引导组织再生联合植骨修复根分叉病变的Meta分析

Combined use of guided tissue regeneration and bone grafting in the treatment of root furcation defects:a meta-analysis

背景:引导组织再生术已被动物实验及临床实践证明可有效引导牙周组织修复再生,产生新的牙周附着。目的:比较并评价引导组织再生术联合植骨术治疗根分叉病变的有效性。方法:计算机联合手工检索从建库截止到2015年公开发表的中英文有关引导组织再生、植骨、根分叉病变治疗的文献。观察指标包括牙周垂直探诊深度、水平探诊深度及附着丧失。采用国际Cochrane协作网推荐的统计软件学Rev-Man5.0完成纳入证据的Meta分析并对发表偏倚进行检验。结果与结论:(1)治疗后6个月复查,引导组织再生组牙周垂直探诊深度改变量、牙周附着水平改变量比牙周清创翻瓣组显著增多(P<0.000 01);引导组织再生+牙周植骨组牙周附着水平改变量、牙周附着水平增加值比牙周清创翻瓣组显著增多(P<0.000 1);引导组织再生+牙周植骨组牙周垂直探诊深度减少值、水平探诊深度减少值、牙周附着水平增加值比引导组织再生组显著增多(P<0.000 01或P=0.01);(2)治疗后12个月复查:引导组织再生+牙周植骨组牙周垂直探诊深度减少值、附着丧失增加值比牙周清创翻瓣组显著增多(P<0.000 01);(3)分析结果表明,引导组织再生+牙周植骨治疗根分叉病变的疗效较引导组织再生或牙周清创翻瓣组更好,引导组织再生的治疗效果明显优于牙周清创翻瓣,但未对不同类型的再生膜以及植骨术应用的不同材料对疗效的影响加以分析,仍需做进一步的循证研究,以明确根分叉病变的治疗方案。

BACKGROUND： Numerous experimental and clinical observations have shown new attachment formation in the periodontium by guided tissue regeneration. OBJECTIVE： To evaluate the efficacy of guided tissue regeneration combined with bone grafting for the treatment of root furcation defects. METHODS： A computer-based online search combined with manual retrieval was conducted up to 2015 to screen the relevant English and Chinese literatures addressing guided tissue regeneration, bone grafting, and root furcation defects. Vertical and horizontal probing depth and attachment loss were analyzed. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles. Moreover, the publication bias was tested. RESULTS AND CONCLUSION： The meta-analysis results showed that at 6 months after treatment, the alterations in vertical probing depth and periodontal attachment were significantly increased after guided tissue regeneration compared with open-flap debridement （P 〈 0.000 01）; the alterations and increment in the periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with open-flap debridement （P 〈 0.000 01）; the reduction in the vertical and horizontal probing depth and the increment in periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration （P 〈 0.000 01 or P = 0.01）. At 12 months after treatment, the reduction in vertical probing depth and the increment in attachment loss were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration （P 〈 0.000 01）. These results indicate that the guided tissue regeneration combined with bone grafting in the treatment of root furcation defects is superior to guided tissue regeneration or open-flap debridement. In addition, in the latter two therapies, guided tissue regeneration shows a better therapeutic effect. However, the therapeutic effects of various types of regenerated membranes and bone grafts need further in-depth study to define the optimal treatment strategy.