Skip to main content Skip to main navigation menu Skip to site footer
Published: 2022-05-13

Major approaches and clinical outcomes of bone regeneration for dental implants: a systematic review

UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
Dental implants Bone regeneration Bone graft Cells Cytokines


Introduction: In the last decades, the number of dental implant procedures has increased in the world, with about 1.0 million dental implants per year. When a tooth is lost in the posterior region of the maxilla, there is a natural resorption of the alveolar process. There are several surgical techniques that can be used to reconstruct the atrophic alveolar ridge. Objective: A systematic review was carried out to present the key considerations of bone regeneration and bone, cellular and molecular grafts for adequate bone formation for successful dental implants. Methods: The present study followed a systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The total of 132 articles were found. A total of 74 articles were fully evaluated and 31 were included in this study. Normal bone formation and tissue repair involve coordinated interaction between bone-forming cells and biological signals. TNF-α stimulates bone and cartilage resorption and inhibits collagen and proteoglycan synthesis. IL-1 induces the expression of a wide variety of cytokines. LIF and IL-6 are two such molecules that are known to stimulate the differentiation of mesenchymal progenitor cells into the osteoblastic lineage. The bioactivation of the dental implant surface with FRP has been described and discussed by the scientific community as a surface treatment for the stimulation and acceleration of the osseointegration process, as well as to achieve greater primary stability to the implant. The combination of FRP and Bio-Oss® has been studied with good clinical results, reducing healing time from 180 days to approximately 106 days. The use of bone grafts significantly improves the residual alveolar ridge regardless of the membrane used. Furthermore, implants placed in fresh extraction sockets with and without elevation of the mucoperiosteal flap can be successfully performed with augmentation procedures.


  1. Zhao R, Yang R, Cooper PR, Khurshid Z, Shavandi A, Ratnayake J. Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments. Molecules. 2021 May 18;26(10):3007. doi: 10.3390/molecules26103007. PMID: 34070157; PMCID: PMC8158510.
  2. Zhuang G, Mao J, Yang G, Wang H. Influence of different incision designs on bone increment of guided bone regeneration (Bio-Gide collagen membrane +Bio-OSS bone powder) during the same period of maxillary anterior tooth implantation. Bioengineered. 2021 Dec;12(1):2155-2163. doi: 10.1080/21655979.2021.1932209. PMID: 34057023.
  3. Abdel-Kader MA, Abdelazeem AF, Ahmed NEB, Khalil YM, Mostafa MI. Oral rehabilitation of a case with regional odontodysplasia using a regenerative approach-A case report and a review of literature. Spec Care Dentist. 2019, May;39(3):330-339. doi: 10.1111/scd.12378. Epub 2019 Apr 16.
  4. Arab H, Shiezadeh F, Moeintaghavi A, Anbiaei N, Mohamadi S. Comparison of Two Regenerative Surgical Treatments for Peri-Implantitis Defect using Natix Alone or in Combination with Bio-Oss and Collagen Membrane. J Long Term Eff Med Implants. 2016;26(3):199-204. doi: 10.1615/JLongTermEffMedImplants.2016016396.
  5. Chiapasco M., Casentini P., Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24 Suppl: 237-59.
  6. Almansoori AA, Kwon OJ, Nam JH, Seo YK, Song HR, Lee JH. Mesenchymal stem cells and platelet-rich plasma-impregnated polycaprolactone-β tricalcium phosphate bio-scaffold enhanced bone regeneration around dental implants. Int J Implant Dent. 2021 May 5;7(1):35. doi: 10.1186/s40729-021-00317-y. PMID: 33948811; PMCID: PMC8096877.
  7. Choukroun J, Diss A., Simonpieri A, Girard M.O. Schhoffler C., Dohan S.L., et al.Platelet-rich-fibrin (FRP): a second generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod 2006: 101 (3): e 56 – 60.
  8. Diana C, Mohanty S, Chaudhary Z, Kumari S, Dabas J, Bodh R. Does platelet-rich fibrin have a role in osseointegration of immediate implants? A randomized, single-blind, controlled clinical trial. Int J Oral Maxillofac Surg. 2018 Sep;47(9):1178-1188. doi: 10.1016/j.ijom.2018.01.001. Epub 2018 May 7.
  9. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJJ, Mouhyi J, et al. Platelet-rich-fibrin (FRP); A second generation concentrate. Part I: Tecnological concepts and evolution. Oral Sugery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2006; 101 (3): e 37- e 44.
  10. Nícoli LG, Pigossi SC, Araújo RFdSB, Marcantonio C, Marcantonio E, Marcantonio JRE. Multidisciplinary approach to oral rehabilitation with dental implants after gunshot injury. A clinical report. The Journal of Prothestic Dentistry. 2018; 119 (3): 329 – 33.
  11. Jeong SM, Lee CU, Son JS, Oh JH, Fang Y, Choi BH. Simultaneous sinus lift and implantation using platelet-rich-fibrin as sole grafting material. J. Craniomaxillofac Surgery. 2014; 42 (6): 990 – 4.
  12. Xuan F, Lee CU, Son JS, Jeong SM, Choi BH. A comparative study of the regenerative effect of sinus bone grafting with platelet-rich fibrin-mixed Bio-Oss® and commercial fibrin-mixed Bio-Oss®: an experimental study. J Craniomaxillofac Surg. 2014 Jun;42(4):e47-50 [ doi: 10.1016/j.jcms.2013.05.029. Epub 2013 Aug 2].
  13. Tajima N, Ohba S, Sawase T, Asahima I. Evaluation of sinus floor augmentation with simultaneous implant placement using platelet-rich-fibrin as sole grafting material. Int J Oral Maxillofac Implants 2013;28(1):77- 83.
  14. Moreira AC, Silva JR, Samico RP, Nishioka GNM, Nishioka RS. Application of Bio-Oss in tissue regenerative treatment prior to implant installation: literature review. Braz Dent Sci. 2019, 22(2).
  15. Li P, Zhu H, Huang D. Autogenous DDM versus Bio-Oss granules in GBR for immediate implantation in periodontal postextraction sites: A prospective clinical study. Clin Implant Dent Relat Res. 2018 Dec;20(6):923-928. doi: 10.1111/cid.12667. Epub 2018 Sep 19.
  16. Costa JBZ, Silva F, Dultra CA, Souza LF, Santos MCNE. Uso de membranas biológicas para regeneração óssea guiada em implantodontia – uma revisão de literatura - Revista Bahiana de Odontologia. 2016 Mar;7(1):14-21.
  17. Saghiri MA, Asatourian A, Garcia-Godoy F, Sheibani N. The role of angiogenesis in implant dentistry part II: The effect of bone-grafting and barrier membrane materials on angiogenesis. Med Oral Patol Oral Cir Bucal (2016), [doi:10.4317/medoral.21200].
  18. Mesimäki K, Lindroos B, Törnwall J, Mauno J, Lindqvist C, Kontio R, Miettinen S, Suuronen R: Novel maxillary reconstruction with ectopic bone formation by GMP adipose stem cells. Int J Oral Maxillofac Surg 2009, 38: 201-209.
  19. Zotarelli Filho IJ, Frascino LF, Greco OT, Araujo JDD, Bilaqui A, Kassis EN, Ardito RV and Bonilla-Rodriguez GO. Chitosan-collagen scaffolds can regulate the biological activities of adipose mesenchymal stem cells for tissue engineering. J Regen Med Tissue Eng. 2013; 2:12.
  20. Egido-Moreno S, Valls-Roca-Umbert J, Céspedes-Sánchez JM, López-López J, Velasco-Ortega E. Clinical Efficacy of Mesenchymal Stem Cells in Bone Regeneration in Oral Implantology. Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Jan 21;18(3):894. doi: 10.3390/ijerph18030894. PMID: 33494139; PMCID: PMC7908266.
  21. You JS, Kim SG, Oh, J.S., Kim, J.S. Effects of Platelet-Derived Material (Platelet-Rich Fibrin) on Bone Regeneration. Implant Dent. 2019 Mar 8 [doi: 10.1097/ID.0000000000000877. Epub ahead of print].
  22. Starch-Jensen T, Aludden H, Hallman M, Dahlin C, Christensen AE, Mordenfeld A. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg. 2018 Jan;47(1):103-116. doi: 10.1016/j.ijom.2017.05.001. Epub 2017 May 22.
  23. Strauss FJ, Stähli A, Gruber R. The use of platelet-rich fibrin to enhance the outcomes of implant therapy: A systematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:6-19. doi: 10.1111/clr.13275.
  24. Wu IH, Bakhshalian N, Galaustian R, Naini RB, Min S, Freire M, Zadeh HH. Retrospective Analysis of the Outcome of Ridge Preservation with Anorganic Bovine Bone Mineral: Marginal Bone Level at Implants Placed Following Healing of Grafted Extraction Sockets. Int J Periodontics Restorative Dent. 2019 Jan/Feb;39(1):131-140. doi: 10.11607/prd.3308.
  25. Zhang Y, Tangl S, Huber CD, Lin Y, Qiu L, Raush-Fan X. Effects of Choukroun’s platelet-rich-fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: a histological and histomorphometric study. J Craniomaxillofac Surg. 2012; 40 (4): 321 -8.
  26. Zhou, J., Li, X., Sun, X., Qi, M., Chi, M., Yin, L., Zhou, Y. Bone regeneration around immediate placed implant of molar teeth with autologous platelet-rich fibrin: Two case reports. Medicine (Baltimore). 2018 Nov;97(44):e13058. doi: 10.1097/MD.0000000000013058.
  27. Momen-Heravi F, Peters SM, Garfinkle L, Kang P. Acellular Dermal Matrix as a Barrier for Guided Bone Regeneration of Dehiscence Defects Around Dental Implants: A Clinical and Histological Report. Implant Dent. 2018 Aug;27(4):521-524 [doi: 10.1097/ID.0000000000000796].
  28. Nizam N, Eren G, Akcali A, Donos N. Maxillary sinus augmentation with leukocyte and platelet-rich fibrin and deproteinized bovine bone mineral: A split-mouth histological and histomorphometric study. Clin Oral Implants Res. 2018 Jan;29(1):67-75 [doi: 10.1111/clr.13044. Epub 2017 Aug 8].
  29. Pichotano EC, De Molon RS, Freitas De Paula LG, De Souza RV, Marcantonio E JR, Zandim-Barcelos DL. Early Placement of Dental Implants in Maxillary Sinus Grafted With Leukocyte and Platelet-Rich Fibrin and Deproteinized Bovine Bone Mineral. J Oral Implantol. 2018 Jun;44(3):199-206. doi: 10.1563/aaid-joi-D-17-00220. Epub 2018 Feb 19.
  30. Bali Y, Singh R, Gill TK, Rela R, Vatsa R, Priyadarshni P. Bone Graft and Intraosseous Anchorage of Dental Implants for Reconstruction of the Residual Alveolar Ridge. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S465-S468. doi: 10.4103/jpbs.JPBS_638_20. Epub 2021 Jun 5. PMID: 34447135; PMCID: PMC8375792.
  31. Sinha S, Kumar S, Sonoo PR, Kumar U, Siddhartha R, Singh SK. Evaluation of Bone Regeneration around Implants with and Without Flap Elevation. J Pharm Bioallied Sci. 2021 Jun;13(Suppl1):S699-S705. doi: 10.4103/jpbs.JPBS_691_20. Epub 2021 Jun 5. PMID: 34447185; PMCID: PMC8375853.

How to Cite

Faveri, L. H. P. de, Braga, I. C., Paiva, D. B. de, & Kassis, E. N. (2022). Major approaches and clinical outcomes of bone regeneration for dental implants: a systematic review. MedNEXT Journal of Medical and Health Sciences, 3(S3).