引导组织再生联合植骨修复治疗牙周骨内缺损效果的Meta分析

发布时间：2018-08-25 11:26

【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(P0.05);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(P0.05),牙龈退缩减少0.35 mm,临床附着水平有所增加0.63 mm(P0.05);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(P0.05)。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。
[Abstract]:Background: guided tissue regeneration and bone grafting are the research focus in the treatment of periodontal bone defects caused by moderate and severe periodontitis. Objective: to evaluate the efficacy of guided tissue regeneration combined with bone graft in the treatment of periodontal intraosseous defect, and to explore the feasibility of this method, and to provide evidence-based basis for clinical application. Methods: PubM ed,Cochrane library,EMbase, China knowledge Network, Weipu and Wanfang databases were searched by computer, the English key words included "guided tissue regeneration,bone grafts,periodontal bone defects", the Chinese key words included "guided tissue regeneration", and bone graft was performed. To find out the relationship between guided tissue regeneration and combined bone grafting in the treatment of periodontal intraosseous defect. The retrieval time was 2000 to 2016. Two researchers independently sifted the literature, extracted the data and evaluated the bias risk in the study, and evaluated the literature quality of 12 randomized controlled trials. The meta analysis was carried out by Rev Man 5.3 statistical software. Results & conclusion: a total of 414 teeth were included in 12 studies, including 228 teeth in the experimental group and 216 teeth in the control group. The guided tissue regeneration combined with bone graft group could reduce the probing depth of periodontal diagnosis by 1.18 mm, reduce the alveolar bone defect depth by 0.23 mm, and increase the clinical attachment level by 2.03 mm (P0.05), and the guided tissue regeneration combined with flap group could reduce the depth of alveolar bone defect by 1.18 mm, (P0.05). Compared with guided tissue regeneration, bone grafting increased 0.34 mm and alveolar bone defect depth decreased 0.73 mm (P0.05), gingival retraction decreased 0.35 mm, clinical attachment level increased 0.63 mm (P0.05), guided tissue regeneration combined with bone grafting group was higher than that of bone graft group (P0.05). The clinical attachment level increased by 0. 04 mm and gingival retraction increased by 0. 13 mm and 0. 11 mm, respectively (P0.05). The results showed that in the patients with periodontal bone defect caused by moderate and severe periodontitis, the effect of guided tissue regeneration combined with bone graft was better than that of simple flap and guided tissue regeneration, but there was no significant difference compared with bone grafting. The results of this Meta analysis have not yet classified the membrane materials and bone substitutes used, and there is still a lack of randomized controlled trials of high quality and large samples.
【作者单位】：新疆医科大学第一附属医院牙周粘膜科;
【基金】：新疆维吾尔自治区自然科学基金资助项目(2011211A071)~~
【分类号】：R781.4

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