Jawbone loss following tooth extraction, severe periodontitis, or tumor surgery is more than just an aesthetic issue. For millions of patients worldwide, loss of alveolar bone can make dental implant placement difficult, alter facial appearance, and reduce quality of life. To address this problem, dentists have long used various bone graft materials, one of the most popular being hydroxyapatite (HA), a synthetic material whose chemical composition closely resembles that of natural bone mineral. But how effective is this material, really? That was the question addressed by Dr. drg. Anne Handrini Dewi, M.Kes., together with Prof. drg. Ika Dewi Ana, M.Kes., Ph.D., from the Department of Biomedical Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, in a systematic review published in the international journal Heliyon in 2018. The findings were surprising: HA does not always work as expected.<\/p>\n\n\n\n
The study used a systematic review method, meaning that the researchers did not conduct experiments directly on patients, but instead systematically collected and analyzed previously available clinical studies. The selection process was rigorous: of the 504 articles identified through the MEDLINE, EMBASE, and Cochrane databases, only 42 studies met all the inclusion criteria.<\/p>\n\n\n\n
These criteria included clinical trials in humans involving at least five patients, a minimum follow-up period of three months, and the presence of a comparison group. Each article was assessed independently by two researchers, with a very high level of inter-rater agreement, reaching a kappa value of 0.968 during the initial selection stage.<\/p>\n\n\n\n
The 42 eligible studies were then grouped according to three main clinical procedures: alveolar ridge preservation (maintaining the shape of the jawbone after tooth extraction), sinus augmentation (increasing bone volume in the maxillary sinus area in preparation for implant placement), and treatment of periodontal bone defects (bone damage caused by gum disease).<\/p>\n\n\n\n
The most striking finding of this review was that the same material did not always produce the same results when used for different procedures.<\/p>\n\n\n\n
For alveolar ridge preservation, the six available studies could not be statistically compared because of substantial methodological differences. The effectiveness of HA for this procedure could not be determined with certainty.<\/p>\n\n\n\n
For sinus augmentation, the picture was clearer. Of the 16 studies analyzed, eight could be directly compared. The results showed that the use of HA had a significant effect on bone regeneration in the sinus area, although the outcomes varied depending on the type and combination of materials used. Autograft, or bone taken from the patient's own body, still produced the greatest amount of new bone formation.<\/p>\n\n\n\n
For periodontal bone defects, no significant difference was found between the HA and control groups among the 20 studies analyzed. In other words, HA was not shown to be superior to standard therapy for this condition.<\/p>\n\n\n\n
\u201cThe use of the HA bone substitute interfered with the normal healing process, with significant differences found for sinus augmentation but not for periodontal bone defects. Thus, a bone substitute with optimal bone regenerative properties for alveolar ridge or socket preservation, sinus augmentation, and periodontal bony defect should be developed.\u201d \u2014 Dr. drg. Anne Handrini Dewi, M.Kes. & Prof. drg. Ika Dewi Ana, M.Kes., Ph.D., Heliyon, 2018<\/p>\n\n\n\n
One issue that cannot be overlooked in this review is the methodological quality of the studies analyzed. Of the 42 studies, only three were categorized as having a low risk of bias. One study had a moderate risk of bias, while the remaining 38 had a high risk of bias.<\/p>\n\n\n\n
The high risk of bias arose because many studies did not conduct adequate randomization, did not conceal group allocation from researchers or patients, and did not perform statistical sample-size calculations. Of the 42 studies, only 13 conducted definitive sample-size calculations. This means that many of the clinical findings on HA reported to date should be interpreted with caution.<\/p>\n\n\n\n
This also explains why comparisons across studies were difficult: each study used different types of HA, different control groups, different measurement methods, and different follow-up periods.<\/p>\n\n\n\n
This review does not mean that HA is useless. On the contrary, HA remains recognized as a good candidate for bone grafting because it can reduce donor-site morbidity and postoperative pain compared with harvesting bone from the patient's own body. However, its potential has not yet been fully demonstrated clinically through research of sufficient quality.<\/p>\n\n\n\n
Autograft, or bone harvested from the patient's own body, remains the gold standard in jawbone grafting procedures. The problem is that this procedure requires additional surgery at the donor site, carries its own risk of complications, and offers limited bone availability. This is why continued development of better synthetic graft materials remains important.<\/p>\n\n\n\n
The study by Dr. drg. Anne Handrini Dewi, M.Kes. and Prof. drg. Ika Dewi Ana, M.Kes., Ph.D. provides a clear roadmap: not only what is already known about HA, but also what remains unanswered and requires further investigation using more rigorous methodological standards. For dentistry, the search for an ideal bone graft material still appears to be a long journey.<\/p>\n\n\n\n
Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam<\/p>\n\n\n\n
Photo: Freepik<\/p>\n\n\n\n
DOI Source: https:\/\/doi.org\/10.1016\/j.heliyon.2018.e00884<\/p>","protected":false},"excerpt":{"rendered":"
Tulang rahang yang hilang setelah pencabutan gigi, periodontitis parah, atau operasi tumor bukan sekadar masalah estetika. Bagi jutaan pasien di seluruh dunia, kehilangan tulang alveolar berarti sulitnya pemasangan implan gigi, perubahan bentuk wajah, dan penurunan kualitas hidup. Untuk mengatasi masalah ini, para dokter gigi telah lama menggunakan berbagai bahan cangkok tulang, dan salah satu yang […]<\/p>\n","protected":false},"author":615,"featured_media":20323,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[359,136],"tags":[298,307,289,291,297],"class_list":["post-20316","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artikel","category-berita-terbaru","tag-sdg-10-mengurangi-ketidaksetaraan","tag-sdg-17-kemitraan-untuk-mencapai-tujuan","tag-sdg-3-kesehatan-dan-kesejahteraan-yang-baik","tag-sdg-4-pendidikan-berkualitas","tag-sdg-9-industri-inovasi-dan-infrastruktur"],"gutentor_comment":0,"yoast_head":"\n