上颌窦侧壁窦底抬高术后非植骨即刻种植的临床疗效:基于随机对照的meta分析

Clinical effect of immediate postoperative implantation without bone graft after sinus elevation in the lateral maxillary sinus wall procedures:a meta-analysis of randomized controlled trials

目的系统评价基于随机对照研究下植骨与非植骨2种方式对上颌窦侧壁窦底抬高术后即刻种植的疗效差异。方法计算机不受限制地检索PubMed、Web of Science、Embase、Cochrane library、中国知网、万方数据库、维普等数据库对比植骨与非植骨对上颌窦侧壁窦底抬高术后即刻种植疗效的临床试验,检索时间为建库至2020年8月,文章采用Cochrane偏倚风险评估工具进行偏倚风险评估,运用Review Man5.3软件对最终纳入文献的研究数据进行meta分析。结果共纳入7篇文献,种植体数共198枚,上颌窦例数170例。种植体脱落率非植骨组与植骨组差异无统计学意义,显示(RR=1.51,95%CI:0.32~7.81,P=0.610)。骨增量方面,非植骨组临床效果差于植骨组(SMD=-2.28,95%CI:-3.27~-0.85,P=0.002),二者相差2.28 mm。种植体稳定性方面,非植骨组与植骨组差异无统计学意义(SMD=-0.03,95%CI:-0.45~0.38,P=0.870)。结论对于上颌窦侧壁窦底抬高术后即刻种植术中,在骨增量方面植骨组优于非植骨组,在种植体脱落率与种植体稳定性方面,二者无显著差异。

Objective To systematically evaluate the difference in the efficacy of bone grafting versus non-bone grafting for immediate postoperative implantation after sinus floor elevation in the lateral maxillary sinus wall based on a randomized controlled study.Methods By searching PubMed,Web of Science,Embase,Cochrane Library,CNKI,Wanfang Database and VIP Journals with a unrestricted computer,the clinical trials comparing the efficacy between bone grafting and non-grafting after the sinus lift procedures were collected from inception of these database above to August 2020.The Cochrane risk of bias′s assessment tool was used to perform the risk of bias assessment.The Review Manager 5.3 software was used to perform a meta-analysis of the study data ultimately included in the literature.Results A total of seven articles were included in this study,including 198 implants and 170 cases of maxillary sinus.The result of the meta-analysis showed that the difference between the non-bone grafting and bone grafting groups was no significant in terms of implant shedding rate(RR=1.51,95%CI:0.32-7.18,P=0.610).In terms of bone gain,clinical effect in the non-grafting group was weaker than the bone grafting(SMD=-2.28,95%CI:-3.72-0.85,P=0.002),and the difference was 1.60 mm.In terms of implant stability there was no significant difference between two groups(SMD=-0.03,95%CI:-0.45-0.38,P=0.870).Conclusion For immediate postoperative implantation after sinus floor elevation in the lateral maxillary sinus wall,the bone grafting group was superior on the bone gain than the non-bone grafting group.There was no significant difference in implant stability and implant shedding rate between the two methods.