Reconstructive materials in orbital floor fracture management: A systematic review and narrative synthesis for clinical practice guidelines of oral and maxillofacial trauma in Japan 2025

Objective This study, initially conducted as a systematic review, applied the Grading of Recommendations Assessment, Development, and Evaluation system to assess the strength and direction of recommendations regarding whether alloplastic materials should be used instead of autologous bone for orbital floor reconstruction. Methods A comprehensive literature search was performed to identify randomized controlled trials (RCTs) in MEDLINE (PubMed), CENTRAL, and Japan Medical Abstracts (Ichushi-Web), covering domestic and international articles published until September 2024. Titles and abstracts were screened based on search terms, and studies that met the research objectives were selected. Results The search identified 52 articles in MEDLINE, 58 in CENTRAL, and 50 in Japan Medical Abstracts, with eight duplicates. No RCT directly comparing orbital floor reconstruction using autologous bone and alloplastic materials was found. However, several nonrandomized comparative studies and meta-analyses addressing this topic were available, and their findings were narratively synthesized in this review. Conclusions Although no RCTs were identified, multiple nonrandomized comparative studies and meta-analyses have examined the relative performance of autologous and alloplastic materials, indicating that both can achieve favorable outcomes when appropriately selected. Recent advances in patient-specific implants have shown promising potential; however, further well-designed prospective studies are required to establish higher-level evidence and formulate definitive recommendations.