可吸收与不可吸收口腔修复膜在牙种植中引导骨再生临床疗效的Meta分析

Efficacy of resorbable membrane and non-resorbable membrane in dental implant to guide bone regeneration: a meta-analysis

目的系统评价可吸收与不可吸收口腔修复膜在牙种植中引导骨再生的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、VIP、CNKI和WanFang Data数据库,搜集有关可吸收和不可吸收口腔修复膜在牙种植中引导骨再生临床疗效的随机对照试验(RCT),检索时限均从建库至2019年2月20日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入22个RCT,包括1 995例患者。Meta分析结果显示:可吸收膜组在修复情况[RR=1.21,95%CI(1.17,1.26),P<0.000 01]、骨厚度[MD=0.40,95%CI(0.36,0.43),P<0.000 01]、植骨厚度[MD=0.40,95%CI(0.35,0.46),P<0.000 01]、患者满意度[RR=1.19,95%CI(1.04,1.36),P=0.009]、组织学水平上的骨结合[MD=4.82,95%CI(0.14,9.50),P=0.04]和矿化组织总量[MD=3.73,95%CI(0.32,7.14),P=0.03]等方面均优于不可吸收膜组,且不良反应发生率更低[RR=0.28,95%CI(0.20,0.39),P<0.000 01]、术前至术后6个月骨缺损宽度变化更小[MD=-0.62,95%CI(-0.93,-0.31),P<0.000 01]。但两组在组织学水平上非矿化组织总量[MD=-2.48,95%CI(-5.81,0.85),P=0.14]的差异无统计学意义。结论当前证据表明,可吸收口腔修复膜具有较好的修复效果,有助于成骨并减少不良反应的发生,具有良好的安全性和有效性。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objectives To systematically review the efficacy of resorbable membrane and non-resorbable membrane in dental implant to guide bone regeneration. Methods PubMed, EMbase, The Cochrane Library, Web of Science, VIP, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs) of the efficacy of resorbable membrane and non-resorbable membrane in dental implant to guide bone regeneration from inception to February 20^th, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 22 RCTs involving 1 995 patients were included. The results of meta-analysis showed that: the resorbable membrane group was superior to non-resorbable membrane group in terms of repair success(RR=1.21, 95%CI 1.17 to1.26, P<0.000 01), the bone thickness(MD=0.40, 95%CI 0.36 to 0.43, P<0.000 01), bone graft thickness(MD=0.40, 95%CI0.35 to 0.46, P<0.000 01), patient satisfaction(RR=1.19, 95%CI 1.04 to 1.36, P=0.009), histological evaluation in bone contact(MD=4.82, 95%CI 0.14 to 9.50, P=0.04) and the total mineralized tissue(MD=3.73, 95%CI 0.32 to 7.14, P=0.03).They also had lower adverse reaction rate(RR=0.28, 95%CI 0.20 to 0.39, P<0.00001) and changes of bone defect width from preoperative to 6 months postoperatively(MD=-0.62, 95%CI-0.93 to-0.31, P<0.00001) with statistically significant differences. However, there was no significant difference in histological evaluation of non-mineralized tissue(MD=-2.48, 95%CI-5.81 to 0.85, P=0.14) between two groups. Conclusions Current evidence shows that the resorbable membrane has better repairing effects, for which helps to promote the development of bone and bone graft,reduce the incidence of adverse reactions, which has good safety and effectiveness. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusion.