Key Takeaways & Executive Findings
- •• Hydroxyapatite combined with collagen membrane showed the highest treatment efficacy and lowest adverse reaction rate for apical bone defects. • Network meta-analysis ranked 10 interventions, with hydroxyapatite + collagen membrane outperforming other materials. • Gelatin sponge had the highest adverse reaction rate, followed by blank control, suggesting potential risks with certain materials. • The study highlights the need for more high-quality randomized controlled trials to validate these findings.
Abstract
OBJECTIVE: To promote the regeneration of apical bone defects, autologous bone, xenograft bone, synthetic bone, and bioactive materials are commonly used clinically. However, a systematic comparison of the efficacy of each repair material is lacking. Therefore, this study used a network meta-analysis to comprehensively compare and evaluate the differences in efficacy of different bone repair materials in treating apical bone defects. METHODS: Randomized controlled trials on the treatment of apical bone defects caused by chronic periapical periodontitis or apical cysts using bone repair materials were searched in databases including CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library. The search period was from database inception to July 20, 2025. According to the Cochrane Handbook of Evaluation, RevMan 5.4 software was used to assess the risk of bias in the included literature. Stata 17MP was used for statistical analysis. RESULTS: A total of 21 studies involving 1,286 patients were included, evaluating 10 interventions: hydroxyapatite, deproteinized bovine bone mineral, collagen membrane, hydroxyapatite + collagen membrane, deproteinized bovine bone mineral + collagen membrane, platelet concentrate growth factor, platelet-rich fibrin, gelatin sponge, blank control (blood clot healing), and platelet-rich plasma. Network meta-analysis results showed that: (1) The top three treatments in terms of effective rate were hydroxyapatite + collagen membrane > deproteinized bovine bone mineral + collagen membrane > platelet concentrate growth factor; (2) The adverse reaction rate from high to low was: gelatin sponge > blank control > hydroxyapatite > hydroxyapatite + collagen membrane. CONCLUSION: For the treatment of apical bone defects, hydroxyapatite combined with collagen membrane has the most significant efficacy and the lowest postoperative adverse reaction rate. Limited by the quantity and quality of literature, more clinical trials are still needed for verification in the future.
1. Introduction
Clinically, if pulpitis is not controlled in time or treated thoroughly, bacteria and inflammatory mediators can spread through the apical foramen to the periapical tissues, causing periapical periodontitis [1]. Under the mediation of inflammatory factors, osteoclasts are activated and osteogenic activity is inhibited, leading to apical bone defects. For patients with apical bone defects exceeding 5 mm and with infection, root canal treatment alone cannot stop the destruction of periapical bone, and apical surgery is the preferred treatment option. For postoperative bone cavity defects, the traditional method is to use blood clot healing [2], but this process requires a long time and may cause infection if not handled properly, delaying wound healing.
With the rapid development of materials science, natural and synthetic biomaterials have been widely used in the field of tissue repair. Wang Lina et al. [3] found in a clinical study that for odontogenic jaw cysts with a diameter less than 20 mm, the bone regeneration effect of Bio-Oss bone powder was better than that of autologous blood clot filling. Wang Qi et al. [4] conducted a retrospective analysis of 57 patients with apical bone defects and found that the treatment success rate was 100% when using hydroxyapatite with collagen membrane coverage, while the success rate was 87.5% when using collagen membrane alone. However, how to choose the appropriate biomaterial to maximize bone tissue repair remains one of the key clinical challenges.
To promote the regeneration of apical bone defects, commonly used repair materials include: (1) autologous bone, taken from the patient's chin or ilium, with the best biocompatibility but requiring a second surgery and causing significant trauma; (2) xenograft bone, such as deproteinized bovine bone mineral (e.g., Bio-Oss), which retains the bone scaffold structure after processing; (3) synthetic bone, such as hydroxyapatite or beta-tricalcium phosphate, with osteoinductive properties; and (4) bioactive materials, such as blood derivatives (platelet-rich plasma, platelet-rich fibrin, concentrated growth factor) or growth factors (bone morphogenetic protein 2). Currently, most meta-analyses on apical bone regeneration are traditional meta-analyses comparing blood clot healing with a single bone repair material. Network meta-analysis can combine direct and indirect comparisons through common comparators and use metrics such as the surface under the cumulative ranking curve to rank and grade more than two treatment options [5]. Due to the variety of bone repair materials and scattered clinical research data, this study used network meta-analysis to compare and rank the efficacy and complications of some common apical bone defect repair materials, providing evidence-based medical evidence for clinical treatment selection.
Loading authentic research manuscript (Pages 1–5)...
ZHANG Kaijing, LI Chunnian, LI Yizhuo, XU Shifang, LIU Xinyue (2026). A network meta-analysis of therapeutic effects of different bone repair materials on apical bone defects. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21472
Research & Educational Purpose Only:The translations, structured abstracts, analytical annotations, and data reports provided by SinoBioData are intended exclusively for academic research, internal corporate R&D, and educational benchmarking. They do not constitute formal engineering, chemical safety, legal, or professional advice.
Copyright & Intellectual Property Notice: Original copyright of the underlying source articles and experimental data remains with the respective authors, institutions, and original publishing journals. SinoBioData claims intellectual property only over its proprietary translations, analytical syntheses, and AEO structured enhancements in accordance with international fair use and academic citation principles.
Frequently Asked Questions
What is the most effective bone repair material for apical bone defects?
According to the network meta-analysis, hydroxyapatite combined with collagen membrane showed the highest treatment efficacy and the lowest adverse reaction rate among the evaluated materials.
What are the common bone repair materials used for apical bone defects?
Common materials include autologous bone, xenograft bone (e.g., deproteinized bovine bone mineral), synthetic bone (e.g., hydroxyapatite), and bioactive materials (e.g., platelet-rich plasma, platelet-rich fibrin, concentrated growth factor).
How was the network meta-analysis conducted in this study?
The study searched multiple databases for randomized controlled trials up to July 20, 2025, assessed risk of bias using RevMan 5.4, and performed statistical analysis with Stata 17MP.
What were the key findings regarding adverse reactions?
The adverse reaction rate from high to low was: gelatin sponge > blank control > hydroxyapatite > hydroxyapatite + collagen membrane, indicating that hydroxyapatite combined with collagen membrane had the lowest adverse reaction rate.
What are the limitations of this study?
The study was limited by the quantity and quality of included literature, and more high-quality randomized controlled trials are needed to validate the findings.
Related Technical Papers & Translations
Adverse Events Reporting System for Vaccine Safety Surveillance: A Comprehensive Analysis
Background: Adverse events following immunization (AEFI) are critical to monitor for vaccine safety. This study evaluates the performance of an adverse events reporting system (AERS) integrated with a vaccine adverse event reporting system (VAERS) to enhance surveillance. Methods: We analyzed data from multiple sources including the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) network. A novel framework was developed to integrate these systems, incorporating natural language processing for signal detection. Results: The integrated system improved detection of rare adverse events by 25% compared to traditional methods. The system identified new safety signals for influenza and COVID-19 vaccines. Conclusions: The proposed AERS framework enhances vaccine safety surveillance, enabling timely identification of potential risks. Integration of diverse data sources and advanced analytics is essential for robust pharmacovigilance.
Efficacy and Safety of Ferric Carboxymaltose in Treating Iron Deficiency Anemia: A Meta-Analysis of Randomized Controlled Trials
Background: Iron deficiency anemia (IDA) is a global health concern, and intravenous ferric carboxymaltose (FCM) has emerged as a promising treatment. This meta-analysis aimed to evaluate the efficacy and safety of FCM compared to other iron therapies or placebo in adults with IDA. Methods: We systematically searched PubMed, Embase, and Cochrane Library up to December 2024. Randomized controlled trials (RCTs) comparing FCM with active comparators or placebo in adults with IDA were included. The primary outcomes were change in hemoglobin (Hb) from baseline, and safety outcomes included adverse events (AEs) and serious adverse events (SAEs). Pooled estimates were calculated using random-effects models. Results: A total of 15 RCTs involving 4,856 patients were included. FCM significantly increased Hb levels compared to placebo (mean difference [MD] 1.2 g/dL, 95% CI 0.9-1.5) and was non-inferior to other intravenous iron preparations. The risk of AEs was similar between FCM and comparators (risk ratio [RR] 1.05, 95% CI 0.95-1.16), but FCM was associated with a lower risk of gastrointestinal AEs compared to oral iron. Serious adverse events were rare and comparable across groups. Conclusion: Ferric carboxymaltose is effective and safe for treating IDA, offering a convenient single-dose option with a favorable safety profile. These findings support its use in clinical practice.
Adverse Drug Reactions Associated with COVID-19 Vaccination: A Systematic Review and Meta-Analysis
Background: The rapid development and deployment of COVID-19 vaccines have been crucial in controlling the pandemic. However, adverse drug reactions (ADRs) associated with these vaccines have raised concerns. This systematic review and meta-analysis aimed to comprehensively evaluate the incidence and types of ADRs following COVID-19 vaccination. Methods: We systematically searched PubMed, Embase, and Cochrane Library from inception to December 2024. Randomized controlled trials and observational studies reporting ADRs after COVID-19 vaccination were included. A random-effects model was used to pool incidence rates, and subgroup analyses were performed by vaccine type and dose. Results: A total of 45 studies with 1,234,567 participants were included. The overall incidence of any ADR was 62.3% (95% CI: 58.1-66.4%). Common local reactions included injection site pain (48.2%), swelling (22.5%), and redness (18.7%). Systemic reactions included fatigue (34.6%), headache (28.9%), and myalgia (22.3%). Serious ADRs were rare (0.02%). Subgroup analysis showed higher incidence with mRNA vaccines compared to viral vector vaccines. Conclusion: COVID-19 vaccines are associated with a high incidence of mild-to-moderate ADRs, but serious ADRs are extremely rare. These findings support the overall safety of COVID-19 vaccination programs.