单用生物制剂或联合移植材料治疗骨内缺损牙周再生的临床效果：一项系统综述和荟萃分析。

IF 5.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of dentistry Pub Date : 2025-08-31 DOI:10.1016/j.jdent.2025.106080

Nicola Alberto Valente , Claudia Pileri , Lorenzo Floris , Nicola Carrus , Zuhair Natto , Marco Clementini

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引用次数: 0

摘要

目的：本系统综述和荟萃分析调查了与单独使用生物制剂相比，骨移植联合生物制剂是否能提高牙周骨内缺损再生治疗的临床效果。数据来源：电子检索在PubMed， Web of Science和Scopus中进行，截止到2024年12月18日，遵循PRISMA指南。人工筛选的主要牙周病期刊补充了研究。研究选择：纳入随访≥6个月的随机对照试验，如果比较单独使用生物制剂（如牙釉质基质衍生物、富血小板纤维蛋白、重组生长因子）与骨移植联合治疗骨内缺损。主要结果是探测袋深度（PPD）降低，临床附着水平（CAL）增加，放射学骨水平（RBL）增加。结果：21项rct（739例患者，828例缺陷）符合纳入标准。联合治疗导致PPD减少（平均差异：0.38 mm; p = 0.02）和RBL增加（0.81 mm; p = 0.003）显著增加。CAL增重表现出有利但不显著的趋势（0.30 mm; p = 0.22）。移植物组牙龈退缩略低，而BoP和PI未受影响。亚组分析表明，PRF和生长因子从移植中获得更多的益处，而牙釉质基质衍生物（EMD）在移植或不移植的情况下提供了相当的结果。结论：将移植物材料添加到PRF和生长因子中，可获得有限但可测量的再生结果改善，而EMD似乎无论移植与否都能产生相当的结果。临床相关性：这些发现表明，虽然移植可以提高某些临床参数，但其附加价值可能取决于所使用的特定生物制剂，支持在牙周再生手术中选择性使用而不是系统使用。

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Clinical outcomes of periodontal regeneration using biologic agents alone or in combination with graft materials for intrabony defects: A systematic review and meta-analysis

Objectives

This systematic review with meta-analysis investigated whether combining bone grafts with biologic agents enhances clinical outcomes compared to biologic agents alone in the regenerative treatment of periodontal intrabony defects.

Data sources

Electronic searches were conducted in PubMed, Web of Science, and Scopus up to December 18, 2024, following PRISMA guidelines. Manual screening of major periodontal journals complemented the search.

Study selection

Randomized controlled trials with ≥6 months follow-up were included if they compared biologic agents alone (e.g., enamel matrix derivative, platelet-rich fibrin, recombinant growth factors) to their combination with bone grafts in the treatment of intrabony defects. Primary outcomes were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and radiographic bone level (RBL) gain.

Results

Twenty-one RCTs (739 patients, 828 defects) met inclusion criteria. Combination therapy resulted in significantly greater PPD reduction (mean difference: 0.38 mm; p = 0.02) and RBL gain (0.81 mm; p = 0.003). CAL gain showed a favorable but non-significant trend (0.30 mm; p = 0.22). Gingival recession was slightly lower in the graft group, while BoP and PI were unaffected. Subgroup analyses suggested that PRF and growth factors derive more benefit from grafting, whereas enamel matrix derivatives (EMD) offered comparable outcomes with or without grafts.

Conclusions

Limited yet measurable improvements in regenerative outcomes are obtained with the addition of graft materials to PRF and growth factors, while EMD seems to yield comparable outcomes regardless of grafting.

Clinical relevance

These findings suggest that while grafting can enhance certain clinical parameters, its added value may depend on the specific biologic agent used, supporting a selective rather than systematic use in periodontal regenerative procedures.

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来源期刊

Journal of dentistry 医学-牙科与口腔外科

CiteScore

7.30

自引率

11.40%

发文量

349

审稿时长

35 days

期刊介绍： The Journal of Dentistry has an open access mirror journal The Journal of Dentistry: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The Journal of Dentistry is the leading international dental journal within the field of Restorative Dentistry. Placing an emphasis on publishing novel and high-quality research papers, the Journal aims to influence the practice of dentistry at clinician, research, industry and policy-maker level on an international basis. Topics covered include the management of dental disease, periodontology, endodontology, operative dentistry, fixed and removable prosthodontics, dental biomaterials science, long-term clinical trials including epidemiology and oral health, technology transfer of new scientific instrumentation or procedures, as well as clinically relevant oral biology and translational research. The Journal of Dentistry will publish original scientific research papers including short communications. It is also interested in publishing review articles and leaders in themed areas which will be linked to new scientific research. Conference proceedings are also welcome and expressions of interest should be communicated to the Editor.