比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession:a Meta-analysis

目的系统评价隧道术(TUN)和冠向复位瓣(CAF)联合结缔组织移植术(CTG)治疗牙龈退缩的疗效及长期稳定性。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试验(RCT),只有用于比较CAF与TUN的RCT才被纳入本篇Meta分析。检索时间自建库至2022年9月1日。结果本研究共纳入8项RCT,包括305位受试者的454个退缩位点。Meta分析结果显示:在主要指标平均根面覆盖率(MRC)长期稳定性方面,CAF组、TUN组在短期和长期结果比较上差异无统计学意义,分别是[MD:1.45%,95%CI(−2.93%,5.82%),P=0.52]、[MD:−0.70%,95%CI(−6.41%,5.00%),P=0.81],但CAF组在术后MRC长期结果上较TUN组表现更佳[MD:5.69%,95%CI(0.87%,10.50%),P=0.02],其中完全根面覆盖率(CRC)分析结果与MRC结果大致相同。次要指标角化龈宽度(KTW)增长量,短期内TUN组显著优于CAF组[MD:−0.38 mm,95%CI(−0.67 mm,−0.10 mm),P=0.008],长期结果显示两组差异无统计学意义[MD:−0.26 mm,95%CI(−0.94 mm,0.43 mm),P=0.46]。次要指标根面覆盖美学评分(RES),TUN组优于CAF组,差异具有统计学意义[MD:0.62,95%CI(0.28,0.96),P=0.0003]。术后VAS疼痛指数评分,由于纳入文献统计的结果较少,且异质性太大,分析的结果未见显著性差异[MD:0.53,95%CI(−1.96,3.03),P=0.68]。结论本研究发现CAF+CTG和TUN+CTG在治疗牙龈退缩均可取得良好CRC,且CAF比TUN表现更佳,两组均能取得良好的长期稳定性。在术后RES,TUN组较CAF组评分更高。考虑到本研究存在一定的局限性,未来仍需要更大样本、更高质量、更长随访时间的临床试验评估TUN在牙龈退缩手术的疗效。

Objective This study aimed to evaluate the efficacy and long-term stability of tunnel technique(TUN)and coronally advanced flap(CAF)combined with connective tissue graft(CTG)in treating gingival recession.Meth⁃ods Databases including PubMed,Web of Science,Embase,and CNKI were electronically searched to collect randomized controlled trial(RCT)of CAF+CTG compared to TUN+CTG in the treatment of Miller classⅠorⅡgingival recession on September 1,2022.Results There were 8 RCTs with 305 patients(454 recession sites)participating.The results of the Meta-analysis revealed that,in terms of mean root coverage(MRC)of main indicators,no significant difference was found between the CAF group and the TUN group in both short-and long-term results,which were[MD:1.45%,95%CI(−2.93%,5.82%),P=0.52]and[MD:−0.70%,95%CI(−6.41%,5.00%),P=0.81].However,the CAF group outperformed the TUN group in the long term[MD:5.69%,95%CI(0.87%,10.50%),P=0.02],and the results of complete root coverage(CRC)analysis were similar to those of MRC.In the short term,the TUN group grew keratinized gingiva significantly faster than the CAF group[MD:−0.38 mm,95%CI(−0.67 mm,−0.10 mm),P=0.008].Long-term findings revealed no significant difference between the two groups[MD:−0.26 mm,95%CI(−0.94 mm,0.43 mm),P=0.46].The TUN group’s secondary index root coverage esthetic score(RES)was statistically significantly higher than the CAF group’s[MD:0.62,95%CI(0.28,0.96),P=0.0003].Given that there were few results included in the literature and the heterogeneity was too great,no significant difference was observed in the postoperative VAS pain index score[MD:0.53,95%CI(−1.96,3.03),P=0.68].Conclusion This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession,with CAF outperforming TUN and both groups achieving good long-term stability.After the operation,the TUN group had a higher RES than the CAF group.Given the limitations of this study,more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.