1.
Radiographic and clinical outcomes of silicate-substituted calcium phosphate (SiCaP) bone grafts in spinal fusion: Systematic review and meta-analysis.
Cottrill, E, Premananthan, C, Pennington, Z, Ehresman, J, Theodore, N, Sciubba, DM, Witham, T
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2020;:353-366
Abstract
Pseudarthrosis continues to affect a nontrivial proportion of spine fusion patients. Given its ties to poorer patient outcomes and high reoperation rates, there remains great interest in interventions aimed at reducing the rates of nonunion. Recently, silicate-substituted calcium phosphate (SiCaP) bone grafts have been suggested to improve fusion rates, yet there exists no systematic review of the body of evidence for SiCaP grafts. Here, we present the first such review along with a meta-analysis of the effect of SiCaP bone grafts on fusion rates. Using the PubMed, Embase, and Web of Science databases, we queried the English-language literature for all studies examining the effect of SiCaPs on spinal fusion. Primary endpoints were: 1) radiographic fusion rate at last follow-up and 2) postoperative improvements in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) at last follow-up. Meta-analyses were performed for each endpoint using random effects. Ten articles (694 patients treated with SiCaP bone grafts) were included. Among SiCaP-treated patients, 93% achieved radiographic fusion (range: 79-100%), with comparable rates across subgroups. Meta-analysis of the three randomized controlled trials demonstrated no difference in fusion rates between SiCaP-treated patients and patients receiving grafts with recombinant human bone morphogenetic protein-2 (rhBMP-2) (OR: 1.11; p = 0.83). Patients treated with SiCaP bone grafts experienced significant improvements in VAS back pain (-3.3 points), VAS leg pain (-4.8 points), and ODI (-31.6 points) by last follow-up (p < 0.001 for each). Additional high-quality research is needed to evaluate the relative cost-effectiveness of SiCaP bone grafts in spinal fusion.
2.
Histological outcomes of sinus augmentation for dental implants with calcium phosphate or deproteinized bovine bone: a systematic review and meta-analysis.
Wu, J, Li, B, Lin, X
International journal of oral and maxillofacial surgery. 2016;(11):1471-1477
Abstract
This study compared the histological outcomes of deproteinized bovine bone (DBB) and technically derived calcium phosphate for sinus floor augmentation. MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until April 2015 with the following key words: dental implants, augmentation/augmented, calcium phosphate/ceramic/tricalcium phosphate, bovine bone/Bio-Oss, deproteinized/anorganic. Randomized controlled trials (RCTs) and two-arm prospective/retrospective studies that used DBB or biphasic calcium phosphate/tricalcium phosphate (BCP/TCP) for sinus augmentation with quantitative results were included. Outcomes were the percentage of new bone formed and percentage of surface contact between the graft material and new bone (bone-to-graft contact). Four RCTs and one prospective study were included, with a total of 110 patients and 145 implants. All studies reported the percentage of new vital bone; however, large heterogeneity was present (Q=15.23, P=0.004, I2=73.8%). BCP/TCP was associated with a higher percentage of new bone, but the pooled results did not reach significance (pooled standardized mean difference (SMD)=0.145, 95% confidence interval (CI) -0.488 to 0.778, P=0.654). Only two studies reported bone-to-graft contact, and BCP/TCP was associated with significantly lower bone-to-graft contact (pooled SMD=-0.807, 95% CI -1.276 to -0.337, P=0.001). This meta-analysis does not allow us to conclude superiority of one particular material with respect to histological outcomes.