国际口腔医学杂志

国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (6): 644-651.doi: 10.7518/gjkq.2020110

• 论著 • 上一篇    下一篇

植骨术与植骨联用屏障膜在牙周再生治疗中临床疗效对比的系统评价与Meta分析

汪是琦1(),常雅琴2,陈斌2,谭葆春2,泥艳红1()   

  1. 1.南京大学医学院附属口腔医院·南京市口腔医院中心实验室 南京 210008
    2.南京大学医学院附属口腔医院·南京市口腔医院牙周病科 南京 210008
  • 收稿日期:2020-06-12 修回日期:2020-08-02 出版日期:2020-11-01 发布日期:2020-11-06
  • 通讯作者: 泥艳红
  • 作者简介:汪是琦,住院医师,学士,Email： 304484176@qq.com
  • 基金资助:
    南京市卫生青年人才基金(QRX17083)

Comparison of clinical outcomes between using bone graft alone and the combination of bone graft with membrane for periodontal regeneration therapy: a systematic review and Meta-analysis

Wang Shiqi1(),Chang Yaqin2,Chen Bin2,Tan Baochun2,Ni Yanhong1()   

  1. 1. Central Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    2. Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
  • Received:2020-06-12 Revised:2020-08-02 Online:2020-11-01 Published:2020-11-06
  • Contact: Yanhong Ni
  • Supported by:
    Nanjing Health Excellent Youth Foundation(QRX17083)

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摘要：

目的 比较牙周再生治疗中单纯植骨术与植骨术联合应用屏障膜的临床疗效差异。方法 在PubMed、Cochrane 、Embase、Web of Science、CNKI、CBM、万方数据库及相关杂志中检索1988年6月至2019年5月植骨术与植骨联用膜材料的临床疗效对比的相关研究,采用RevMan 5.3软件进行数据分析。结果 22篇研究符合纳入标准,经评估,最终15篇研究被纳入。Meta分析结果显示,术后6个月植骨组与联合组在临床附着水平、探诊深度、骨增量方面无明显的统计学差异（P>0.05）;牙龈退缩方面,与植骨组相比,联合组使用不可吸收膜产生了更多的退缩（P<0.05）,而使用可吸收膜产生了较少的退缩（P<0.05）。结论 牙周再生治疗时单纯植骨术与植骨联用膜材料均有良好的临床疗效,除牙龈退缩外,尚未发现两者的临床疗效存在明显差异。

关键词: 引导组织再生术, 植骨术, 牙周再生, 临床疗效, Meta分析

Abstract:

Objective This study aimed to compare the clinical effect of using bone graft alone with the combination of bone grafts and membrane in the periodontal regeneration therapy. Methods Relevant studies on the comparison of using bone graft alone and the combination of bone graft with membrane published from June 1988 to May 2019 were identified by electronic and manual search in PubMed, Cochrane, Embase, Web of Science, CNKI, CBM and Wanfang Databases. Using RevMan 5.3 software to make a statistical analysis of all the clinical outcomes. Results Twenty-two studies ful-filling the inclusion criteria were included in the analysis. After assessment, fifteen studies were selected for Meta-analysis and systematic review. Results showed at 6 months of post-surgery, there has no significant differences between bone grafts group and the combined group in terms of clinical attachment level, probing depth and vertical bone fill (P>0.05). For the gingival recession, the combined use of non-absorbable membrane lead to more recession (P<0.05) while the use of absorbable membrane lead to less recession (P<0.05). Conclusion Both the combined therapy and bone grafts alone are effective in the periodontal regeneration therapy, but the statistically differences between two methods were not observed in this limited study except for the gingival recession.

Key words: guided tissue regeneration, bone trans-plantation, periodontal regeneration, clinical effect, Meta-analysis

中图分类号: 

  • R782.1

图1

文献筛选流程图"

表1

纳入研究的基本特征"

纳入研究 方法 例数 干预措施 随访/月 结局指标
类型 地区 试验组 对照组
Taheri等[8] 分口+平行 伊朗 8/10 Bio-Oss+Bio-Gide Bio-Oss 6 ①②③④
Kumar等[9] 分口设计 印度 27/27 Hydroxyapatite+AM Hydroxyapatite 6 ①②④
Chung等[10] 平行对照 韩国 10/10/10 BM+NC/BM+BC BM 3 ①②③④
Sali等[11] 分口设计 印度 10/10 DFDBA+AM DFDBA 12 ①②③④
Lyons等[12] 平行对照 美国 9/11 DFDBA+PLA DFDBA 9 ①②③④
Tsao等[13] 平行对照 美国 9/9 MBA+CM MBA 6 ①②④
Nygaard-Østby等[14] 平行对照 美国 19/20 AB+PLA AB 9 ①②③④
Keles等[15] 分口设计 土耳其 12/12 ACB+PLA ACB 6 ①②③④
Pajnigara等[16] 分口设计 印度 20/20 DFDBA+AM DFDBA 6 ①②③④
Kiliç等[17] 平行对照 土耳其 10/10 HAC+ePTFE HAC 6 ①②③④
Guillemin等[18] 分口设计 美国 15/15 DFDBA+ePTFE DFDBA 6 ①②③④
Reddy等[19] 分口设计 印度 10/10 Bio-Oss Collagen+Bio-Gide Bio-Oss Collagen 6 ①②③④
Khashu等[20] 分口设计 印度 6/6 PepGen P-15+Atrisorb PepGen P-15 9 ①②③④
Srivastava等[21] 平行对照 印度 16/14 Grabio Glascera+PerioCol™ GrabioGlascera™ 6 ①②④
Agarwal等[22] 平行对照 印度 8/8 DFDBA+PLA/PGA DFDBA 3、6 ①②④

表2

纳入研究的偏倚风险"

纳入研究 随机方法 盲法 分配隐藏 结果的完整性 选择性报告 其他
Taheri等[8] 掷骰子 恰当 不清楚 无失访 恰当 恰当
Kumar等[9] 计算机 恰当 恰当 有失访（3/30） 恰当 恰当
Chung等[10] 计算机 恰当 恰当 无失访 恰当 恰当
Sali等[11] 计算机 恰当 恰当 无失访 恰当 恰当
Lyons等[12] 计算机 恰当 恰当 有失访（1/30） 恰当 恰当
Tsao等[13] 抽签 恰当 不清楚 有失访（3/30） 恰当 恰当
Nygaard-Østby等[14] 计算机 恰当 不清楚 有失访（1/40） 恰当 恰当
Keles等[15] 掷硬币 恰当 不清楚 无失访 恰当 恰当
Pajnigara等[16] 掷硬币 恰当 不清楚 无失访 不清楚 不清楚
Kiliç等[17] 不清楚 恰当 不清楚 无失访 不清楚 恰当
Guillemin等[18] 不清楚 不清楚 不清楚 无失访 恰当 不清楚
Reddy等[19] 掷硬币 不清楚 不清楚 无失访 恰当 不清楚
Khashu等[20] 不清楚 恰当 不清楚 无失访 不清楚 不清楚
Srivastava等[21] 掷硬币 不清楚 不清楚 无失访 不清楚 不清楚
Agarwal等[22] 不清楚 不清楚 不清楚 无失访 恰当 不清楚

图2

术后6个月CAL改变的漏斗图"

表3

敏感性分析结果"

结局指标 纳入研究数 异质性检验结果 效应模型 Meta分析结果
P（组内） I2（组内） P（组间） I2（组间） MD（95%CI） P
CAL 6[8,13,15,19,21-22] 0.33 13% — — 固定 0.15（-0.04,0.34） 0.13
PD 5[8,13,15,19,21] 0.52 0% — — 固定 0.10（-0.28,0.48） 0.61
VBF 4[8,17-19] 0.36 6% — — 固定 0.84（0.42,1.26） <0.000 1
GR 4[8,15-16,19] 0.45 0% 0.27 22.6% 固定 -0.26（-0.46,-0.05） 0.01
GR 5[8,16-19] 0.01 69% 0.002 84.6% 随机 0.01（-0.40,0.42） 0.97
GR 5[8,15,17-19] 0.12 46% 0.03 72.5% 随机 0.08（-0.23,0.39） 0.61
GR 4[15,16,17,18] 0.005 77% 0.002 84.3% 随机 0.07（-0.43,0.58） 0.77
[1] 闫福华, 李丽丽. 牙周再生治疗研究进展[J]. 口腔医学研究, 2018,34(3):217-222.
Yan FH, Li LL. Development in periodontal re-generative treatment[J]. J Oral Sci Res, 2018,34(3):217-222.
[2] Heitz-Mayfield LJ, Trombelli L, Heitz F, et al. A systematic review of the effect of surgical debride-ment vs non-surgical debridement for the treatment of chronic periodontitis[J]. J Clin Periodontol, 2002,29(Suppl 3):92-102.
[3] Stoecklin-Wasmer C, Rutjes AW, da Costa BR, et al. Absorbable collagen membranes for periodontal regeneration: a systematic review[J]. J Dent Res, 2013,92(9):773-781.
pmid: 23842107
[4] Darby IB, Morris KH. A systematic review of the use of growth factors in human periodontal regenera-tion[J]. J Periodontol, 2013,84(4):465-476.
pmid: 22612370
[5] Needleman I, Tucker R, Giedrys-Leeper E, et al. Guided tissue regeneration for periodontal intrabony defects: a Cochrane systematic review[J]. Periodontol 2000, 2005,37:106-123.
pmid: 15655028
[6] Trombelli L, Heitz-Mayfield LJ, Needleman I, et al. A systematic review of graft materials and biological agents for periodontal intraosseous defects[J]. J Clin Periodontol, 2002,29(Suppl 3):117-135.
[7] Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, et al. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A sys-tematic review[J]. Ann Periodontol, 2003,8(1):227-265.
pmid: 14971256
[8] Taheri M, Molla R, Radvar M, et al. An evaluation of bovine derived xenograft with and without a bioab-sorbable collagen membrane in the treatment of mandibular Class Ⅱ furcation defects[J]. Aust Dent J, 2009,54(3):220-227.
doi: 10.1111/j.1834-7819.2009.01122.x pmid: 19709109
[9] Kumar A, Chandra RV, Reddy AA, et al. Evaluation of clinical, antiinflammatory and antiinfective pro-perties of amniotic membrane used for guided tissue regeneration: a randomized controlled trial[J]. Dent Res J (Isfahan), 2015,12(2):127-135.
[10] Chung YM, Lee JY, Jeong SN. Comparative study of two collagen membranes for guided tissue regenera-tion therapy in periodontal intrabony defects: a ran-domized clinical trial[J]. J Periodontal Implant Sci, 2014,44(4):194-200.
doi: 10.5051/jpis.2014.44.4.194 pmid: 25177521
[11] Sali DD, Pauline George J. Demineralized freeze dried bone allograft with amniotic membrane in the treatment of periodontal intrabony defects-12 month randomized controlled clinical trial[J]. J Periodontol, 2016,88(5):1-18.
doi: 10.1902/jop.2016.160513
[12] Lyons LC, Weltman RL, Moretti AJ, et al. Regenera-tion of degree ii furcation defects with a 4% doxycy-cline hyclate bioabsorbable barrier[J]. J Periodontol, 2008,79(1):72-79.
pmid: 18166095
[13] Tsao YP, Neiva R, Al-Shammari K, et al. Effects of a mineralized human cancellous bone allograft in re-generation of mandibular Class Ⅱ furcation defects[J]. J Periodontol, 2006,77(3):416-425.
pmid: 16512756
[14] Nygaard-Østby P, Bakke V, Nesdal O, et al. Perio-dontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresor-bable barrier device when combined with autogenous bone grafting. A randomized controlled clinical trial[J]. J Clin Periodontol, 2008,35(1):37-43.
doi: 10.1111/j.1600-051X.2007.01160.x pmid: 18173400
[15] Keles GC, Sumer M, Cetinkaya BO, et al. Effect of autogenous cortical bone grafting in conjunction with guided tissue regeneration in the treatment of intraosseous periodontal defects[J]. Eur J Dent, 2010,4(4):403-411.
pmid: 20922160
[16] Pajnigara NG, Kolte AP, Kolte RA, et al. Volumetric assessment of regenerative efficacy of demineralized freeze-dried bone allograft with or without amnion membrane in grade Ⅱ furcation defects: a cone beam computed tomography study[J]. Int J Periodontics Restorative Dent, 2017,37(2):255-262.
pmid: 28196167
[17] Kiliç AR, Efeoğlu E, Yilmaz S. Guided tissue re-generation in conjunction with hydroxyapatite-collagen grafts for intrabony defects. A clinical and radiolo-gical evaluation[J]. J Clin Periodontol, 1997,24(6):372-383.
doi: 10.1111/j.1600-051x.1997.tb00200.x pmid: 9205915
[18] Guillemin MR, Mellonig JT, Brunsvold MA, et al. Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes. Assessment by computerized densitometric analysis[J]. J Clin Periodontol, 1993,20(7):520-527.
doi: 10.1111/j.1600-051x.1993.tb00401.x pmid: 8354728
[19] Reddy KP, Nayak DG, Uppoor AS. A clinical evalua-tion of anorganic bovine bone graft plus 10% collagen with or without a barrier in the treatment of class Ⅱfurcation defects[J]. J Contemp Dent Pract, 2006,7(1):60-70.
pmid: 16491148
[20] Khashu H, Vandana KL. Clinical and radiographic evaluation of human periodontal osseous defect (mandibular grade Ⅱ furcation) treated with PepGen P-15 and a bioresorbable membrane (Atrisorb)[J]. J Indian Soc Periodontol, 2012,16(4):569-576.
pmid: 23493651
[21] Srivastava S, Tandon P, Gupta K, et al. A comparative clinico-radiographic study of guided tissue regenera-tion with bioresorbable membrane and a composite synthetic bone graft for the treatment of periodontal osseous defects[J]. J Indian Soc Periodontol, 2015,19(4):416-423.
doi: 10.4103/0972-124X.154544 pmid: 26392691
[22] Agarwal A, Gupta ND. Comparative evaluation of decalcified freeze-dried bone allograft use alone and in combination with polylactic acid, polyglycolic acid membrane in the treatment of noncontained human periodontal infrabony defects[J]. Quintes-sence Int, 2012,43(9):761-768.
[23] Niknejad H, Peirovi H, Jorjani M, et al. Properties of the amniotic membrane for potential use in tissue engineering[J]. Eur Cell Mater, 2008,15:88-99.
doi: 10.22203/ecm.v015a07 pmid: 18446690
[24] Kiany F, Moloudi F. Amnion membrane as a novel barrier in the treatment of intrabony defects: a con-trolled clinical trial[J]. Int J Oral Maxillofac Implants, 2015,30(3):639-647.
pmid: 26009915
[25] 周旭毓, 方积乾. Meta分析的常见偏倚[J]. 循证医学, 2002,2(4):216-220.
Zhou XY, Fang JQ. Bias in Meta-analysis[J]. J Evid- Based Med, 2002,2(4):216-220.
[26] Al-Hamdan K, Eber R, Sarment D, et al. Guided tissue regeneration-based root coverage: meta-analysis[J]. J Periodontol, 2003,74(10):1520-1533.
doi: 10.1902/jop.2003.74.10.1520 pmid: 14653400
[27] Ling LJ, Hung SL, Lee CF, et al. The influence of membrane exposure on the outcomes of guided tissue regeneration: clinical and microbiological aspects[J]. J Periodont Res, 2003,38(1):57-63.
[28] Cosyn J, Cleymaet R, Hanselaer L, et al. Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft: a 1-year prospective study on clinical and aesthetic outcome[J]. J Clin Perio-dontol, 2012,39(10):979-986.
[29] Slutzkey S, Kozlovsky A, Artzi Z, et al. Collagen barrier membranes May accelerate bacterial growth in vitro: a potential clinical risk to regenerative procedures[J]. Quintessence Int, 2015,46(1):43-50.
doi: 10.3290/j.qi.a32821 pmid: 25262679
[30] Sanz M, Tonetti MS, Zabalegui I, et al. Treatment of intrabony defects with enamel matrix proteins or barrier membranes: results from a multicenter practice-based clinical trial[J]. J Periodontol, 2004,75(5):726-733.
doi: 10.1902/jop.2004.75.5.726 pmid: 15212355
[31] Camelo M, Nevins ML, Schenk RK, et al. Clinical, radiographic, and histologic evaluation of human periodontal defects treated with Bio-Oss and Bio-Gide[J]. Int J Periodontics Restorative Dent, 1998,18(4):321-331.
pmid: 12693419
[32] Nevins ML, Camelo M, Lynch SE, et al. Evaluation of periodontal regeneration following grafting intrabony defects with bio-oss collagen: a human histologic report[J]. Int J Periodontics Restorative Dent, 2003,23(1):9-17.
pmid: 12617364
[33] Nevins ML, Camelo M, Rebaudi A, et al. Three-dimensional micro-computed tomographic evalua-tion of periodontal regeneration: a human report of intrabony defects treated with Bio-Oss collagen[J]. Int J Periodontics Restorative Dent, 2005,25(4):365-373.
pmid: 16089044
[34] Sculean A, Nikolidakis D, Schwarz F. Regeneration of periodontal tissues: combinations of barrier mem-branes and grafting materials-biological foundation and preclinical evidence: a systematic review[J]. J Clin Periodontol, 2008,35(8 Suppl):106-116.
pmid: 18724845
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[6] 温秀杰. 氟化物对牙本质脱矿抑制作用的体外实验研究[J]. 国际口腔医学杂志, 1999, 26(05): .
[7] 杨春惠. 耳颞神经在颞颌关节周围的分布[J]. 国际口腔医学杂志, 1999, 26(04): .
[8] 王昆润. 牙周炎加重期应选用何种抗生素[J]. 国际口腔医学杂志, 1999, 26(04): .
[9] 杨儒壮 孙宏晨 欧阳喈. 纳米级高分子支架材料在组织工程中的研究进展[J]. 国际口腔医学杂志, 2004, 31(02): 126 -128 .
[10] 严超然,李龙江. 肿瘤靶向药物载体系统的研究进展[J]. 国际口腔医学杂志, 2008, 35(S1): .