牙周微创手术联合再生生物材料治疗牙周骨内缺损的随机对照试验的Meta分析

发布时间：2018-08-03 16:29

【摘要】：背景:现如今伴随人们生活质量的提升及对口腔健康认识的增强,更多的成年人希望通过正畸治疗实现牙齿的整齐与功能的完善。然而流行病学调查发现我国绝大部分成年人均存在不同程度的牙周炎,轻中度的牙周炎可通过正畸治疗前及治疗中的牙周基础洁治控制炎症,使患者能够进行正畸治疗,但伴重度牙周炎患者无法单纯通过牙周基础洁治彻底清除牙周有害物质控制炎症,从而导致无法接受正畸治疗。对于这类患者,通过牙周手术治疗进一步控制炎症同时促进牙周组织的再生将使其接受正畸治疗成为可能。近几十年来,微创手术已成为一种常规的治疗手段并在很多医学领域得到了广泛的应用。随着微创手术在牙周治疗领域的不断发展,通过微创手术使牙周组织再生能一定程度帮助重度牙周炎患者改善牙周状况。目前大量临床文献对牙周微创手术联合再生生物材料与单独应用牙周微创手术治疗牙周骨内缺损的疗效进行了对比研究,但是否需要在牙周微创手术中运用再生生物材料仍存在一定争议。基于上面提出的临床问题,我们将筛选高质量的随机对照试验并采取Meta分析的方法,用于比较牙周微创手术联合再生生物材料治疗牙周骨内缺损的牙周再生临床结果是否比单独应用牙周微创手术更佳。方法:全面检索相关英文文献,计算机检索数据库包括:Cochrane CENTRAL,Pub Med,Medline,Embase,Clinical Evidence以及灰色文献数据库Clinical Trails.gov。检索截至日期为2015年6月30号。两名研究员从检索数据库中筛选出比较牙周微创手术联合再生生物材料与单独应用牙周微创手术对牙周骨内缺损病人牙周再生效果的随机对照试验研究,并对纳入的文献进行文献质量评价。选取的临床测量指标分别为临床附着水平增加量,探诊深度降低量,牙龈退缩量以及影像学骨增加量的百分比。选用Cochrane协作网推荐Meta分析专用的Rev Man5.2软件对提取的数据整合分析,检测各项临床测量指标的异质性,平均差及方差,95%可信区间。结果:初步检索总共纳入464篇文献,通过查重,阅读题目及摘要,最后根据制定的纳入排除标准排除不符合要求的文献后最终纳入4篇文献。Meta分析结果显示,四项临床测量指标异质性I2=0,选用固定效应模型进行分析。牙周微创手术联合再生生物材料与单独应用牙周微创手术对牙周骨内缺损病人牙周再生效果在临床附着水平增加量(P=0.32),探诊深度降低量(P=0.40),牙龈退缩量(P=0.81),及影像学骨增加量的百分比(P=0.64)四个临床检查指标均无统计学差异。结论:Meta分析结果表明牙周微创手术联合再生生物材料与单独应用牙周微创手术对牙周骨内缺损病人牙周再生的临床治疗效果在四个临床常用检测指标上均无统计学差异,表明单独应用牙周微创手术已能够达到较好手术效果。这一结果提示我们在决定牙周手术治疗方案时应从成本和疗效两方面综合考虑决定是否需要将再生生物材料常规应用于牙周微创手术中。同时,研究也提示对于牙周微创手术应用于治疗牙周骨内缺损的牙周自愈机制仍需要更深入的探究。
[Abstract]:Background: Nowadays, with the improvement of people's quality of life and the enhancement of understanding of oral health, more adults want orthodontic treatment to achieve the integrity and function of the teeth. However, the epidemiological survey found that most adults in our country have different degrees of periodontitis, and the mild and moderate periodontitis can be treated by orthodontic treatment. Periodontal cleaning before and in treatment controls inflammation to enable patients to perform orthodontic treatment, but patients with severe periodontitis can not simply eliminate periodontal harmful substances to control inflammation simply through periodontal basic cleanup, resulting in unacceptable orthodontic treatment. For these patients, periodontal surgery is used to further control the inflammation and promote the simultaneous promotion of inflammation. The regeneration of the periodontal tissue will make it possible to receive orthodontic treatment. In the past few decades, minimally invasive surgery has become a conventional treatment and has been widely used in many medical fields. With the continuous development of minimally invasive surgery in the field of periodontal treatment, minimally invasive surgery can help the periodontal tissue regeneration to a certain extent. Patients with periodontitis improve periodontal status. A large number of clinical literatures have compared the effects of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery in the treatment of periodontal defects. However, there are still some disputes in the use of recycled biomaterials in minimally invasive surgery. Clinical problems, we will select a high quality randomized controlled trial and adopt a Meta analysis to compare the results of periodontal regeneration between periodontal and regenerative biomaterials for periodontal regeneration compared with the individual periodontal minimally invasive surgery. The library includes: Cochrane CENTRAL, Pub Med, Medline, Embase, Clinical Evidence, and the grey literature database Clinical Trails.gov. retrieval date is June 30, 2015. Two researchers screened the comparative periodontal minimally invasive surgery combined with regenerative biological materials from the retrieval database and the individual periodontal minimally invasive surgery on the periodontal defect. A randomized controlled trial of the effect of periodontal regeneration of the patients and the literature quality evaluation of the included literature. The selected clinical measurements were the increase in clinical attachment level, the depth of detection, the amount of gingival contraction and the percentage of image bone increase. The Cochrane collaborative network was selected to recommend the specific Rev Man5.2 for the Meta analysis. The software integrated analysis of the extracted data to detect the heterogeneity, mean difference and variance of various clinical measurements, and 95% confidence interval. Results: a total of 464 documents were included in the preliminary retrieval, and the titles and abstracts were read through weight checking. Finally, 4 literature.Meta analysis was finally included in the literature after the exclusion criteria were excluded. The results showed that four clinical measurement indexes were heterogeneous I2=0, and the fixed effect model was used to analyze the effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal bone defects, the increase in clinical attachment level (P=0.32), depth reduction (P=0.40) and gingival retraction (P=0.81 There was no statistical difference between the four clinical examination indexes of the percentage of bone increase (P=0.64). Conclusion: the results of Meta analysis showed that the clinical therapeutic effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal defects was no more than four clinical tests. Statistical differences indicate that the use of periodontal minimally invasive surgery has been able to achieve better surgical results. This result suggests that we should consider two aspects of the cost and efficacy of the periodontal surgery to determine whether regenerative biomaterials should be routinely used in periodontal microinvasive surgery. The mechanism of periodontal self-healing in minimally invasive surgery for periodontal bone defects still needs further investigation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1

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