Effect of Bioactive Agents on Alveolar Ridge Augmentation: A Systematic Review and Meta-Analysis

Objectives: This review aimed at investigating the impact of bioactive agents on alveolar ridge augmentation at peri-implant sites and edentulous ridges. Material and Methods: Electronic and manual literature searches were conducted for articles up to April 2021. Human randomized clinical trials, clinical trials, or retrospective studies reporting outcomes of alveolar ridge augmentation procedures with or without bioactive agents were included. Sinus lifting or extraction socket preservation articles were excluded in this study. A random-effect meta-analysis was conducted to investigate ridge dimensional changes and complication rate. Results: Overall, ten articles were included in the quantitative analysis. In bone width and height augmentation, the weighted mean difference (WMD) of the horizontal bone gain at edentulous ridges was 0.38 mm (95% CI = 0.07 to 0.69 mm, p = 0.02) when comparing sites with and without PRP/PRF. The WMD of the vertical bone gain at edentulous ridges was 0.46 mm (95% CI = 0.06 to 0.86 mm, p = 0.02) when comparing sites with and without platelet- rich plasma (PRP) or platelet-rich fibrin (PRF). When evaluating the effect of adjunctive use of bone morphogenetic proteins (BMPs) at alveolar ridge augmentation sites compared to alveolar ridge augmentation sites without BMP application, the WMD of the horizontal bone gain at edentulous ridges was 0.90 mm (95% CI = 0.30 to 1.49 mm, p = 0.003). In addition, the odds ratio of the titanium mesh exposure was 0.13 (95% CI of 0.02 to 0.71, p = 0.02). All analyses showed favorable outcomes at the sites with bioactive agent. Conclusion: Within the limits of this review, application of bioactive agents during alveolar ridge augmentation procedures presents increased horizontal and vertical bone augmentative changes. The complication rate can also be reduced with usage of PRP/PRF in titanium mesh-guided alveolar ridge augmentation.