不翻瓣种植术与翻瓣种植术对软组织影响的Meta分析

Effects of flapless and flapped implantations on soft tissue:a systematic review and Meta-analysis

目的系统比较不翻瓣种植术与翻瓣种植术对种植体周围软组织产生的影响。方法检索PubMed、Embase、Cochrane Library、Web of Science、Clinical Trails、OpenGrey、OpenDoar、Scopus、Ovid等9个数据库,纳入比较不翻瓣种植术与翻瓣种植术修复缺失牙的相关随机对照试验,检索时限为从2013年1月1日到2023年8月27日,采用软件RevMan 5.3、Stata 14.0对符合纳入标准的研究进行Meta分析。结果共检得1245篇文献,最终纳入17项研究。Meta分析结果表明:不翻瓣种植术可产生更好的种植体周围软组织愈合,种植体成功率[均数差(MD)=1.06,95%可信区间(CI)(1.02,1.10),P=0.004]、角化龈宽度变化[MD=0.10,95%CI(0.00,0.20),P=0.04]、探诊深度[MD=-0.60,95%CI(-0.67,-0.53),P<0.00001]均优于翻瓣种植术,差异有统计学意义;改良牙菌斑指数[标准化均数差(SMD)=-0.41,95%CI(-0.81,0.00),P=0.05]、改良龈沟出血指数[SMD=-0.44,95%CI(-0.78,-0.10),P=0.01]最终合并结果显示优于翻瓣种植术;不翻瓣种植术龈乳头指数高于翻瓣种植术;两者间牙菌斑指数、牙龈指数变化的差异无统计学意义。结论与翻瓣种植术相比,不翻瓣种植术能实现更高的种植体成功率、更小的角化龈宽度变化、更小的探诊深度,不翻瓣种植术的改良牙菌斑指数、改良龈沟出血指数、龈乳头指数也存在优势。

Objective This study aimed to systematically compare the effects of flapless and flapped implantations on the surrounding soft tissues of dental implants.Methods Nine databases were searched,including PubMed,Embase,Cochrane Library,Web of Science,Clinical Trials,OpenGrey,OpenDoar,Scopus,and Ovid,from January 1,2013,to August 27,2023.Randomized controlled trials comparing flapless implantation with flapped implantation for restoration of missing teeth were included.Meta-analysis was conducted on studies that met the inclusion criteria by using Rev-Man 5.3 and Stata 14.0.Results A total of 1245 articles were retrieved,and 17 studies were ultimately included.The results of Meta-analysis showed that flapless implantation resulted in better healing of the soft tissues around the dental implants than flapped implantation.Moreover,flapless implantation showed superior changes in implant success rate[mean difference(MD)=1.06,95%confidence interval(CI)(1.02,1.10),P=0.004],the width of keratinized gingival changes[MD=0.10,95%CI(0.00,0.20),P=0.04],and probing depth[MD=-0.60,95%CI(-0.67,-0.53),P<0.00001],with statistically significant differences.The final combined results of modified plaque index[standardized mean difference(SMD)=-0.41,95%CI(-0.81,0.00),P=0.05]and modified sulcus bleeding index[SMD=-0.44,95%CI(-0.78,-0.10),P=0.01]showed superiority over flapped implantation.The papillary presence index was higher in the flapless implantation group than in the flapped implantation group.No statistically significant differences were observed in plaque index and gingival indices changes between the two groups.Conclusion Flapless implantation can achieve higher implant success rate,smaller changes in the width of keratinized gingival,and smaller probing depths than flapped implantation.It also has advantages in terms of modified plaque index,modified sulcus bleeding index,and papillary presence index.