Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Cell‐based approaches, utilizing adult mesenchymal stem cells (<jats:styled-content style="fixed-case">MSCs</jats:styled-content>), are reported to overcome the limitations of conventional bone augmentation procedures.</jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p>The study aims to systematically review the available evidence on the characteristics and clinical effectiveness of cell‐based ridge augmentation, socket preservation, and sinus‐floor augmentation, compared to current evidence‐based methods in human adult patients.</jats:p></jats:sec><jats:sec><jats:title>Materials and Methods</jats:title><jats:p><jats:styled-content style="fixed-case">MEDLINE</jats:styled-content>, <jats:styled-content style="fixed-case">EMBASE</jats:styled-content>, and <jats:styled-content style="fixed-case">CENTRAL</jats:styled-content> databases were searched for related literature. Both observational and experimental studies reporting outcomes of “tissue engineered” or “cell‐based” augmentation in ≥5 adult patients alone, or in comparison with noncell‐based (conventional) augmentation methods, were eligible for inclusion. Primary outcome was histomorphometric analysis of new bone formation. Effectiveness of cell‐based augmentation was evaluated based on outcomes of controlled studies.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twenty‐seven eligible studies were identified. Of these, 15 included a control group (8 randomized controlled trials [<jats:styled-content style="fixed-case">RCTs</jats:styled-content>]), and were judged to be at a moderate‐to‐high risk of bias. Most studies reported the combined use of cultured autologous <jats:styled-content style="fixed-case">MSCs</jats:styled-content> with an osteoconductive bone substitute (<jats:styled-content style="fixed-case">BS</jats:styled-content>) scaffold. Iliac bone marrow and mandibular periosteum were frequently reported sources of <jats:styled-content style="fixed-case">MSCs</jats:styled-content>. In vitro culture of <jats:styled-content style="fixed-case">MSCs</jats:styled-content> took between 12 days and 1.5 months. A range of autogenous, allogeneic, xenogeneic, and alloplastic scaffolds was identified. Bovine bone mineral scaffold was frequently reported with favorable outcomes, while polylactic–polyglycolic acid copolymer (<jats:styled-content style="fixed-case">PLGA</jats:styled-content>) scaffold resulted in graft failure in three studies. The combination of <jats:styled-content style="fixed-case">MSCs</jats:styled-content> and <jats:styled-content style="fixed-case">BS</jats:styled-content> resulted in outcomes similar to autogenous bone (<jats:styled-content style="fixed-case">AB</jats:styled-content>) and <jats:styled-content style="fixed-case">BS</jats:styled-content>. Three <jats:styled-content style="fixed-case">RCTs</jats:styled-content> and one controlled trial reported significantly greater bone formation in cell‐based than conventionally grafted sites after 3 to 8 months.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Based on limited controlled evidence at a moderate‐to‐high risk of bias, cell‐based approaches are comparable, if not superior, to current evidence‐based bone grafting methods, with a significant advantage of avoiding <jats:styled-content style="fixed-case">AB</jats:styled-content> harvesting. Future clinical trials should additionally evaluate patient‐based outcomes and the time‐/cost‐effectiveness of these approaches.</jats:p></jats:sec>