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首页> 外文期刊>Journal of tissue engineering and regenerative medicine >Bone tissue engineering in oral peri-implant defects in preclinical in vivo research: A systematic review and meta-analysis
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Bone tissue engineering in oral peri-implant defects in preclinical in vivo research: A systematic review and meta-analysis

机译：体内研究中临床前植入口腔植入缺陷的骨组织工程：系统评价和荟萃分析

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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 (I-2 70-88%); 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 (c) 2017 John Wiley & Sons, Ltd.
机译：口腔种植体周围骨缺损的再生和骨整合的建立仍然是一个临床挑战。骨组织工程（BTE）正在成为自体和/或基于生物材料的骨移植的一种有前途的替代方法。本系统综述的目的是回答一个重点问题：在动物模型中，与自体骨移植或仅生物材料支架相比，基于细胞的BTE策略是否能增强实验性种植体周围缺损的骨再生和/或种植体骨整合？根据系统评价和荟萃分析（PRISMA）指南的首选报告项目，在电子数据库中搜索关于种植体周围缺陷和植入间充质干细胞（MSC）或其他植入生物材料支架的细胞的对照动物研究。对骨组织形态计量学骨面积分数（BA）和骨与种植体接触（BIC）的结果进行随机效应荟萃分析。包括19项关于大型动物模型（狗和羊）的研究。实验性缺损是通过手术（16项研究）或通过结扎诱导的种植周炎（LIPI，3项研究）造成的。总的来说，研究呈现出不明确到高风险的偏倚。在大多数研究中，MSC与异塑性矿物相或聚合物支架结合使用；没有直接比较细胞支架和自体骨的研究。在三项研究中，细胞也通过骨诱导因子的体外基因转移进行了修饰。荟萃分析显示，在统计学上显著有利于：（a）在犬外科缺损和LIPI模型中，细胞负载支架与无细胞支架[加权平均差异（WMD）为10.73-12.30%BA和11.77-15.15%BIC]；（b）在犬LIPI模型中，基因修饰和未修饰的细胞（29.44%BA和16.50%BIC的WMD）。总体而言，荟萃分析的异质性较高（I-2 70-88%）；在关于所用细胞和支架性质的研究中，观察到了相当大的差异。总之，在生物材料支架中添加成骨细胞可以促进种植体周围缺损的骨再生和骨整合。尽管治疗结果的方向显然有利于BTE策略，但由于观察到的治疗效果有限，目前尚无法就此类口服适应症治疗的临床益处做出结论性陈述。版权所有（c）2017约翰威利父子有限公司。

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