Knochen- und Knochenersatzmaterialien zur parodontalen Regeneration und zum Knochenaufbau für Implantate (Health Technology Assessment, Bd. 32)
|Autor||Gernreich NC, Gerhardus A, Velasco-Garrido M|
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Policy and research questions: Bone and bone substitutes are currently used for two indications in oral health: 1) for periodontal rehabilitation to prevent loss of tooth in the case of chronic periodontitis and 2) to replace insufficient bone structure after loss of one or more teeth in order to prepare the tissue for dental implants (bone reconstruction or augmentation). The aim of this report is to systematically evaluate the efficacy of the different materials for both indications. For each indication the following research questions were formulated:
1. Is the use of bone / bone substitutes efficacious?
2. What do we know about the relative efficacy if different bone / bone substitutes are compared?
3. Does the isolated or additional use of membranes lead to a relevant increase in the efficacy?
4. Which are the side effects associated with the different materials and how frequent and how serious are they?
5. For which indication(s) can the use of bone / bone substitutes be recommended?
6. Which areas can be identified for further research, especially regarding the application of bone / bone substitutes in everyday use?
Methodology: The target population includes patients who 1) are suffering from periodontal disease that may lead to dental loss or 2) are scheduled for the insertion of an implant under the condition of insufficient bone structure. Primary outcome parameters are for indication the reduction of probing depth, attachment gain, or bone gain (in mm) and for indication the survival rate of implants (in %). Only randomised controlled studies (open flap debridement, OFD, was the control intervention) were considered to evaluate the efficacy for the first indication. For the evaluation of side effects other study types were also included. To assess the efficacy for the second indication included also non-controlled prospective observational studies included. For this indication the underlying assumption hat different materials have comparative advantages at different locations mostly precluded the use of controlled designs. We searched the electronic databases MEDLINE, SOMED, NEED, DARE, HTA, The Cochrane Library, GBV, HealthSTAR, HSTAT and EMBASE for publications between 1990 and 2000 (the MEDLINE search was updated in January 2002) and screened the publication lists of HTA organisations. We analysed the methodological quality of publications using checklists. Data synthesis was done qualitatively and where possible by meta-analyses.
Results and Conclusions: We included two systematic reviews and 53 primary studies. The results and conclusions are presented for each indication separately.