Clinical Use of S53P4 Bioactive Glass in the Treatment of Bone Defects and Infected Bone: A Systematic Review of the Quality of Clinical Outcomes and A Grade Assessment

Bioactive glass (BAG) S53P4 is a synthetic bone substitute consisting of oxides of silicon, sodium, calcium and phosphorus and exhibits both osteoconductive and antibacterial properties. Clinically it has been used in the treatment of benign bone tumor surgery, in spine surgery, in trauma surgery, in frontal sinus surgery, in diabetic foot osteomyelitis surgery, in mastoid surgery, in oral and maxillofacial surgery, and in the treatment of bone infections with excellent clinical outcomes. A systematic review following PRISMA guidelines is performed to evaluate the level of evidence, clinical efficacy, and safety of BAG S53P4 as a bone graft substitute in the treatment of bone defects and infected bone. Clinical studies published between 1990 until 2024 are extracted and analyzed (N = 99). The highest level of clinical evidence (L1-L2) of successful use of BAG S53P4 is found in the treatment of benign bone tumor surgery (N = 5), in oral and maxillofacial surgery (N = 5), in the treatment of bone infection (N = 6), in spinal surgery (N = 3), and in trauma surgery (N = 3). The highest evidence on successful treatment in respect to the number of publications on BAG S53P4 are found in the categories of infection treatment (N = 24) and in mastoid surgery (N = 30). Derived from this systematic literature review and level of evidence assessment, BAG S53P4 is a safe and effective alternative to autograft bone and offers excellent long-term outcomes in various clinical indications when bone grafts are needed. In the management of osteomyelitis in infected non-unions, mastoid surgery and diabetic foot, BAG S53P4 demonstrates high infection eradication rates and successful bone healing. Considering the increasing incidence of microbial resistance to antibiotics its role may become critical in the fight against antimicrobial resistance.