富血小板纤维蛋白用于年轻恒牙牙髓血运重建术效果的系统评价与Meta分析

The effect of platelet rich fibrin in pulp revascularization of young permanent teeth: a Systematic review and Meta-analysis

目的系统评价富血小板纤维蛋白(platelet rich fibrin,PRF)、富血小板血浆(platelet rich plasma,PRP)用于年轻恒牙牙髓血运重建术的效果。方法检索PubMed、Ovid、Web of sciences、Sinomed、中国知网、万方等数据库,检索时限为建库至2022年5月,搜索PRF用于年轻恒牙牙髓血运重建术效果的随机对照试验,筛选文献,提取数据,用RevMan5.4软件和Stata16进行Meta分析。结果纳入12个随机对照试验,共455例患者。Meta分析结果显示,PRF牙髓血运重建术、PRP牙髓血运重建术和常规牙髓血运重建术的临床成功率相似,均利于牙髓活力的恢复、根尖孔闭合及根尖直径的缩小,差异无统计学意义。与常规牙髓血运重建术相比,PRF牙髓血运重建术更有利于增加根管壁厚度[P=0.002,MD=0.28,95%CI(0.10,0.46)]和牙根长度[P<0.00001,MD=1.55,95%CI(0.96,2.13)],诱导牙骨质样组织沉积(P<0.05),而与PRP无显著差异。结论当前证据显示,PRF用于牙髓血运重建术更有利于增加根管壁厚度和牙根长度。

Objective To systematically evaluate the effect of platelet rich fibrin(PRF)on pulp revascularization,as well as classic revascularization and platelet rich plasma(PRP)on pulp revascularization of young permanent teeth.Methods The databases including PubMed,OVID,Web of Sciences,Sinomed,CNKI and Wanfang were searched from inception to May 2022 to collect randomized controlled trials of PRF on endodontic revascularization procedures of young permanent teeth.Literature was screened,data were extracted,and Meta-analysis was performed using Revman 5.4 software and Stata16.Results Twelve RCTs with 455 patients were included.The results of the Meta-analysis showed that the clinical outcomes of PRF,and classic revascularization,PRP were similar,both favoring the restoration of pulp vitality,apical foramen closure and decreasing apical diameter,with no significant differences.PRF was more beneficial than classic revascularization for increasing root canal wall thickness[P=0.002,MD=0.28,95%CI(0.10,0.46)]and root length[P<0.00001,MD=1.55,95%CI(0.96,2.13)]and inducing cementum like tissue deposition(P<0.05),whereas there was no significant difference between PRF and PRP.Conclusion Current evidence showed that PRF was more beneficial for increasing root canal wall thickness and root length than classic revascularization.