国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (2): 149-155.doi: 10.7518/gjkq.2019018

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种植体周围角化龈宽度与种植体周围骨高度的相关性

黄婕,林云红()   

  1. 昆明医科大学附属口腔医院修复科 昆明 650000
  • 收稿日期:2018-05-27 修回日期:2018-11-06 出版日期:2019-03-01 发布日期:2019-03-15
  • 通讯作者: 林云红
  • 作者简介:黄婕,住院医师,硕士,Email： 294447702@qq.com

Effect of keratinized mucosa width on peri-implant bone loss

Jie Huang,Yunhong Lin()   

  1. Dept. of Prosthodontics, Affiliated Hospital of Stomatology, Kunming Medical University, Kunming 650000, China
  • Received:2018-05-27 Revised:2018-11-06 Online:2019-03-01 Published:2019-03-15
  • Contact: Yunhong Lin

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摘要：

目的 口腔种植体袖口周围角化龈的存在被认为是种植体周围的一个黏膜屏障,角化龈的存在无论从生物学角度还是美学立场都确保了种植体周围组织长期的稳定。本次研究运用了Meta分析的方法,通过对种植修复牙体缺失患者临床对照试验进行总结,评估了口腔种植体周围角化龈宽度与种植体周围骨丧失量的相关性。方法 电子检索EMBASE（Ovid）、Cochrane对照试验中心注册库（CENTRAL）、Medline、Pubmed、中国生物医学文献数据库（CBMdisc）和中国知识基础设施工程（CNKI）,手动检索国家医学图书馆（NLM）、坎贝尔图书馆等。检索日期截止至2017年5月,检索要求无发表语言以及发表时间的限制。3位评价者独立使用Cochrane质量评价表评价纳入研究的方法学质量,按照纳入、排除标准筛选相关研究,提取数据并进行风险偏倚评价。采用Revman 5.3软件进行Meta分析。结果 在最终纳入的10项研究中,有8项为回顾性研究,另外2项为前瞻性研究,这10篇文献均为中等偏倚风险。其主要研究内容为口腔种植体周围的角化龈宽度与种植体周围骨丧失量的相关性。以“骨丧失量、骨丧失高度、边缘骨丧失量、随访时间均大于2个月”为结局指标,Meta分析的结果显示：排除有明显异质性研究之后,种植体周围角化龈的宽度与骨吸收无负性相关性（P<0.01）,该结果稳定并且证据质量较高;随着角化龈宽度的增加,骨吸收量反而逐渐减少,即角化龈对种植体周围骨组织有保护作用,但是对种植体周围骨高度的影响因素很多,例如：自身免疫力的强弱、饮食习惯、依从性等等,则需要更多高质量的对照试验进一步的研究来证实。结论 种植体周围角化龈的宽度对种植体周围骨丧失程度的影响无负性相关性,因此,在今后的临床工作中,应当尽量保存角化龈,才能更大程度地获得植体周围骨稳定性。

关键词: 角化龈宽度, 种植体周围骨高度, Meta分析

Abstract:

Objective The existence of keratinized gingival tissue around the mouth of the oral implant is considered as a mucosal barrier around the implant. The existence of keratinized gingival tissue ensures long-term stability of the tissue around the implants. In this study, Meta-analysis was performed to summarize the clinical controlled trials of dental implants in patients with dental implants. Methods An electronic search strategy was performed on EMBASE (Ovid), Cochrane (CENTRAL), Medline, Pubmed, China Biology Medicine disc, China National Knowledge Infrastructure, National Library of Medicine, and Campbell Library. Then, the extraction of the included studies and risk of bias assessment with the recommended tool of Cochrane collaboration was performed until May 2017. Meta-analysis was processed by Rveman 5.3. Three evaluators independently used the Cochrane quality evaluation form to evaluate the methodological quality of the included studies. According to the inclusion and exclusion criteria, we screened related studies, extracted data, and evaluated risk bias. Results At the end of screening, 10 studies with moderate bias risk were included, 8 of which were retrospective studies, and 2 were prospective studies. The main focus of the study was the correlation between the width of the keratinized gingival tissue around the oral implant and the loss of bone around the implant. The outcome indicators included bone loss, height of bone loss, marginal bone loss, and follow-up time are more than 2 months. The Meta-analysis results showed that evident heterogeneity was excluded, the results were stable, and the quality of evidence was high. The results also showed the width of the keratinized gingival tissue around the implant and bone absorption without negative correlation (P<0.01). With the increase in the width of the keratinized gingival tissue and decrease in bone resorption, the keratinized gingival tissue exhibited a protective effect on the peri-implant bone tissue. However, many influencing factors, including bone height around the body and the strength of the immunity, diet, and compliance, need further high-quality control testing to confirm the results. Conclusion No negative correlation was observed between the width of keratinized gingival tissue and the degree of bone loss around the implant. Therefore, in future clinical work, we should preserve the keratinized gingival tissue to increase the bone stability around the implant.

Key words: keratinized mucosa width, peri-implant bone height, Meta-analysis

中图分类号: 

  • R783.4

图 1

文献筛选流程及结果"

图 2

纳入研究中的偏倚风险项目判断"

表 1

纳入研究特征表"

参考文献 日期 国家 类型 纳入患者数 植体数目 平均随访时间
[12] 1987 美国 前瞻性 26 58 ≥2年
[15] 2014 巴西 回顾性 32 161 ≥1年
[16] 2009 韩国 回顾性 100 276 1年1个月
[17] 2015 芬兰 回顾性 211 967 1年3个月
[18] 2015 土耳其 回顾性 18 60 3个月、6个月
[19] 2015 巴西 回顾性 193 725 ≥5年
美国 <5年
[20] 2016 意大利 回顾性 103 421 >2年
[21] 2006 美国 前瞻性 69 339 8.1年
[22] 2009 伊朗 回顾性 未提及 66 1年6个月
[23] 2008 美国 回顾性 未提及 200 4.91年

图 3

未去除异质源时的分析表"

图 4

去除异质源后的分析图"

图 5

亚组分析"

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