What solid evidence do systematic reviews provide about post-traumatic orbital reconstruction materials? An overview of systematic reviews

Orbital fractures pose considerable challenges in the field of maxillofacial surgery. With advancements in materials engineering, various models and biomaterials have emerged for orbital reconstructions. Given the increasing number of Systematic Reviews (SRs) on orbital reconstructions, we aim to provide a comprehensive overview of SRs about biomaterials used in these procedures. Employing the PRIOR checklist, we scrutinized 14 SRs addressing materials for orbital reconstructions and their findings. The risk of bias was evaluated using the ROBIS tool, while the methodological quality of the reviews was assessed through the AMSTAR 2 tool. Our analysis revealed five low- or critically low-quality evidence, four of which had a strong recommendation for use and one that had a weak one. Despite the abundant literature on orbital reconstructions, high-quality evidence was notably absent. Still, this overview has generated pivotal and clear recommendations for surgical practice. We advocate for further randomized controlled trials featuring robust research designs to enhance the quality and reliability of evidence within this domain.