中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (34): 7447-7460.doi: 10.12307/2025.885

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

对比不同生物支架用于年轻恒牙牙髓血运重建效果的贝叶斯网状Meta分析

王凯刚1，郝东升1，马  沛1，周  硕1，李睿敏1，2   

  1. 1宁夏医科大学口腔医学院，宁夏回族自治区银川市   750004；2宁夏医科大学总医院口腔医院牙体牙髓病科，宁夏回族自治区银川市   750004
  • 收稿日期:2024-07-29 接受日期:2024-09-29 出版日期:2025-12-08 发布日期:2025-01-18
  • 通讯作者: 李睿敏，博士，硕士生导师，宁夏医科大学口腔医学院，宁夏回族自治区银川市 750004；宁夏医科大学总医院口腔医院牙体牙髓病科，宁夏回族自治区银川市 750004
  • 作者简介:王凯刚，男，2002年生，宁夏回族自治区固原市人，汉族，宁夏医科大学口腔学院2020 级口腔医学专业本科在读。
  • 基金资助:
    中国牙病防治基金会项目(A2021-135)，项目负责人：李睿敏；宁夏回族自治区重点研发计划项目(2020BEG03029)，项目负责人：李睿敏

Comparison of efficacy of different biological scaffolds for pulp regeneration therapy in immature permanent teeth: a Bayesian network meta-analysis

Wang Kaigang1, Hao Dongsheng1, Ma Pei1, Zhou Shuo1, Li Ruimin1, 2   

  1. 1School of Stomatology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China; 2Department of Endodontics, Stomatology Hospital, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • Received:2024-07-29 Accepted:2024-09-29 Online:2025-12-08 Published:2025-01-18
  • Contact: Li Ruimin, MD, Master’s supervisor, School of Stomatology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China; Department of Endodontics, Stomatology Hospital, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • About author:Wang Kaigang, School of Stomatology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • Supported by:
    China Dental Disease Prevention and Treatment Foundation Project, No. A2021-135 (to LRM); Ningxia Hui Autonomous Region Key Research & Development Plan Project, No. 2020BEG03029 (to LRM)

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摘要：


文题释义：

浓缩生长因子：是利用特制的变速离心机，依靠物理性加速度和减速度充分激活血小板中的α颗粒，产生富含更高浓度生长因子和CD34+细胞的自体血液浓缩制品，表现出更佳的骨组织、软组织及皮肤的再生能力。
牙髓血运重建术：是治疗牙髓坏死性年轻恒牙的主要治疗方法之一，通过彻底有效的根管消毒，刺激根尖出血形成以血凝块为主的天然支架并提供丰富的生长因子，为根尖乳头干细胞等种子细胞的增殖和分化提供良好微环境，并诱导其分化为成牙本质细胞和成骨细胞等，从而促使牙髓再生和牙根继续发育。


目的：临床中用于牙髓血运重建的生物支架多种多样，不同支架材料之间的疗效差异存在争议。采用贝叶斯网状Meta分析方法评价9种生物支架在牙髓血运重建术中的效果。

方法：检索中国知网、维普、万方、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of Science、Embase、Scopus数据库，收集各数据库建库至2024-04-01符合纳入标准的关于不同生物支架用于年轻恒牙牙髓血运重建治疗的随机对照试验。由2位研究者筛选文献，独立完成数据的收集和整理提取，并对纳入的文献质量进行偏倚风险评价，使用R 4.2.0软件的BUGSnet 1.1.1包进行网状Meta分析。
结果：共纳入22篇研究，包含926例患牙数和9种不同的干预措施，网状Meta分析结果显示：①临床成功率(一级目标)：富血小板纤维蛋白优于血凝块[OR=1.45，95%CI(0.32，2.69)]，等级概率排序结果前3为：浓缩生长因子(82.77%)>富血小板纤维蛋白(75.38%)>改良富血小板纤维蛋白(62.39%)；②牙根长度增加(二级目标)：随访1-6个月时，7种生物支架之间比较无差异(P > 0.05)，等级概率排序结果前3为：浓缩生长因子(86.25%)>富血小板血浆(53.76%)>富血小板纤维蛋白(51.11%)；随访> 6个月且≤12个月时，浓缩生长因子优于血凝块[MD=9.59，95%CI(0.52，18.40)]，等级概率排序结果前3为：浓缩生长因子(92.42%)>富血小板血浆(56.03%)>富血小板纤维蛋白(55.76%)；随访大于12个月时，浓缩生长因子优于改良富血小板纤维蛋白[MD=11.01，95%CI(0.02，22.72)]，等级概率排序结果前3为：浓缩生长因子(86.95%)>富血小板纤维蛋白(68.61%)>血凝块联合胶原蛋白(52.5%)；③根壁厚度增加(二级目标)：随访1-6个月时，富血小板纤维蛋白优于血凝块[MD=11.37，95%CI(4.74，17.71)]，等级概率排序结果前3为：富血小板纤维蛋白(93.66%)>浓缩生长因子(63.11%)>改良富血小板纤维蛋白(50.48%)；随访> 6个月且≤12个月时，6种生物支架之间比较无差异(P > 0.05)，等级概率排序结果前3为：改良富血小板纤维蛋白(73.63%)>富血小板纤维蛋白(62.36%)>浓缩生长因子(56.25%)；随访大于12个月时，9种生物支架之间比较无差异(P > 0.05)，等级概率排序结果前3为：血凝块联合胶原蛋白(81.9%)>富血小板血浆(62.67%)>改良富血小板纤维蛋白(59.49%)；④牙髓活力(三级目标)：6种生物支架之间比较无差异(P > 0.05)，等级概率排序结果前3为：血凝块联合胶原蛋白(84.22%)>浓缩生长因子(67.71%)>富血小板纤维蛋白(48.79%)。

结论：现有证据表明，不同支架在牙髓血运重建术中的临床成功率均较高，其中富血小板纤维蛋白优于血凝块；牙根长度和根壁厚度增加综合比较方面，浓缩生长因子在随访1-6个月与> 6个月且≤12个月时间段中表现最佳，而随访大于12个月后血凝块联合胶原蛋白表现最佳；浓缩生长因子在各级目标中表现突出，相对其他支架可能更有利于牙根的继续发育，在牙髓再生治疗中有巨大潜力。受限于文献质量及数量，上述结论仍需更多高质量研究予以验证。

https://orcid.org/0009-0007-9859-0860(王凯刚)；https://orcid.org/0000-0001-8076-4614(李睿敏)

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: 生物支架, 牙髓血运重建术, 牙髓再生, 血凝块, 富血小板血浆, 富血小板纤维蛋白, 浓缩生长因子, 网状Meta分析

Abstract: OBJECTIVE: There are many kinds of biological scaffolds used for pulp revascularization in clinical practice, and the difference of efficacy between different scaffolds is controversial. The efficacy of nine kinds of biological scaffolds in endodontic revascularization was evaluated by Bayesian network meta-analysis.
METHODS: The computer was used to search the literature in CNKI, VIP, WanFang, China Biomedical Literature Service System, PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases. Randomized controlled trials of different biological scaffolds for the treatment of pulp revascularization in young permanent teeth meeting inclusion criteria were collected from each database up to April 1, 2024. Two researchers sifted through the literature, data collection, sorting and extraction were completed independently, and the quality of the included literature was assessed for risk of bias. A network meta-analysis was performed using BUGSnet1.1.1 package of R4.2.0 software.
RESULTS: A total of 22 studies with 926 affected teeth and 9 different interventions were included in this study. The results of network meta-analysis showed that: (1) Clinical success rate (primary goal): platelet-rich fibrin was superior to blood clot [OR=1.45, 95%CI (0.32, 2.69)], and the top three ranking results were: concentrated growth factor (82.77%) > platelet-rich fibrin (75.38%) > modified platelet-rich fibrin (62.39%). (2) Increased root length (secondary goal): There was no difference among the 7 biological scaffolds at 1-6 months of follow-up (P > 0.05), the top 3 ranking results of rank probability were: concentrated growth factor (86.25%) > platelet-rich plasma (53.76%) > platelet-rich fibrin (51.11%). When followed up for > 6 months and ≤ 12 months, concentrated growth factor was superior to blood clot [MD=9.59, 95%CI(0.52,18.40)], the top 3 ranking results of rank probability were: concentrated growth factor (92.42%) > platelet-rich plasma (56.03%) > platelet-rich fibrin (55.76%). When followed up for more than 12 months, concentrated growth factor was superior to modified platelet-rich fibrin [MD=11.01, 95%CI(0.02 , 22.72)], the top 3 ranking results of rank probability were: concentrated growth factor (86.95%) > platelet-rich fibrin (68.61%) > blood clot combined with collagen (52.5%). (3) Increased root wall thickness (secondary goal): at 1-6 months of follow-up, platelet-rich fibrin was superior to blood clot [MD=11.37, 95%CI (4.74, 17.71)], the top 3 ranking results of rank probability were: platelet-rich fibrin (93.66%) > concentrated growth factor (63.11%) > modified platelet-rich fibrin (50.48%). At > 6 months and ≤ 12 months of follow-up, there was no difference among the 6 biological scaffolds (P > 0.05), the top 3 ranking results of rank probability were: modified platelet-rich fibrin (73.63%) > platelet-rich fibrin (62.36%) > concentrated growth factor (56.25%). When followed up for more than 12 months, there was no difference among the 9 biological scaffolds (P > 0.05), and the top 3 ranking results of rank probability were: blood clot combined with collagen (81.9%) > platelet-rich plasma (62.67%) > modified platelet-rich fibrin (59.49%). (4) Pulp vitality (third-level goal): there was no difference among the 6 biological scaffolds (P > 0.05), and the top 3 ranking results of rank probability were: blood clot combined with collagen (84.22%) > concentrated growth factor (67.71%) > platelet-rich fibrin (48.79%).
CONCLUSION: Existing evidence shows that the clinical success rate of different scaffolds is higher in pulp revascularization, among which platelet-rich fibrin is better than blood clots. In terms of comprehensive comparison of root length and root wall thickness increase, concentrated growth factor performs best in the follow-up period of 1-6 months and > 6 months and ≤ 12 months, while blood clot combined with collagen performs best after follow-up of more than 12 months; concentrated growth factor performs outstandingly in all levels of goals, and may be more conducive to the continued development of the tooth root than other scaffolds, and has great potential in pulp regeneration treatment. Limited by the quality and quantity of literature, the above conclusions still need to be verified by more high-quality studies.

Key words: biological scaffold, pulp revascularization, pulp regeneration, blood clot, platelet-rich plasma, platelet-rich fibrin, concentrated growth factor, network meta-analysis

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