Bone grafting materials in critical defects in rabbit calvariae. A systematic review and quality evaluation using ARRIVE guidelines.

Abstract

To perform a systematic literature review of the regenerative potential of bone substitutes used to fill critical size defects (CSDs) in rabbit calvariae; to determine the quality of the included studies using ARRIVE guidelines. An Internet search was performed in duplicate using MEDLINE, PubMed and Google Scholar databases (without restrictions on publication date) for studies reporting the regenerative potential of bone substitutes in CSDs in rabbit calvariae. Four parameters were analyzed by histomorphometry: new bone formation (NB); defect closure (DC); residual graft (RG); and connective tissue (CT). Animal Research Reporting in In Vivo Experiments (ARRIVE) guidelines (a list of 20 aspects for scoring texts and ensuring comparison between different experimental studies in animals) were used to evaluate the quality of the selected works. Twenty-one manuscripts were included. CSDs with 15mm were predominant (57.14%). Only one study described the four histomorphometric parameters. NB formation was analyzed in 15 studies (71.42%) and was higher for particulate autogenous bone grafts (range 52.1-82%) after 12weeks. DC was evaluated in six studies (28.57%) and was higher for fragmented adipose tissue grafts (range 53.33-93.33%) after 12weeks. RG was evaluated in four studies (19.04%) and was higher for hydroxyapatite/beta-tricalcium phosphate grafts with silica (HA/ß-TCP + Si) (range 35.78-47.54%) at 12weeks. CT was evaluated in two studies (9.5%) and was higher for HA/ß-TCP + membrane (44.2%) at 12weeks. Quality evaluation identified three items (title, introduction/objectives and experimental procedure) (15%) with excellent scores, 10 items (abstract, introduction/background, methods/ethical statement, experimental animals, experimental outcomes, statistics, results/baseline data, outcome/estimation and discussion interpretation/scientific implications) (50%) with average scores, and seven items (housing and husbandry, sample size, allocation, numbers analyzed, adverse effects, general applicability/relevance and funding) (35%) obtained poor scores. Only one manuscript obtained a quality evaluation considered as excellent. Autogenous bone grafts increase NB. DC is enhanced by the use of fragmented adipose tissue. RG remains in the defect for longer when hydroxyapatite/beta-tricalcium phosphate with silica is used, and more CT can be expected when hydroxyapatite/beta-tricalcium phosphate with silica grafts are covered by a membrane. The addition of stem cells of different origins to grafting materials enhances bone formation in early healing periods. The ARRIVE guidelines are still insufficiently used and the overall quality of studies remains low.