Comparison of the efficacy of different biodegradable membranes in guided bone/tissue regeneration: a systematic review and network meta-analysis
Zili Zhou, Jiahao Yun, Jie Li, Yimeng Chen, Tingting Duan, Liqiao Wang, Jianmin Han, Heng Bo Jiang, Guangliang Niu
Abstract
Guided bone/tissue regeneration (GBR/GTR) is commonly used in dental treatment. The desired bone/tissue regeneration is achieved by placing a barrier membrane over the defect to avoid the downward growth of faster-growing connective and epithelial tissue into the defect. This review aimed to evaluate osteogenic properties, degradation characteristics, and postoperative complications of eight biodegradable membranes in animal experiments, including non-crosslinked collagen membrane (NCCM), crosslinked collagen membrane (CCM), silk membrane (SM), polylactic-co-glycolic acid, polylactic acid, polyethylene glycol hydrogel, polycaprolactone (PCL), and magnesium alloys. Seven electronic databases (PubMed, Embase, Web of Science, Cochrane Library, Science Direct, Wiley, Scopus and Google Scholar) were screened. Study selection, data extraction and quality assessment were made in duplicate. The SYRCLE assessment tool, CERQual (Confidence in the Evidence from Reviews of Qualitative Research) tool and GRADE tool were used to grade the risk of bias and level of evidence. A total of 2512 articles were found in the electronic database. Finally, 94 articles were selected, of which 53 were meta-analyzed. Surface under the cumulative ranking curve showed the best results for new bone formation in the magnesium barrier membrane group, followed by SM, PCL, NCCM, and CCM. Qualitative analysis showed good biocompatibility for natural polymer membranes and a longer degradation time for synthetic polymer membranes. In addition, 34 studies all showed high bias risks, while other studies had unclear bias risks. Natural polymer membranes were more effective for bone regeneration and magnesium alloys were proved to be promising barrier materials that warrant future research.