磷酸钙移植结合引导组织再生治疗牙周骨缺损--系统回顾和荟萃分析

IF 4.1 4区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Evidence-Based Dental Practice Pub Date : 2024-07-25 DOI:10.1016/j.jebdp.2024.102022

MONIREH KOUHI PhD , SABA YOUSEFI MSc , ZAHRA SADAT SAJADI-JAVAN Pharm D , ERFAN SADEGHI PhD , OMID SAVABI MD , MOHAMMADJAVAD SHIRANI DDS, MSc

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引用次数: 0

摘要

背景本系统性综述的目的是评估采用磷酸钙（CP）移植物结合引导组织再生（GTR）膜的再生方法治疗骨内和毛缘缺损的临床疗效，并与开放皮瓣清创术（OFD）进行比较。方法根据PRISMA检查表制定了综述方案，以寻找在骨内和/或毛缘缺损患者中比较磷酸钙移植物结合引导组织再生（GTR）膜与开放皮瓣清创术的英文随机临床试验（RCT）。该研究同时进行了电子和人工搜索。研究结果为探诊袋深度（PD）和临床附着水平（CAL）。为了评估治疗效果，我们使用限制性最大似然法建立了随机效应模型，以估计汇总效应大小和相应的 95% 置信区间。对纳入研究的质量评估采用 Cochrane 偏倚风险工具 5.1.0 版。结果在确定的 451 条记录中，有 7 项研究在剔除重复和不符合纳入标准的研究后进行了荟萃分析。其中 5 篇论文的治疗部位为牙槽窝内缺损，2 项研究的治疗部位为毛面缺损。根据荟萃分析的结果，骨内缺损的 CAL 增加和 PD 减少的加权平均差（WMD）分别为 1.536 毫米（95% CI -0.933 至 2.139）和 1.601 毫米（95% CI -0.727 至 2.474）。CP移植物加GTR组与OFD组在CAL增大和PD缩小方面的差异具有统计学意义。同样，对于毛面缺损，应用 CP 移植物加 GTR 比 OFD 在 CAL 增加（WMD 为 1.807 mm；95% CI 为 0.346-3.268）和 PD 减少（WMD 为 1.519 mm，95% CI 为 1.215-4.253）方面具有辅助优势。结论：考虑到本系统综述的局限性，研究结果表明，磷酸钙移植物联合 GTR 在牙周骨内和毛囊缺损的愈合方面优于 OFD。

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CALCIUM PHOSPHATE GRAFTS COMBINED WITH GUIDED TISSUE REGENERATION IN THE TREATMENT OF PERIODONTAL BONY DEFECTS- A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

The objective of this systematic review is to assess the clinical outcomes of intrabony and furcation defects treated using a regenerative approach with calcium phosphate (CP) grafts combined plus guided tissue regeneration (GTR) membrane in comparison to open flap debridement (OFD).

Method

A review protocol was created under PRISMA checklist to find randomized clinical trials (RCTs) in English that compared CPs plus GTR with OFD in humans with intrabony and/or furcation defects. Both electronic and manual searches were conducted. The studied outcomes were probing pocket depth (PD) and clinical attachment level (CAL). To evaluate the treatment effect, a random effects model using restricted maximum likelihood method was performed to estimate the pooled effect size and corresponding 95% confidence interval. The quality assessment of the included studies was performed using Cochrane risk of bias tools version 5.1.0.

Results

Out of the 451 records identified, 7 studies were subjected to meta-analysis after discarding duplicates and excluding the studies that did not meet the inclusion criteria. While treated sites were intrabony defects in 5 papers, 2 studies focused on furcation defects. Based on the findings of the meta-analysis, the weighted mean difference (WMD) of 1.536 mm (95% CI −0.933 to 2.139) and 1.601 mm (95% CI −0.727 to 2.474) was obtained for CAL gain and PD reduction, respectively, in intrabony defects. The differences between CP grafts plus GTR groups and OFD groups for CAL gain and PD reduction were statistically significant. Similarly, for furcation defects, the application of CP grafts with GTR resulted in adjunctive advantages over OFD in terms of CAL gain (WMD of 1.807 mm; 95% CI 0.346-3.268), and PD reduction (WMD of 1.519 mm, 95% CI 1.215-4.253). The analysis on the limited number of study on furcation treatment revealed a statistically significant difference in CAL gain between CP grafts plus GTR groups and OFD groups, but a nonsignificant difference for PD reduction.

Conclusion

The results revealed that calcium phosphate grafts combined with GTR are superior to OFD in the healing of periodontal intrabony and furcation defects, considering the limitations of the present systematic review.

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来源期刊

Journal of Evidence-Based Dental Practice DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

6.00

自引率

16.70%

发文量

105

审稿时长

28 days

期刊介绍： The Journal of Evidence-Based Dental Practice presents timely original articles, as well as reviews of articles on the results and outcomes of clinical procedures and treatment. The Journal advocates the use or rejection of a procedure based on solid, clinical evidence found in literature. The Journal''s dynamic operating principles are explicitness in process and objectives, publication of the highest-quality reviews and original articles, and an emphasis on objectivity.