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Review
. 2025 Jul 15;11(1):47.
doi: 10.1186/s40729-025-00636-4.

New bone formation of biphasic calcium phosphate bone substitute material: a systematic review and network meta-analysis of randomized controlled trials (RCTs)

Chutikarn Somngam  1 , Sutiwat Samartkit  1 , Sukrit Kanchanasurakit  2   3   4   5 , Frank Peter Strietzel  6 , Pathawee Khongkhunthian  7
Affiliations
Review

New bone formation of biphasic calcium phosphate bone substitute material: a systematic review and network meta-analysis of randomized controlled trials (RCTs)

Chutikarn Somngam et al. Int J Implant Dent. .

Abstract

Objective: • To systematically determine the effectiveness of biphasic calcium phosphate (BCP) as bone substitute materials (BSM) compared to other BSMs for new bone formation in dental implant treatment through a network meta-analysis (NMA).

Materials and method: • Following PRISMA-NMA guidelines, randomized controlled trials (RCTs) on lateral sinus augmentation and dental implants comparing BCP with other BSMs for histomorphometric new bone formation were included. Studies were retrieved from MEDLINE, Cochrane, Scopus, and Embase (up to November 2024), with quality assessed via the Cochrane risk of bias 2 (RoB2.0) tool. Analysis included direct and network meta-analyses using a random-effects model, with SUCRA scores determining treatment rankings. The PROSPERO registration number was CRD42024607526.

Results: • Of 268 studies, 11 met criteria, covering 283 patients and 362 sinus augmentations using autografts (AB), allografts (AL), beta tricalcium phosphate (TCP), BCP, and xenografts (Xeno). NMA showed AB resulted in 12.33% more new bone formation than BCP (95% CI: 10.74, 13.93), with AL showing 5.14% more (95% CI: 3.33, 6.95). Xeno showed 4.14% less bone formation than BCP (95% CI: -6.38, -1.90). AB ranked highest for new bone formation, followed by AL, BCP, TCP, and Xeno. Residual graft material was highest in Xeno (6.21%; 95% CI: 2.81, 9.61).

Conclusion: • BCP demonstrated sufficient new bone formation, outperforming xenografts in both bone formation and residual graft material. While autografts and allografts exhibited superior bone regeneration, BCP remains an effective option for bone augmentation treatments.

Keywords: BCP; Biphasic calcium phosphate; Dental implants; Histomorphometry; Hydroxyapatite-beta tricalcium phosphate; Network meta-analysis; Sinus floor augmentation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This meta-analysis was registered under the trial number CRD42024607526 in the International Prospective Register of Systematic Reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO ). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram depicts the searching and studies selection process [58]
Fig. 2
Fig. 2
Risk of bias of individual study
Fig. 3
Fig. 3
Network map of new bone formation outcomes, presenting autografts (AB), allografts (AL), beta tricalcium phosphate (TCP), BCP, and xenografts (Xeno) as the BSM used in the NMA. BCP and Xeno are the most frequently compared BSM
Fig. 4
Fig. 4
Forest plot comparing the effectiveness of each BSM in new bone formation to that of BCP
Fig. 5
Fig. 5
League table shows network-estimated, weighted mean difference percentage of new bone formation using different BSM
Fig. 6
Fig. 6
The SUCRA graph represents the probability that each BSM is among the best materials for new bone formation
Fig. 7
Fig. 7
The comparison-adjusted funnel plot illustrates small-study effects and publication bias for new bone formation across all comparisons. Different comparisons are represented by different colors (A: AB, B: AL, C: BCP, D: TCP, E: Xeno)
Fig. 8
Fig. 8
Forest plot comparing the residual graft materials of each BSM to BCP
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