Clinical Efficacy of Tooth-Bone Graft: A Systematic Review and Risk of Bias Analysis of Randomized Control Trials and Observational Studies

Purpose: The objective of this systematic review was to assess the clinical efficacy of the tooth-bone graft as a bone substitute in the oral and maxillofacial region in humans as compared to ungrafted sites and other bone substitutes. Materials and Methods: Databases were electronically and manually searched up to January 2017 to identify animal and human studies and a risk of bias analysis and descriptive statistics was performed. Results: Eighteen animal controlled trials (401 animals), 4 human randomized controlled trials, 1 cohort study, and 3 controlled trials (184 patients) were included. Graft processing was highly heterogeneous. 71.42% clinical and 55.56% animal studies reported no significant difference between tooth-bone graft and controls. Histologically, a dentin-bone complex was reported. A low risk of bias was noted in only 50% of the randomized controlled trials and 63.33% animal study entries. An independent analysis of 6 high-quality case reports (350 patients) revealed complications in 18.86% cases. Conclusion: Tooth-bone graft demonstrated no added benefits over conventional graft materials. Absence of standardized processing and heterogeneous study results limit its use in clinical practice. Until long-term studies determine its success, clinicians are recommended to use it with caution because of high variability in resorption time (2-24 weeks) and a risk of graft dehiscence (12.96%-34.38%).