摘要
背景:引导组织再生术及植骨术是目前治疗中重度牙周炎导致的牙周骨缺损的研究热点,但临床研究存在样本量较小的问题,会导致研究结果存在差异。目的:系统评价引导组织再生术联合植骨术治疗牙周骨内缺损的效果,探讨该方法的可行性,为临床应用提供循证依据。方法:计算机检索PubM ed、Cochrane library、EMbase、中国知网、维普及万方数据库,英文检索词包括"guided tissue regeneration,bone grafts,periodontal bone defects";中文检索词包"引导组织再生术,植骨术,牙周骨内缺损",查找有关引导组织再生与联合植骨术治疗牙周骨内缺损的相关研究,检索时间为2000至2016年。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,对纳入的12篇随机对照试验进行文献质量评价,采用Rev Man 5.3统计学软件进行meta分析。结果与结论:共纳入12个研究,总计414颗患牙,其中试验组228颗,对照组216颗。Meta分析结果显示,引导组织再生术联合植骨术组较单纯翻瓣术组可使牙周探诊深度降低1.18 mm、牙龈退缩减少0.23 mm、牙槽骨缺损深度降低1.57 mm,临床附着水平增加2.03 mm(P<0.05);引导组织再生术联合植骨术较引导组织再生术在探诊深度增加0.34 mm和牙槽骨缺损深度降低0.73 mm(P>0.05),牙龈退缩减少0.35 mm,临床附着水平有所增加0.63 mm(P<0.05);引导组织再生术联合植骨术组较植骨术组在牙周探诊深度减少0.11 mm、临床附着水平增加0.04 mm和牙龈退缩增加0.13 mm(P>0.05)。结果证实,在中重度牙周炎导致的牙周骨缺损的患者中,引导组织再生术联合植骨术较单纯翻瓣术以及引导组织再生术疗效更好,但较植骨术无明显统计学差异。此次Meta分析结果尚未对使用的膜材料及骨材料及骨替代品进行分类,仍缺少高质量大样本的随机对照试验予以证实。
BACKGROUND： Guided tissue regeneration and bone grafting are a hot spot in the treatment of periodontal bone defect caused by severe periodontitis, but a small sample size in clinical research will lead to bias. OBJECTIVE： To systematically evaluate the effect of guided tissue regeneration combined with bone grafting in the treatment of periodontal bone defect, and explore its feasibility, thus providing evidence for clinical application. METHODS： A computer-based search of Pub Med, Cochrane Library, EMbase, CNKI, Cq Vip and Wan Fang databases was performed for articles about the guided tissue regeneration and bone graft for periodontal bone defects, published from 2000 to 2016. The keywords were ＂guided tissue regeneration, bone grafts, periodontal bone defects＂ in English and Chinese, respectively. The literature selection, data collection and evaluation of bias were conducted by two researchers independently, and then quality assessment of the included 12 randomized controlled tests was conducted, followed by Meta-analysis using Revman 5.3 software. RESULTS AND CONCLUSION： A total of 12 studies were enrolled, including 414 teeth（228 of which in the experimental group and 216 in the control group）. Meta-analysis results showed that compared with the single flap surgery, guided tissue regeneration combined with bone graft could reduce periodontal probing depth by 1.18 mm gingival, make a gingival recession by 0.23 mm, reduce alveolar bone defect depth by 1.57 mm, and increase clinical attachment level by 2.03 mm（P〈0.05）. Compared with guided tissue regeneration technique, guided tissue regeneration combined with bone graft made probing depth increase by 0.34 mm, alveolar bone defect depth reduce by 0.73 mm, gingival recession reduce 0.35 mm and clinical attachment level increase by 0.63 mm（P〈0.05）. Compared with bone graft, guided tissue regeneration combined with bone graft made periodontal probing depth reduce by 0.11 mm, clinical attachment levels increase by 0.04 mm and gingival recession increase by 0.13 mm（P〈0.05）. These results reveal that for moderate to severe chronic periodontitis with periodontal bone defects, guided tissue regeneration combined with bone graft has better clinical effects than simply flap surgery and guided tissue regeneration, but has no significant differences from the bone graft surgery. Herein, we have not yet classified the membrane materials, bone materials and bone substitutes, and there is still a lack of high-quality and large-sample randomized controlled trials.
作者
沈玥
何攀龙
魏奕茹
热依拉.居热提
古丽努尔.阿吾提
Shen Yue He Pan-long Wei Yi-ru Reyila.Jureti Gulinuer.Awuti(Department of Periodontics ＆ Oral Medicine, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, Chin)
出处
《中国组织工程研究》
CAS
北大核心
2017年第4期641-649,共9页
Chinese Journal of Tissue Engineering Research
基金
新疆维吾尔自治区自然科学基金资助项目(2011211A071)~~
