拔牙后富血小板血纤蛋白作为牙槽嵴位点保留材料可显著减少牙槽骨高度及宽度的吸收:一项Meta分析

Platelet-rich fibrin as a material for alveolar ridge preservation significantly reduces the resorption of alveolar bone height and width after tooth extraction: a meta-analysis

目的:目前富血小板血纤蛋白在拔牙后位点保留中的应用更加广泛,而与其他材料相比富血小板血纤蛋白保存牙槽嵴的效果不是很明确。文章评估富血小板血纤蛋白在拔牙后牙槽嵴保存中的应用效果,为临床应用富血小板血纤蛋白减少牙槽骨吸收提供理论依据。方法:截止到2020年6月,在The Cochrane Library、PubMed、Web of Science核心合集、EMbase、中国知网、维普和万方数据库进行文献检索,收集所有关于富血小板血纤蛋白用于牙槽嵴保存的临床随机对照研究,包括单纯应用富血小板血纤蛋白和富血小板血纤蛋白复合异质骨。由2位研究人员从检索的文献中提取数据,使用Cochrane偏倚风险评估工具评价纳入研究的偏倚风险。由RevMan 5.3软件对结果指标进行Meta分析。结果:(1)共检索出159篇文献,最终纳入11个随机对照试验,共531例患者,575个拔牙位点;(2)Meta分析结果显示:单纯应用富血小板血纤蛋白时牙槽骨高度吸收量(SMD=-0.38,95%CI:-0.83至-0.06,P> 0.05)差异无显著性意义;富血小板血纤蛋白复合异质骨与单纯异种骨在拔牙后3,6个月时牙槽骨吸收高度(3个月:SMD=-1.40,95%CI:-1.79至-1.01,P <0.05;6个月:SMD=-1.37,95%CI:-1.68至-1.06,P <0.05)、牙槽骨吸收宽度(SMD=-0.18,95%CI:-0.25至-0.11,P <0.05)及拔牙2周后术区黏膜愈合率(SMD=9.90,95%CI:8.61-11.19,P <0.05)方面差异均有显著性意义。结论:拔牙后应用富血小板血纤蛋复合异质骨作为牙槽嵴位点保留的材料时可以明显减少牙槽骨高度及宽度的吸收,也可以加快软组织愈合,但由于纳入研究的样本量较少,还需要更大的样本量临床研究来验证以上结论。

OBJECTIVE: At present, platelet-rich fibrin is widely used in site retention after tooth extraction, but the effect of platelet-rich fibrin in alveolar ridge preservation is not very clear compared with other materials. This study evaluated the effect of applied platelet-rich fibrin in the preservation of alveolar ridge after tooth extraction to provide theoretical basis for clinical application of platelet-rich fibrin to reduce alveolar bone resorption. METHODS: Up to June 2020, all clinical randomized controlled studies on platelet-rich fibrin for alveolar ridge preservation, including platelet-rich fibrin alone and platelet-rich fibrin combined with heterogeneous bone, were collected by using The Cochrane Library, PubMed, Web of science core set, EMbase, CNKI, and Wanfang databases. Two researchers extracted data from the retrieved documents and used Cochrane bias risk assessment tools to evaluate the bias risk included in the study. RevMan 5.3 software was used for meta-analysis.RESULTS:(1) Totally 159 articles were retrieved, and 11 randomized controlled trials were finally included, involving 531 patients and 575 implants.(2) The results of meta-analysis showed that the difference in the height absorption of tooth alveolar bone was not statistically significant when platelet-rich fibrin was applied alone(SMD=-0.38, 95%Ci:-0.83 to-0.06, P > 0.05). There were significant differences between platelet-rich fibrin composite heterogeneous bone and simple xenogeneic bone in alveolar bone resorption height(3 months: SMD=-1.40, 95%Ci:-1.79 to-1.01, P < 0.05;6 months: SMD=-1.37, 95%Ci:-1.68 to-1.06, P < 0.05), alveolar bone resorption width at 3 and 6 months after tooth extraction(SMD=-0.18, 95%Ci:-0.25 to-0.11, P < 0.05), and mouth mucosa healing rate at 2 weeks after tooth extraction(SMD=9.90, 95%Ci:8.61-11.19, P < 0.05). CONCLUSION: Applying platelet-rich fibrin composite heterogeneous bone after tooth extraction can remarkably reduce the resorption of alveolar bone both in height and width and accelerate soft tissue healing. Because of the small sample size included in the study, clinical studies with a large sample size are needed to verify the above conclusions.