Abstract
The search for bone reconstruction materials and methods is an ongoing challenge. The aim of this review is to systemically search the available literature concerning the clinical performance of eggshell as a substitute material in guided bone regeneration in oral surgery. Five databases (PubMed, Cochrane, Web of Science, Scopus, and Embase) were searched up to February 2020. Clinical trials that used eggshell as a bone substitute material were included in the review. Animal and in vivo studies were excluded from the review. ROBINS-I was used to evaluate the risk of bias. A total of 840 studies were retrieved, out of which 55 full-text articles were screened. Five studies were finally included: one study showed critical and four serious risk of bias. A total of 74 patients and 88 intervention sites were included in the five studies. Clinical and radiological evaluation showed complete healing during the follow-ups. Statistically significant radiological and clinical evidence of new bone formation was achieved for socket preservation, grafting after third molar extraction, and cystic/apicectomy grafting. One patient with complications was reported. Histological analysis and micro computed tomography confirmed that it promotes bone regeneration. A comparison with synthetic hydroxyapatite showed similar healing characteristics. Within the limitations of the included studies, the eggshell can be safely and efficiently used in guided bone regeneration procedures, but more research is needed to completely evaluate the full potential of this material.
Highlights
Bone regeneration is a major challenge in reconstructive surgery [1]
For third molar extraction sites, no significant difference (p < 0.05) in the lamina dura was seen as opposed to the control group at 1-month and 6-months follow-up in a split-mouth model [31]
When comparing the surgical site of the synthetic HA (SHA) and eggshell-derived HA (EHA) groups, there was no significant difference in the lamina dura between the two at 1, 2, 3, and 6 months [28]
Summary
Bone regeneration is a major challenge in reconstructive surgery [1]. The gold standard for alveolar reconstruction is the autologous bone, enhancing osteogenesis, osteoinduction, and osteoconduction [2]. The problem lies in its scarcity, depending on the donor site, and association with several risks like nerve damage, infection, bleeding, scarring, and loss of function [3]. New materials that strive to overcome these shortcomings have emerged. Their success is limited due to the scarcity of viable osteoblasts [4]. The oral cavity is a unique environment due to the presence of bacteria and saliva, and due to the mastication that occurs there. It is very important to take all these into consideration when searching for a suitable biomaterial to be used [5]
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