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Sara AlFadil, MD, Anne Tong Jia Wei, MBBS, Anand R. Kumar, MD, FACS, FAAP.
Johns Hopkins School of Medicine, Baltimore, MD, USA.

Background: Autograft bone remains the current gold-standard for the treatment of the cleft alveolus in mixed dentition. Despite its widespread use, efficacy of graft take, infection, and recurrent fistula remain troublesome clinical problems. Recent interest in bone regeneration using autograft substitutes has increased yet comparative efficacy remains understudied. The purpose of our meta- analysis study is to evaluate the efficacy and safety of autograft substitutes vs. autograft based on current published clinical evidence.
Methods: A systematic review of PubMed, EMBASE, SCOPUS and the Cochrane library database using inclusion and exclusion criteria was performed for articles that studied the use of autograft vs. allograft in secondary alveolar bone grafting in cleft repair. A comparative analysis of outcomes was performed using RevMan 5 software.
Results: Our search found 1830 citations of which 739 abstracts were excluded and 1091 were screened yielding 263 abstracts that were eligible for full-text screening. Eleven studies qualified for data abstraction with emphasis given to studies that reported computed tomography (CT) evaluation of preoperative, postoperative and volume ratio (%) for alveolar bone volume defect. Of the 11 studies, 3 studies compared the use of BMP-2 and biological material to autograft grafts, 2 studies compared the use of Platelet Rich Plasma (PRP) to autograft, 5 studies reported the use of BMP-2 in grafting, and 1 study on the use of non-resorbable membranes. Four studies (n=51) assessed bone volume (cm3) at postoperative 4-6 months where in patients who underwent grafting with BMP-2/scaffold achieved a significantly greater restoration of bone volume (Mean P<0.0001). The outcome demonstrated moderate heterogeneity across our study population (I2=47%).
Conclusion: This is the first meta-analysis of observational studies with comparison groups. Our results suggest that autograft substitutes have an improved engraftment and volume profile when compared to autograft only. The long term safety of autograft substitutes remains in question, but sufficient clinical evidence of efficacy is present. As such, longer term trials will be required to further evaluate risk vs. benefit ratios.

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