |||||
| Patient or population: adults requiring replacement of missing teeth Setting: dental implantology Intervention: grafting materials for alveolar ridge preservation Comparison: other grafting materials for alveolar ridge preservation | |||||
| Outcomes | Number of participants (studies) | Relative effect (95% CI) | Anticipated absolute effects* (95% CI) | Certainty of the evidence (GRADE) | |
| Risk with other grafting material for alveolar ridge preservation | Risk difference with one grafting material for alveolar ridge preservation | ||||
| Allografts versus xenografts | |||||
| Changes in width of alveolar ridge (mm) Follow‐up: 6 months | 87 (3 RCTs) | ‐ | Risk with xenografts: mean change in width of alveolar ridge (mm) was ‐0.53 | Risk difference with allografts: MD 0.40 lower (1.13 lower to 0.34 higher) | ⊕⊝⊝⊝ VERY LOWa,d |
| Changes in height of alveolar ridge (mm) Follow‐up: 6 months | 60 (2 RCTs) | ‐ | Risk with xenografts: mean change in height of alveolar ridge (mm) was ‐2.92 | Risk difference with allografts: MD 0.45 lower (1.48 lower to 0.58 higher) | ⊕⊝⊝⊝ VERY LOWa,c,f |
| Complications (e.g. discomfort, pain and swelling) Follow‐up: 6 months | 87 (3 RCTs) | 1 trial (Scheyer 2016) reported moderate glazing, redness and oedema, while 2 trials (Santana 2019; Serrano Mendez 2017) reported there were no adverse events | ⊕⊕⊝⊝ LOWa,f | ||
| Need for additional augmentation prior to implant placement Follow‐up: 6 months | 40 (1 RCT) | RR 6.36 (0.35 to 115.73) | Additional bone augmentation procedure was required for 3 sites in the allograft group, while none of the sites in the xenograft group required additional augmentation procedure before implant placement (Scheyer 2016) | ⊕⊝⊝⊝ VERY LOWa,e | |
| Aesthetic outcomes of future prosthodontic rehabilitation Follow‐up: 6 months | Outcome not reported | ||||
| Implant failure rate Follow‐up: 6 months | Outcome not reported | ||||
| Alloplasts versus xenografts | |||||
| Changes in width of alveolar ridge (mm) Follow‐up: range 6 months to 8 months | 37 (2 RCTs) | ‐ | Risk with xenografts: mean change in width of alveolar ridge (mm) was ‐0.52 | Risk difference with alloplasts: MD 0.31 lower (0.66 lower to 0.04 higher) | ⊕⊝⊝⊝ VERY LOWa,d |
| Changes in height of alveolar ridge (mm) Follow‐up: range 6 months to 8 months | 25 (1 RCT) | ‐ | Risk with xenografts: mean change in height of alveolar ridge (mm) was 0.25 | Risk difference with alloplasts: MD 0.60 lower (1.27 lower to 0.07 higher) | ⊕⊝⊝⊝ VERY LOWa,e |
| Complications (e.g. discomfort, pain and swelling) Follow‐up: range 6 months to 8 months | 37 (2 RCTs) | 1 trial (Patel 2013) reported pain, swelling, membrane exposure and partial loss of grafting material, while the other trial (Gholami 2012) reported that the procedure was uneventful | ⊕⊕⊝⊝ LOWa,f | ||
| Need for additional augmentation prior to implant placement Follow‐up: range 6 months to 8 months | 37 (2 RCTs) | RR 1.09 (0.65 to 1.83) | 1 trial (Patel 2013) reported 9 events in the alloplasts groups and 8 events in the xenografts group, while the other trial (Gholami 2012) reported 3 events in the alloplasts group and 1 event in the xenograft group | ⊕⊝⊝⊝ VERY LOWa,c,f | |
| Aesthetic outcomes of future prosthodontic rehabilitation Follow‐up: range 6 months to 8 months | Outcome not reported | ||||
| Implant failure rate Follow‐up: range 6 months to 8 months | 25 (1 RCT) | 1 trial (Patel 2013) reported that none of the implants failed after 12 months of loading | ⊕⊝⊝⊝ VERY LOWa,e | ||
| Alloplasts with membrane versus alloplasts without membrane | |||||
| Changes in width of alveolar ridge (mm) Follow‐up: 9 months | 20 (1 RCT) | ‐ | Risk with alloplasts without membrane: mean change in width of alveolar ridge (mm) was 0.86 | Risk difference with alloplasts with membrane: MD 0.43 higher (0.18 higher to 0.68 higher) | ⊕⊝⊝⊝ VERY LOWb,e |
| Changes in height of alveolar ridge (mm) Follow‐up: 9 months | 20 (1 RCT) | ‐ | Risk with alloplasts without membrane: mean change in height of alveolar ridge (mm) was 0.12 | Risk difference with alloplasts with membrane: MD 0.38 higher (0.26 higher to 0.50 higher) | ⊕⊝⊝⊝ VERY LOWb,e |
| Complications (e.g. discomfort, pain and swelling) Follow‐up: 9 months | 20 (1 RCT) | Fibrous adhesions at the cervical part of previously preserved sockets were observed in 2 participants (Brkovic 2012) | ⊕⊝⊝⊝ VERY LOWb,e | ||
| Need for additional augmentation prior to implant placement Follow‐up: 9 months | Outcome not reported | ||||
| Aesthetic outcomes of future prosthodontic rehabilitation Follow‐up: 9 months | Outcome not reported | ||||
| Implant failure rate Follow‐up: 9 months | Outcome not reported | ||||
| Allografts with versus allografts without synthetic cell‐binding peptide P‐15 | |||||
| Changes in width of alveolar ridge (mm) Follow‐up: 6 months | 18 (1 RCT) | ‐ | Risk with allografts without P‐15: mean change in width of alveolar ridge (mm) was 3.40 | Risk difference with allografts with P‐15: MD 0.87 lower (1.61 lower to 0.13 lower) | ⊕⊝⊝⊝ VERY LOWb,e |
| Changes in height of alveolar ridge (mm) Follow‐up: 6 months | 18 (1 RCT) | ‐ | Risk with allografts without P‐15: mean change in height of alveolar ridge (mm) was 1.50 | Risk difference with allografts with P‐15: MD 0.30 lower (1.06 lower to 0.46 higher) | ⊕⊝⊝⊝ VERY LOWb,e |
| Complications (e.g. discomfort, pain and swelling) Follow‐up: 6 months | 18 (1 RCT) | Included study (Fernandes 2011) reported there were no adverse effects | ⊕⊝⊝⊝ VERY LOWb,e | ||
| Need for additional augmentation prior to implant placement Follow‐up: 6 months | Outcome not reported | ||||
| Aesthetic outcomes of future prosthodontic rehabilitation Follow‐up: 6 months | Outcome not reported | ||||
| Implant failure rate Follow‐up: 6 months | Outcome not reported | ||||
| Alloplasts single particle size versus alloplasts multiple particle size | |||||
| Changes in width of alveolar ridge (mm) Follow‐up: 6 months | 30 (1 RCT) | ‐ | Risk with alloplasts multiple particle size: mean change in width of alveolar ridge (mm) was 1.30 | Risk difference with alloplasts single particle size: MD 0.10 higher (0.97 lower to 1.17 higher) | ⊕⊝⊝⊝ VERY LOWa,e |
| Changes in height of alveolar ridge (mm) Follow‐up: 6 months | 30 (1 RCT) | ‐ | Risk with alloplasts multiple particle size: mean change in height of alveolar ridge (mm) was 0 | Risk difference with alloplasts single particle size: MD 0.10 higher (1.22 lower to 1.42 higher) | ⊕⊝⊝⊝ VERY LOWa,e |
| Complications (e.g. discomfort, pain and swelling) Follow‐up: 6 months | 30 (1 RCT) | Included study (Hoang 2012) reported there were no adverse effects | ⊕⊝⊝⊝ VERY LOWa,e | ||
| Need for additional augmentation prior to implant placement Follow‐up: 6 months | Outcome not reported | ||||
| Aesthetic outcomes of future prosthodontic rehabilitation Follow‐up: 6 months | Outcome not reported | ||||
| Implant failure rate Follow‐up: 6 months | Outcome not reported | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | |||||
aCertainty of the evidence downgraded 1 level due to unclear risk of bias. bCertainty of the evidence downgraded 2 levels due to high risk of bias. cCertainty of the evidence downgraded 1 level due to inconsistency (moderate heterogeneity). dCertainty of the evidence downgraded 2 levels due to inconsistency (substantial heterogeneity). eCertainty of the evidence downgraded 2 levels due to imprecision (single study with limited number of participants). fCertainty of the evidence downgraded 1 level due to imprecision (small studies and/or wide confidence intervals).