运用脱细胞真皮基质或结缔组织移植物治疗多发性相邻牙龈退缩的Meta分析

Treatment of multiple adjacent gingival recessions with an acellular dermal matrix or a connective tissue graft:a Meta-analysis

目的应用Meta分析方法评估运用脱细胞真皮基质或自体结缔组织移植物治疗多发性相邻牙龈退缩的差异性。方法根据纳入和排除标准在4个英文电子数据库中筛选随机对照试验,检索日期截止至2022年4月20日,主要结局指标为角化牙龈组织宽度、退缩深度、探诊深度、临床附着水平、完全根面覆盖和根面覆盖美学评分。结果共纳入7项随机对照试验,术后12个月后,对照组结缔组织移植物较试验组脱细胞真皮基质能增加角化牙龈组织宽度[MD=−0.28(−0.47,−0.08),P=0.006]、降低牙龈退缩深度[MD=0.23(0.12,0.35),P<0.0001]和提高完全根面覆盖[RR=0.80,95%CI(0.69,0.93),P=0.003];探诊深度、临床附着水平和根面覆盖美学评分差异无统计学意义。结论多发性相邻牙龈退缩治疗后,结缔组织移植物在增加角化牙龈组织宽度、降低牙龈退缩深度和提高完全根面覆盖方面具有优势,但脱细胞真皮基质由于手术简便并有相似的效果亦有临床应用价值。

Objective To evaluate the effectiveness of an acellular dermal matrix or a connective tissue autograft in the treatment of multiple adjacent gingival recessions through Meta-analysis. Methods Randomized controlled trials were screened in four electronic databases in English according to the inclusion and exclusion criteria until April 20,2022. The main outcome indicators were keratinized gingival tissue width, recession depth, probing depth, clinical attachment level, complete root coverage, and root coverage esthetic score. Results Seven randomized controlled trials were included. After 12 months, the connective tissue graft in the control group could increase the keratinized gingival tissue width [mean difference(MD) =-0.28(-0.47,-0.08), P=0.006], reduce the gingival recession depth [MD=0.23(0.12,0.35), P<0.000 1], and improve the complete root coverage [risk ratio=0.80, 95% confidence interval(0.69, 0.93), P=0.003] compared with the acellular dermal matrix in the experimental group. No significant difference was found in probing depth, clinical attachment level, and root coverage esthetic score between groups. Conclusion Connective tissue grafts have advantages in increasing the keratinized gingival tissue width, reducing the gingival recession depth, and improving the complete root coverage in surgeries for treating multiple adjacent gingival recessions. Acellular dermal matrices also have some clinical value in terms of operation simplicity and similar effectiveness.