Combined use of guided tissue regeneration and bone grafting in the treatment of root furcation defects: a meta-analysis

doi:10.3969/j.issn.2095-4344.2016.33.019

Abstract

Abstract:

BACKGROUND: Numerous experimental and clinical observations have shown new attachment formation in the periodontium by guided tissue regeneration.
OBJECTIVE: To evaluate the efficacy of guided tissue regeneration combined with bone grafting for the treatment of root furcation defects.
METHODS: A computer-based online search combined with manual retrieval was conducted up to 2015 to screen the relevant English and Chinese literatures addressing guided tissue regeneration, bone grafting, and root furcation defects. Vertical and horizontal probing depth and attachment loss were analyzed. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles. Moreover, the publication bias was tested.
RESULTS AND CONCLUSION: The meta-analysis results showed that at 6 months after treatment, the alterations in vertical probing depth and periodontal attachment were significantly increased after guided tissue regeneration compared with open-flap debridement (P < 0.000 01); the alterations and increment in the periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with open-flap debridement (P < 0.000 01); the reduction in the vertical and horizontal probing depth and the increment in periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration (P < 0.000 01 or P = 0.01). At 12 months after treatment, the reduction in vertical probing depth and the increment in attachment loss were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration (P < 0.000 01). These results indicate that the guided tissue regeneration combined with bone grafting in the treatment of root furcation defects is superior to guided tissue regeneration or open-flap debridement. In addition, in the latter two therapies, guided tissue regeneration shows a better therapeutic effect. However, the therapeutic effects of various types of regenerated membranes and bone grafts need further in-depth study to define the optimal treatment strategy.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Guided Tissue Regeneration, Periodontal, Bone Transplantation

CLC Number:

R318

Li Dan-dan, Maliyamuguli Pataer, Huang Ping, Zhao Jin. Combined use of guided tissue regeneration and bone grafting in the treatment of root furcation defects: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(33): 4999-4998.

Figures/Tables 5

2.2 纳入证据的基本特征见表1。 2.3 纳入文献的质量评价见表2。马捷等[24]在探索系统评价中对纳入RCT的质量评价工具(Jadad量表和Cochrane偏倚风险评估工具)的应用中提到，JADAD量表针对会导致一些质量较好的文献被评价为低质量的RCT而被排除，最终影响系统评价的质量，因此本文选择参照最新Corchane协作网推荐的偏倚风险评估工具，更加科学透明的评价随机对照研究的质量，具体内容：①随机分配方法是否正确；②是否应用分配隐藏方案；③盲法的应用；④结果数据的完整性，包含有无失访或退出，是否ITT分析；⑤选择性报告研究结果；⑥其他偏倚来源。所有质量标准均满足者，发生选择性偏倚、实施偏倚、损耗性偏倚和测量偏倚的可能性最低，评为A级；如其中任何一条或多条质量评价标准仅部分满足(或不清楚)，则该研究存在相应偏倚的可能性为中等，评为B级；如其中任何一条或多条完全不满足(未使用或不正确)，则该研究存在相应偏倚的高度可能性，评为C级。 2.4 Meta分析结果 2.4.1 引导组织再生与牙周清创翻瓣后6个月复查时牙周垂直探诊深度的Meta分析结果 4个符合标准的RCT均测量了干预后6个月的牙周垂直探诊深度，比较其垂直探诊深度减少值，异质性检验结果：I2=89%，说明各证据间有统计学异质性，故采用随机效应模型进行Meta 分析，结果显示：SMD=1.18，95%CI(0.80，1.57)， P < 0.000 01，差异有显著性意义，表明术后6个月，引导组织再生组牙周垂直探诊深度改变量比牙周清创翻瓣组多1.18 mm，见图2。 2.4.2 引导组织再生与牙周清创翻瓣术后6个月复查时牙周附着水平的Meta分析结果纳入研究中有3个测量了干预措施后6个月的牙周附着丧失水平，比较其附着水平增加量，异质性检验结果：I2=0%，说明各证据间同质性较好，故采用固定效应模型进行Meta分析，结果显示：加权均数差(WMD)=1.52，95%CI(1.43，1.61)，P < 0.000 01，表明术后6个月，引导组织再生组牙周附着水平改变量比牙周清创翻瓣组多1.52 mm，差异有显著性意义，见图3。 2.4.3 引导组织再生+牙周植骨与牙周清创翻瓣术后6 个月复查时牙周垂直探诊深度的Meta分析纳入研究中有6个测量了干预措施后6个月的牙周垂直探诊深度，比较其牙周垂直探诊深度减少值，异质性检验结果：I2=84%，说明各证据间具有统计学异质性，故采用随机效应模型进行Meta分析，结果显示：标准化均差(SMD)=1.28，95% CI(0.89，1.67)，P < 0.000 01，表明术后6个月，引导组织再生+牙周植骨组牙周附着水平改变量比牙周清创翻瓣组多1.28 mm，差异有显著性意义，见图4。 2.4.4 引导组织再生+牙周植骨与牙周清创翻瓣术后6 个月复查时牙周水平探诊深度的Meta分析纳入研究中有4个测量了干预措施后6个月的牙周水平探诊深度，比较其探诊深度的减少值，异质性检验结果：I2=98%，说明各证据间有明显的异质性，故采用随机效应模型进行Meta分析，结果显示：SMD=0.61，95%CI(-1.27，2.49)，P=0.52，差异无显著性意义，见图5。 2.4.5 引导组织再生+牙周植骨与牙周清创翻瓣术后6 个月复查时牙周附着水平的Meta分析 6个符合标准的RCT均测量了干预术后6个月的附着丧失，比较其附着丧失的增加量，异质性检验结果：I2=92%，说明各证据间 "

References

[1] Bower RC. Furcation morphology relative to periodontol treatment. Furcation root surface anatomy. J Periodontol. 1979;50:366.
[2] Ross IF,Thompson RH Jr.Furcation involvement in maxillary and mandibular molars.J Periodontol. 1980; 51(8):450-454.
[3] 詹暶, 闫福华,林敏魁.PRP和自体骨髓基质细胞移植修复狗牙Ⅱ度根分叉病变的研究[J].口腔医学研究,2005, 21(2): 450-454.
[4] Al-Arrayed F, Adam S.Clinical trial of cross-linked human type I collagen as a barrier material in surgical periodontal treatment.J Clin Periodontol.1995; 22: 371-379.
[5] Khanna D.Malhotra S,Naidu DV.Treatment of gradeⅡfurcation involvement using resorbable guided tissue regeneration membrane:A Six-month study.J Indian Soc Periodontal.2012;16(3):404-410.
[6] 胡卫岚,陈晓明,李湘南.骨组织工程材料β-磷酸三钙及其复合材料改性的研究进展[J].生物骨科材料与临床研究, 2008,5(4):43-47.
[7] 王云,王青山.纳米羟基磷灰石及其复合材料在口腔医学中的应用[J].中国组织工程研究与临床康复,2010,14(8): 1426-1428.
[8] 刘海光,柏宁,梅予锋.胶原复合β-磷酸三钙在治疗Ⅱ度根分叉病变中的疗效分析[J].口腔医学,2011,31(11):670-671.
[9] 范卫华.引导组织再生术联合多孔无机骨治疗磨牙Ⅱ类根分叉病变的临床观察[J]. 实用医学杂志,2008,24(15): 2625-2627.
[10] 李斌,邱桂芹.GTR引导组织再生术与人工骨移植联合治疗根分叉病变26例[J].宁夏医学杂志,2010,32(8):763-764.
[11] 邓炳涛,李业荣,郭庆平.富血小板血浆、多孔牛骨无机材料及引导组织再生术联合治疗人下颌磨牙Ⅱ 度根分叉病变的疗效分析[J].吉林医学,2012,33(17):3602-3603.
[12] 何建明,王慧明.骨形态蛋白复合物联合引导组织再生技术治疗根分叉病变的研究[J].现代口腔医学杂,2007, 21(1):1-3.
[13] 李小玲,刘淑华.磷酸三钙联合引导组织再生术治疗根分叉病变(附10例报告)[J].临床口腔医学,2010,26(2):113-114.
[14] Tsao YP, Neiva R, Al-Shammari K,et al.Effects of a Mineralized Human Cancellous Bone Allograft in Regeneration of Mandibular Class II Furcation Defects.J Periodontol.2006;77(3):416-425.
[15] Kannan AL, Bose BB, Muthu J, et al.Efficacy of combination therapy using an organic bovine bone graft with resorbable GTR membrane vs. open flap debridement alone in the management of grade II furcation defects in mandibular molars-A comparative study.J Int Soc Prev Community Dent. 2014;4(Suppl 1): S38-43.
[16] 郑玲莉,陆国平,李水兰,等.胶原膜联合多孔磷酸三钙治疗Ⅱ-Ⅲ根分叉的近期疗效[J].实用临床医学,2007,8(8):95-96.
[17] 陈铁楼,王刚,陈婷,等.引导骨再生术和引导组织再生术治疗牙周根分叉病变的临床研究[J].口腔医学,2006,26(6): 404-407.
[18] 乔静,段晋瑜,孙昌洲,等.锥束CT评价下颌磨牙根分叉病变再生治疗疗效[J].北京大学学报:医学版,2014,46(5): 727-732.
[19] 叶扬,詹兵,周村,等.牙周引导组织再生术治疗根分叉病变的临床观察[J].临床口腔医学,2007,23(6):344-345.
[20] Lekovic V, Camargo PM, Weinlaender M.Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans.J Clin Periodontol.2003,30:746-751.
[21] 刘涛,耿发云,杨萍,等.引导组织再生术治疗Ⅱ度根分叉病变的临床研究[J].中山大学学报,2004,25(3S):216-218.
[22] Pontoriero R, Lindhe J.Guided tissue regeneration in the treatment of degree II furcations in maxillary molars.J Clin Peridontol.1995;22: 756-763.
[23] Cury PR, Sallum EA, Nociti Jr FH.Long-term results of guided tissue regeneration therapy in the treatment of class II furcation defects: a randomized clinical trial. J Periodontol 2003;74:3-9.
[24] 马捷.Jadad量表与Cochrane偏倚风险评估工具在随机对照试验质量评价中的应用与比较[J] .中国口腔颌面外科杂志,2012,10(5):417-422.
[25] 郑麟藩,张震康,俞光岩.实用口腔医学[M].北京:人民卫生出版社,1999,134-136.
[26] 杨路,张秀清.根分叉区病损的研究[J].山西医学院院报, 1994,25(3):277.
[27] Nyman S, Lindhe J,Karring T, et al. New attachment following surgical treatment of human periodontal disease.J Clinic Periodontol.1982;9(4):290-296.
[28] 庞杰.GTR联合nHA引导组织再生术治疗根分叉病变疗效分析[J].中国老年保健医学,2012,10(5):19-20.
[29] Kinaia M, Steiger J, Neely AL,et al. Treatment of class II molar furcation involvement: meta-analyses of reentry results. J Periodontol.2011; 82: 413-428.