自体牙本质用于牙槽嵴增量的Meta分析

Meta-analysis of application of autogenous dentin for alveolar ridge augmentation

目的通过Meta分析方法系统评估在牙槽嵴缺损需要骨增量时使用自体牙本质(ATD)移植的有效性及安全性。方法电子检索2010年1月1日—2022年3月19日PubMed、Embase、WebofScience、CochraneLibrary、CNKI、万方数据库有关牙槽嵴增量使用ATD的临床研究。使用CochraneTool评估随机对照试验的偏倚风险,使用Newcastle-OttawaScale评估队列研究。RevMan 5.4对数据进行合并分析。结果共纳入10项研究,其中5项研究对照组采用自体骨,另5项研究对照组采用脱蛋白牛骨基质(DBBM)。Meta分析结果显示,牙槽嵴增量术后6个月,ATD较自体骨获得更多水平向牙槽嵴增量[MD=2.01,95%可信区间(CI)(1.09,2.93),P<0.0001],但在垂直向牙槽嵴增量上效果相似[MD=−0.06,95%CI(−0.21,0.08),P=0.39]。ATD与自体骨或DBBM相比呈现更少的材料吸收[MD=−0.59,95%CI(−1.03,−0.15),P=0.008;MD=−0.63,95%CI(−1.18,−0.07),P=0.03],而在种植体稳定系数和术后并发症上均无显著差异[MD=−0.76,95%CI(−3.04,1.52),P=0.51;RR=1.01,95%CI(0.33,3.12),P=0.98]。结论有限证据表明,在牙槽嵴缺损中移植ATD可取得与移植自体骨或DBBM类似或更佳的骨增量效果且材料吸收更少,可作为扩增牙槽嵴的植骨材料。但仍需要进行更大样本、更高质量、更长随访时间的临床试验评估ATD在牙槽嵴增量中的疗效。

Objective This investigation aimed to systematically evaluate the efficacy and safety of applying autogenous dentin(ATD)in alveolar ridge augmentation.Methods The PubMed,Embase,Web of Science,Cochrane Library,CNKI,and Wanfang databases were electronically searched from January 1,2010 to March 19,2022 to identify clinical trials and cohort studies that employed ATD in alveolar ridge augmentation.The Cochrane Tool and the Newcastle-Ottawa Scale were employed to assess the risk of bias in randomized controlled trials and cohort studies,respectively.Data were analyzed via RevMan 5.4 software.Results A total of 10 studies were included,5 of which compared ATD with autologous bone and 5 with deproteinized bovine bone matrix(DBBM).Meta-analysis indicated that ATD had preferable performance[MD=2.01,95%confidence interval(CI)(1.09,2.93),P<0.0001]in horizontal ridge augmentation compared with autologous bone but similar effect in vertical ridge augmentation[MD=−0.06,95%CI(−0.21,0.08),P=0.39]at 6 months after alveolar ridge augmentation.In terms of material absorption,ATD was significantly less than autologous bone or DBBM[MD=−0.59,95%CI(−1.03,−0.15),P=0.008;MD=−0.63,95%CI(−1.18,−0.07),P=0.03],but no significant difference in implant stability quotient and postoperative complications was observed[MD=−0.76,95%CI(−3.04,1.52),P=0.51;RR=1.01,95%CI(0.33,3.12),P=0.98].Conclusion ATD,as a bone grafted material for alveolar ridge augmentation,not only achieves similar or better bone incremental performance than autologous bone or DBBM but also has less absorption.However,further evidence from clinical trials with larger samples,higher quality,and longer follow-up period are needed to evaluate its superiority.