国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (2): 135-141.doi: 10.7518/gjkq.2019010

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异种胶原蛋白基质与自体结缔组织移植瓣牙周软组织增量效果的系统评价与Meta分析

房方方1,常雅琴1,董迎春2,秦莎莎3,陈斌1()   

  1. 1.南京大学医学院附属口腔医院牙周科 南京 210008
    2.南京大学医学院附属口腔医院麻醉科 南京 210008
    3.西安市疾病预防控制中心慢性非传染性疾病防治科 西安 710054
  • 收稿日期:2018-07-22 修回日期:2018-12-15 出版日期:2019-03-01 发布日期:2019-03-15
  • 通讯作者: 陈斌
  • 作者简介:房方方,住院医师,硕士,Email： 975895906@qq.com
  • 基金资助:
    南京市医学科技发展资金(QRX17176);江苏省科教强卫医学青年人才(QNRC2016117)

Xenogeneic collagen matrix versus autogenous connective tissue graft in periodontal soft tissue augmentation: a systematic review and Meta-analysis

Fangfang Fang1,Yaqin Chang1,Yingchun Dong2,Shasha Qin3,Bin Chen1()   

  1. 1. Dept. of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    2.Dept. of Anesthesiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
    3.Dept. of Chronic Non-communicable Diseases Prevention and Control, Xi’an Center for Disease Control and Prevention, Xi’an 710054, China)
  • Received:2018-07-22 Revised:2018-12-15 Online:2019-03-01 Published:2019-03-15
  • Contact: Bin Chen
  • Supported by:
    This study was supported by Nanjing Medical Science and Technique Development Foundation(QRX17176);Jiangsu Provincial Medical Youth Talent, the Project of Invigorating Health Care though Science, Technology and Education(QNRC2016117)

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摘要：

目的 比较异种胶原蛋白基质（XCM）和自体结缔组织移植瓣（CTG）用于牙周软组织增量的效果。方法 检索PubMed、Web of Science、EMBASE、Cochrane、CNKI、CBM、万方数据库、中文科技期刊全文数据库,查找利用XCM和CTG进行牙周软组织增量效果的临床随机对照研究。利用RevMan 5.3软件分析、比较两者牙周软组织增量的效果,包括角化龈宽度增量、角化龈厚度增量、平均根面覆盖率和手术时间。结果 共纳入10篇临床随机对照研究。Meta分析结果显示,两组患者在术后6个月时角化龈宽度增量及根面覆盖率方面效果的差异无统计学意义（P>0.05）,术后12个月时XCM效果不如CTG（P<0.05）;术后12个月XCM的角化龈厚度增量效果不如CTG（P<0.05）;XCM的手术时间短于CTG（P<0.05）。结论 有限的证据表明,在增加角化龈宽度和提高根面覆盖率方面,XCM与CTG无差异;在增加角化龈厚度方面,无足够证据表明XCM不如CTG;但XCM的手术时间显著短于CTG。尚需随访时间更长的、多中心、大样本、前瞻性随机对照临床研究来进一步验证该问题。

关键词: 异种胶原蛋白基质, 结缔组织移植, 牙周软组织增量

Abstract:

Objective In this systematic review, we aimed to compare the effectiveness of xenogeneic collagen matrix (XCM) and autogenous connective tissue graft (CTG) in periodontal soft tissue augmentation. Methods We searched randomized controlled clinical studies published from 2000 to July 2018 in electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, Wanfang database, and VIP. RevMan5.3 software was used to analyze and compare the width of keratinized tissue (KTW), thickness of keratinized tissue (TKT), average root coverage (ARC), and surgery time. Results A total of 10 randomized controlled trials were included. There was no difference between XCM and CTG (P>0.05) in terms of the augmentation of KTW and ARC at the follow time of 6 months, XCM was less effective than CTG at 12 months. CTG had a higher augmentation in TKT compared with XCM (P<0.05) at 12 months. XCM needed shorter operation time than CTG (P<0.05). Conclusion The limited evidence showed XCM had similar augmentation of KTW and ARC. There was insufficient evidence to prove that CTG was more effective in the augmentation of TKT than XCM and that XCM required shorter surgery time. Long-term, multicenter, and prospective randomized controlled clinical studies with large sample sizes are necessary to further validate the problem.

Key words: xenogeneic collagen matrix, connective tissue graft, soft tissue augmentation

中图分类号: 

  • R781.4

表 1

纳入研究的特征"

研究 试验设计 数量（患者/位点） 年龄/岁 材料（试验组/ 对照组） 牙体类型 颌位 观察指标 研究时
长/月		 测量时间点/月
Sanz等[12] RCT（平行对照） 20/20 T：64.3
C：59.2		 XCM（MG）/ CTG 天然牙/种植体 NR KTW、手术时间 6 0、1、3、6
McGuire等[13] RCT（平行对照） 25/50 43.7±12.2 XCM（MG）/ CTG 天然牙 上下颌 KTW、ARC 12 0、1、2、3、6、12
Cardaropoli等[14] RCT（平行对照） 18/22 41.39±10.02 XCM（MG）/ CTG 天然牙 T：上颌7下颌4 C：上颌11 KTW、TKT、ARC 12 0、1、3、6、12
Lorenzo等[15] RCT（平行对照） 24/24 T：62±8.7
C：63±7.9		 XCM（MG）/ CTG 种植体 T：上颌1下颌11 C：下颌12 KTW、手术时间 6 0、1、3、6
Aroca等[16] RCT（口内分组对照） 22/156 >18 XCM（MG）/ CTG 天然牙 上下颌 KTW、TKT、ARC、手术时间 12 0、1、3、6、12
Cie?lik-Wege-mund等[17] RCT（平行对照） 28/106 20~50 XCM（MD）/ CTG 天然牙 上下颌 KTW、ARC 6 0、3、6
Cairo等[18] RCT（平行对照） 60/60 T：50.3±12.4
C：48.3±11.8		 XCM（MG）/ CTG 种植体 上下颌 KTW、TKT、手术时间 6 0、1、3、6
Thoma等[11] RCT 20/20 T：64.3
C：59.2		 XCM（MG）/ CTG 种植体 T：上颌10
C：上颌 9下颌1		 TKT、手术时间 3 0、1、3
Puzio等[19] RCT 25/30 T：43.8±13.2
C：42.7±19.1		 XCM（MG）/ CTG 种植体 T：上颌12下颌3
C：上颌14下颌1		 TKT 12 0、3、12
Tatarakis等[20] RCT 8/8 T：38.75±11.70
C：37.75±18.17		 XCM（MG）/ CTG 天然牙 上颌 KTW 6 0、2、6

表 2

纳入研究的偏倚风险"

纳入研究 随机序列生成 分配隐藏 实施盲法 结果测量盲法 失访偏倚 报告偏倚 其他偏倚
Sanz等[12] 恰当 恰当 恰当 不清楚 不清楚 不清楚 恰当
McGuire等[13] 恰当 不清楚 恰当 恰当 恰当 恰当 恰当
Cardaropoli等[14] 恰当 不清楚 恰当 恰当 恰当 恰当 恰当
Lorenzo等[15] 恰当 恰当 恰当 恰当 恰当 不清楚 恰当
Aroca等[16] 恰当 恰当 恰当 恰当 恰当 恰当 恰当
Cie?lik-Wegemund等[17] 恰当 恰当 恰当 不恰当 恰当 恰当 恰当
Cairo等[18] 恰当 恰当 恰当 恰当 恰当 恰当 恰当
Thoma等[11] 恰当 恰当 恰当 恰当 不恰当 不清楚 恰当
Puzio等[19] 恰当 恰当 不清楚 恰当 恰当 恰当 恰当
Tatarakis等[20] 恰当 恰当 恰当 不清楚 恰当 恰当 恰当

图 1

KTW增量的Meta分析结果"

图 2

TKT增量的Meta分析结果"

图 3

ARC的Meta分析结果"

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