Autologous Bone Grafts versus Alloplastic Implants for Orbital Floor Reconstruction: A Systematic Review and Meta-Analysis

Purpose: The choice of reconstructive material for orbital floor fractures remains a subject of debate. While autologous bone has historically been considered the "gold standard," alloplastic implants offer potential advantages in reducing surgical morbidity. This meta-analysis aimed to compare the safety and efficacy of autologous bone grafts versus alloplastic implants in orbital floor reconstruction. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251140583). Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to August 2025. Randomized controlled trials and comparative cohort studies evaluating functional outcomes (diplopia, enophthalmos) and complications (ectropion, infection, malposition) were included. Data were synthesized using a random-effects model, with risk ratios (RR) and 95% confidence intervals (CI) calculated. Results: Twenty studies comprising 2,119 patients were included. Alloplastic implants demonstrated statistically significant superiority in periocular safety, with a reduced risk of postoperative ectropion compared to autologous grafts (RR = 2.245; p = 0.020). Furthermore, sensitivity analysis revealed a significantly higher risk of implant malposition in the autologous group (RR = 2.074; p = 0.004). Autologous reconstruction was associated with a strong trend toward increased postoperative pain ( p = 0.052) and inherent donor-site morbidity. No statistically significant differences were observed regarding infection ( p = 0.402), enophthalmos ( p = 0.201), or diplopia ( p = 0.221), confirming the functional non-inferiority of alloplastic materials. Conclusion: Alloplastic implants demonstrate a superior safety profile regarding ectropion and implant positioning while offering functional efficacy equivalent to autologous bone. Given the elimination of donor-site morbidity and reduced periocular complications, alloplastic biomaterials should be considered the preferred standard of care for routine orbital floor reconstruction.