Tenting screw (tent pole) technique in vertical and horizontal alveolar ridge augmentations: a systematic review and meta-analysis

PURPOSE: Providing an overview on tenting screws/tent-pole technique for space-maintenance in vertical and horizontal alveolar ridge augmentation. METHODS: The protocol was registered at PROSPERO (CRD420251178321). PRISMA-2020 guidelines were applied. Medline via PubMed, Web of Science, Scopus, Embase, and Cochrane Library were all searched/screened. Randomized and non-randomized human studies with at least 10 patients were eligible. Random-effects model analysis was used in all cases. The risk of publication bias was assessed using a funnel plot and the Egger's test. All statistical analyses were executed using STATA 17.0. RESULTS: Four randomized, 7 non-randomized and 13 cohort studies were included; 23 were selected for meta-analysis. Overall vertical and horizontal bone gains using tenting screws/tent-pole as the sole space-maintenance technique were at 5.43 mm (95% CI: 3.79-7.07) and 3.62 mm (95% CI: 3.21-4.02), respectively. One-staged augmentations/dental implantation showed significantly higher vertical gain compared to two-staged procedures (P = 0.03). Regarding complementary grafted bone materials/particles, autografts (with/without xenografts) had significantly higher vertical gains than allografts (with/without xenografts) (P = 0.00). Five cohorts compared the outcomes of tenting technique against conventional GBR (with no bone-blocks) in horizontal reconstruction; tenting technique significantly outperformed with 0.49 mm (95% CI: 0.00-0.97) superiority (P = 0.05); GRADE certainty assessment reported as moderate. There were no signs of publication bias in any of the analyses (P = 0.75, P = 0.75, and P = 0.23, respectively). CONCLUSIONS: Tent-pole technique is desirable for space-maintenance without the complexity and surgical/healing complications of onlay-bone-blocks and titanium meshes. More RCTs are required to reach reliable conclusions.