摘要
目的比较并评价引导组织再生术联合骨代用品的联合牙周再生技术治疗牙周病骨内缺损与单用屏障膜的引导组织再生术治疗的有效性,为临床治疗提供依据。方法计算机联合手工检索1994-2004年公开发表的中英文引导组织再生术相关文献。利用Meta分析方法综合筛选出的10篇适用文献。进行综合的测量结果包括术后牙周袋深度的减少、附着水平的增加、牙龈退缩以及二次手术探查的骨水平变化。结果联合牙周再生技术组共171例,引导组织再生术对照组共159例,Meta分析结果显示,联合牙周再生技术术后的牙龈退缩比引导组织再生术少(加权均差为-0．39 mm,95％可信区间为-0．61--0．17 mm),其他临床指标两组未见差异。敏感性分析显示两组在牙龈退缩上的差异结果可靠,以牙槽嵴顶的吸收和骨损底部骨增加为结果的研究问异质性显著,改变纳入标准去除质量较低的研究后,异质性消失,余下研究使用的骨代用品恰好一致,均为同种异体脱矿冻干骨,分析结果显示两组疗效仍无差异。结论现有的证据支持联合牙周再生技术治疗骨内缺损术后的牙龈退缩小于单用屏障膜的引导组织再生术,但是目前的证据水平仍不能充分支持联合牙周再生技术治疗牙周病骨内缺损疗效优于单用屏障膜,尚需进行高质量的随机对照研究以确定联合牙周再生技术的有效性。
Objective To systematically review the evidence for efficacy of combined periodontal regenerative technique（CPRT） in comparison with guided tissue regeneratlon（GTR） for the treatment of intrabony defects. Methods We searched four major electronic databases for randomized controlled trials with at least 12 months of follow-up. Several English journals were handsearched. Outcome measures were： changes in probing depths（PD）, probing attachment levels （PAL）,gingival recession （REC）,some marginal bone levels. Results A meta-analysis showed that gingival recession in CPRT was less than in GTR （weighted mean difference was -0.39 mm,95%CI：-0.67 to -0.17 mm）. No differences in another outcomes were observed. After sensitivity analyses,the statistically significant difference of gingival recession still existed. The heterogeneity among the studies which had absorption of alveolar crest and increase base level of bone defects as an outcome was statistically significant. We examined periodontal outcomes with exclusion of studies with poor quality （Jadad score ≤2） according to change the inclusion criteria. After that there was no heterogeneity. Meta-analysis showed that CPRT groups had less resorption of alveolar crest and more raise of defect base than GTR controls. But those 95%CI line intersected the ineffective line, the differences had no statistically significance. Conclusions CPRT was more effective than GTR in reducing gingival recession. We need more high quality RCTs to certify the efficacy of the CPRT for intrabony defects in other clinical outcomes.
出处
《循证医学》
CSCD
2006年第1期28-34,共7页
The Journal of Evidence-Based Medicine
关键词
引导组织再生
骨代用品
骨内缺损
guided tissue regeneration
bone substitute
intrabony defects
