比较富血小板纤维蛋白和上皮下结缔组织治疗单个牙位牙龈退缩效果的Meta分析

Comparison of platelet-rich fibrin and connective tissue graft in conjunction with coronally advanced flap in the treatment of single gingival recessions:a meta-analysis

目的:系统评价富血小板纤维蛋白(plateletrich fibrin, PRF)和结缔组织移植术(connective tissue graft, CTG)联合冠向复位瓣(coronally advanced flap, CAF)治疗单个牙位牙龈退缩(single gingival recessions, S-GRs)的疗效。方法:通过计算机检索PubMed、Web of Science、Embase、CNKI数据库,搜集相关的临床随机对照实验(randomized clinical trials, RCT)。检索时间自建库至2022年3月。结果:本研究最终纳入7项RCT,包括137位受试者的224个退缩位点。Meta分析结果显示:与PRF相比,CTG在主要指标结果GRD、MRC上可获得更好的表现,分别是[MD=0.19,95%CI(0.04,0.33),P=0.01]、[MD=12.15,95%CI(8.62,15.69),P<0.00001];在KTW变化量上,两组差异具有统计学意义[MD=0.25,95%CI(0.06,0.45),P=0.01],CTG组KTW变化量更多。但VAS指标上PRF表现更优[MD=0.97,95%CI(0.80,1.15),P<0.00001]。结论:PRF与CTG相比,在MRC、GRD、KTW上依然是CTG表现更优,但使用PRF治疗S-GRs可减轻患者术后疼痛不适、降低感染发生率。

Objective:To systematically review the efficacy of coronally advanced flap(CAF)combined with plateletrich fibrin(PRF)compared to the CAF in addition to connective tissue graft(CTG)in the treatment of Miller Class I or II single gingival recessions(S-CRs).Methods:Databases including PubMed,Web of Science,Embase,CNKI were electronically searched to collect randomized controlled trials(RCTs)of CAF+PRF compared to CAF+CTG in the treatment of Miller class I or II single GRs to March 1,2022.Two reviewers worked separately to screen literature,gather data,and assess the likelihood of bias in the studies that were included.The RevMan 5.3 software was then used to do the meta-analysis.Results:There were 7 RCTs in total,with 137 patients(224 recession sites)participating.The results of the meta-analysis revealed that CTG groups had higher percentages of GRD(MD=0.19,95%CI 0.04 to 0.33,P=0.01),more MRC(MD=12.15,95%CI 8.62 to 15.69,P<0.0001).There was a statistically significant difference in KTW between the two groups(MD=0.25,95%CI 0.06 to 0.45,P=0.01).However,the CAF+PRF group had a statistically significant advantage in VAS when compared to the CAF+CTG group(MD=0.97,95%CI 0.80 to 1.15,P<0.00001).Conclusion:In the treatment of S-CRs,CTG outperformed the other in MRC,GRD and KTW.However,PRF can considerably minimize postoperative pain,discomfort,and infection when compared to CTG.