中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (4): 643-648.doi: 10.12307/2022.105

• 生物材料循证医学 evidence-based medicine of biomaterials • 上一篇    下一篇

拔牙后富血小板血纤蛋白作为牙槽嵴位点保留材料可显著减少牙槽骨高度及宽度的吸收:一项Meta分析

魏舟丹1,李文晋2,朱  莉2,王  瑜2,赵娇阳1,陈亚楠1,郭  栋1,郝  敏2     

  1. 1山西医科大学口腔医学院口腔医院,山西省太原市   030001;2山西医科大学第二医院口腔科,山西省太原市   030001
  • 收稿日期:2020-09-08 修回日期:2020-09-11 接受日期:2020-10-16 出版日期:2022-02-08 发布日期:2021-12-06
  • 通讯作者: 李文晋,博士,硕士生导师,副主任医师,山西医科大学口腔医学院,山西医科大学第二医院口腔科,山西省太原市 030001
  • 作者简介:魏舟丹,女,1995年生,汉族,山西省太原市人,山西医科大学在读硕士,医师,主要从事口腔修复学研究。
  • 基金资助:
    山西省卫生健康委科研课题(2019042),项目负责人:李文晋;山西省应用基础研究计划(201901D111385),项目负责人:李文晋;山西省留学回国人员科技活动择优资助项目(20200010),项目负责人:李文晋

Platelet-rich fibrin as a material for alveolar ridge preservation significantly reduces the resorption of alveolar bone height and width after tooth extraction: a meta-analysis

Wei Zhoudan1, Li Wenjin2, Zhu Li2, Wang Yu2, Zhao Jiaoyang1, Chen Yanan1, Guo Dong1, Hao Min2   

  1. 1Stomatological Hospital, School of Stomatology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2Department of Stomatology, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2020-09-08 Revised:2020-09-11 Accepted:2020-10-16 Online:2022-02-08 Published:2021-12-06
  • Contact: Li Wenjin, MD, Master’s supervisor, Associate chief physician, Department of Stomatology, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Wei Zhoudan, Master candidate, Physician, Stomatological Hospital, School of Stomatology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Supported by:
    Scientific Research Project of Shanxi Health and Health Commission, No. 2019042 (to LWJ); Shanxi Province Applied Basic Research Program, No. 201901D111385 (to LWJ); Fund Program for the Scientific Activities of Selected Returned Overseas Professionals in Shanxi Province, No. 20200010 (to LWJ) 

摘要:

文题释义:
富血小板血纤蛋白:由法国学者CHOUKROUN在2000年首次从血液中成功提取,是通过对自体血进行离心处理所得到的,较少引发交叉感染及免疫反应,其生物安全性及生物活性均较高。富血小板血纤蛋白主要由富血小板、白细胞、纤维蛋白基质、白细胞细胞因子和生长因子等其他因子组成,有抗炎、促进成骨细胞分化、加快骨组织的形成及矿化,同时促进成纤维细胞的增殖和迁移、加速软组织的愈合等作用。
位点保存:对牙槽窝采取相应的干预措施如平台转移、植入骨移植材料来减少拔牙位点牙槽窝骨吸收,促进拔牙窝的骨再生,减少骨质密度与骨量的降低,提高后期口腔种植骨结合水平,保证种植成功率。

目的:目前富血小板血纤蛋白在拔牙后位点保留中的应用更加广泛,而与其他材料相比富血小板血纤蛋白保存牙槽嵴的效果不是很明确。文章评估富血小板血纤蛋白在拔牙后牙槽嵴保存中的应用效果,为临床应用富血小板血纤蛋白减少牙槽骨吸收提供理论依据。
方法:截止到2020年6月,在The Cochrane Library、PubMed、Web of Science核心合集、EMbase、中国知网、维普和万方数据库进行文献检索,收集所有关于富血小板血纤蛋白用于牙槽嵴保存的临床随机对照研究,包括单纯应用富血小板血纤蛋白和富血小板血纤蛋白复合异质骨。由2位研究人员从检索的文献中提取数据,使用Cochrane偏倚风险评估工具评价纳入研究的偏倚风险。由RevMan 5.3软件对结果指标进行Meta分析。
结果:①共检索出159篇文献,最终纳入11个随机对照试验,共531例患者,575个拔牙位点;②Meta分析结果显示:单纯应用富血小板血纤蛋白时牙槽骨高度吸收量(SMD=-0.38,95%CI:-0.83至-0.06,P > 0.05)差异无显著性意义;富血小板血纤蛋白复合异质骨与单纯异种骨在拔牙后3,6个月时牙槽骨吸收高度(3个月:SMD=-1.40,95%CI:-1.79至-1.01,P < 0.05;6个月:SMD=-1.37,95%CI:-1.68至-1.06,P < 0.05)、牙槽骨吸收宽度(SMD=-0.18,95%CI:-0.25至-0.11,P < 0.05)及拔牙2周后术区黏膜愈合率(SMD=9.90,95%CI:8.61-11.19,P < 0.05)方面差异均有显著性意义。
结论:拔牙后应用富血小板血纤蛋复合异质骨作为牙槽嵴位点保留的材料时可以明显减少牙槽骨高度及宽度的吸收,也可以加快软组织愈合,但由于纳入研究的样本量较少,还需要更大的样本量临床研究来验证以上结论。

https://orcid.org/0000-0001-8380-7245 (魏舟丹);https://orcid.org/0000-0002-4555-5857 (李文晋)

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料口腔生物材料纳米材料缓释材料材料相容性;组织工程

关键词: 牙, 牙槽, 富血小板血纤蛋白, 无机牛骨材料, 位点保存, 骨吸收量, Meta分析, 随机对照试验

Abstract: OBJECTIVE: At present, platelet-rich fibrin is widely used in site retention after tooth extraction, but the effect of platelet-rich fibrin in alveolar ridge preservation is not very clear compared with other materials. This study evaluated the effect of applied platelet-rich fibrin in the preservation of alveolar ridge after tooth extraction to provide theoretical basis for clinical application of platelet-rich fibrin to reduce alveolar bone resorption. 
METHODS: Up to June 2020, all clinical randomized controlled studies on platelet-rich fibrin for alveolar ridge preservation, including platelet-rich fibrin alone and platelet-rich fibrin combined with heterogeneous bone, were collected by using The Cochrane Library, PubMed, Web of science core set, EMbase, CNKI, and Wanfang databases. Two researchers extracted data from the retrieved documents and used Cochrane bias risk assessment tools to evaluate the bias risk included in the study. RevMan 5.3 software was used for meta-analysis.
RESULTS: (1) Totally 159 articles were retrieved, and 11 randomized controlled trials were finally included, involving 531 patients and 575 implants. (2) The results of meta-analysis showed that the difference in the height absorption of tooth alveolar bone was not statistically significant when platelet-rich fibrin was applied alone (SMD=-0.38, 95%CI:-0.83 to -0.06, P > 0.05). There were significant differences between platelet-rich fibrin composite heterogeneous bone and simple xenogeneic bone in alveolar bone resorption height (3 months: SMD=-1.40, 95%CI:-1.79 to -1.01, P < 0.05; 6 months: SMD=-1.37, 95%CI:-1.68 to -1.06, P < 0.05), alveolar bone resorption width at 3 and 6 months after tooth extraction (SMD=-0.18, 95%CI:-0.25 to -0.11, P < 0.05), and mouth mucosa healing rate at 2 weeks after tooth extraction (SMD=9.90, 95%CI:8.61-11.19, P < 0.05). 
CONCLUSION: Applying platelet-rich fibrin composite heterogeneous bone after tooth extraction can remarkably reduce the resorption of alveolar bone both in height and width and accelerate soft tissue healing. Because of the small sample size included in the study, clinical studies with a large sample size are needed to verify the above conclusions.

Key words: tooth, alveolar, platelet-rich fibrin, inorganic bovine bone material, site preservation, bone resorption, meta-analysis, randomized controlled trial

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