title: Bone tissue engineering in oral peri-implant defects in preclinical in vivo research: A systematic review and meta-analysis.
abstract: The regeneration and establishment of osseointegration within oral peri-implant bone defects remains a clinical challenge. Bone tissue engineering (BTE) is emerging as a promising alternative to autogenous and/or biomaterial-based bone grafting. The objective of this systematic review was to answer the focused question: in animal models, do cell-based BTE strategies enhance bone regeneration and/or implant osseointegration in experimental peri-implant defects, compared with grafting with autogenous bone or only biomaterial scaffolds? Electronic databases were searched for controlled animal studies reporting on peri-implant defects and implantation of mesenchymal stem cells (MSC) or other cells seeded on biomaterial scaffolds, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Random effects meta-analyses were performed for the outcomes histomorphometric bone area fraction (BA) and bone-to-implant contact (BIC). Nineteen studies reporting on large animal models (dogs and sheep) were included. Experimental defects were created surgically (16 studies) or via ligature-induced peri-implantitis (LIPI, three studies). In general, studies presented with an unclear to high risk of bias. In most studies, MSC were used in combination with alloplastic mineral phase or polymer scaffolds; no study directly compared cell-loaded scaffolds vs. autogenous bone. In three studies, cells were also modified by ex vivo gene transfer of osteoinductive factors. The meta-analyses indicated statistically significant benefits in favour of: (a) cell-loaded vs. cell-free scaffolds [weighted mean differences (WMD) of 10.73-12.30% BA and 11.77-15.15% BIC] in canine surgical defect and LIPI models; and (b) gene-modified vs. unmodified cells (WMD of 29.44% BA and 16.50% BIC) in canine LIPI models. Overall, heterogeneity in the meta-analyses was high (I270-88%); considerable variation was observed among studies regarding the nature of cells and scaffolds used. In summary, bone regeneration and osseointegration in peri-implant defects are enhanced by the addition of osteogenic cells to biomaterial scaffolds. Although the direction of treatment outcome is clearly in favour of BTE strategies, due to the limited magnitude of treatment effect observed, no conclusive statements regarding the clinical benefit of such procedures for oral indications can yet be made. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Department of Clinical Dentistry, Centre for Clinical Dental Research, University of Bergen, Norway.|Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Shanbhag
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pandis
authors.affiliation: Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Kamal
authors.initials: K
authors.lastname: Mustafa
authors.affiliation: Stereology and Electron Microscopy Laboratory, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Nyengaard
authors.affiliation: Department of Clinical Dentistry, Centre for Clinical Dental Research, University of Bergen, Norway.
authors.forename: Andreas
authors.identifier: 0000-0001-8161-3754
authors.initials: A
authors.lastname: Stavropoulos
mesh_terms: D000818:Animals; D001842:Bone and Bones / Q000502:physiology*; D015921:Dental Implants / Q000009:adverse effects*; D008026:Ligation; D057873:Peri-Implantitis / Q000209:etiology*; D017594:Publication Bias; D023822:Tissue Engineering / Q000379:methods*; D054457:Tissue Scaffolds / Q000737:chemistry
chemical_list: D015921:Dental Implants
keywords: bone tissue engineering; dental implants; mesenchymal stem cells; meta-analysis; osseointegration; scaffolds