非翻瓣法与翻瓣法在口腔种植手术治疗中疗效的Meta分析

Flapless Versus Flap:Which Technique is More Effective for the Dental Implants?A Meta-Analysis

目的:通过Meta分析评价非翻瓣法与常规翻瓣法,对种植手术中种植体生存率、术后疼痛与肿胀以及手术时长的影响。方法:检索Cochrane图书馆、PUBMED、荷兰医学文摘(EMBASE)和中国生物医学文献数据库;同时手检纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价完成后,进行数据提取。运用Revman 5.2软件进行Meta分析。结果:纳入10篇研究,其中8篇随机对照试验,2篇前瞻性队列研究,涉及患者366名,种植体1 152颗,偏倚风险评价显示8个研究为中度偏倚风险,2个研究为低度偏倚风险。Meta分析的结果显示,非翻瓣法在种植手术过程中,虽然种植体生存率与常规翻瓣法未见明显差别[RR=0.99,95%CI(0.97,1.02),P=0.64],但对于术后疼痛与肿胀发生率,非翻瓣法明显降低了48%和53%(P<0.01,P<0.01),对于手术时长,则缩短了约16min(P<0.01)。结论:在种植手术过程中,非翻瓣法相对于常规翻瓣法,明显降低术后疼痛与肿胀的发生率,缩短了手术时长,提高了手术效率。但还需要更多的临床随机对照试验的支持。

Objective：To systematically review the papers to compare implant survival,postoperative complications and surgical procedure duration of dental implantation between flap and flapless elevation.Methods：We searched PubMed,the Cochrane Central Register of Controlled Trials（CENTRAL）,and EMBASE in June 2013 and selected studies according to the criteria for inclusion.Risk of bias of the included studies was assessed and meta-analysis was achieved depending on Revman 5.2.Results：Eight randomized controlled trials and two comparable prospective cohort trials involving 366 subjects and 1 152 implants were included in this meta-analysis.Eight of them had moderate risk of bias and two had low risk of bias.The implant survival rate revealedno statistically significant difference between the two groups[RR=0.99,95%CI（0.97,1.02）,P=0.64].However,at a patient level,the postoperative complications（postoperative pain and postoperative edema）in the flapless group were significantly reduced [RR = 0.52,95%CI（0.37,0.74）,P〈0.01;RR= 0.47,95%CI（0.33,0.66）,P〈0.01].The analysis also identified that flapless technique significantly reduced the duration of operative procedure [MD=-16.23,95%CI（-29.33,-3.13）,P〈0.01].Conclusion：The present meta-analysis confirmed the effectiveness of flapless technique in dental implant.The implant survival rates of the different between the two techniques are comparable;however,the flapless technique significantly reduced the duration of implant procedure and occurrence of postoperative pain and edema.