Effects of guided tissue regeneration combined with bone graft in the repair of periodontal bone defects: a Meta-analysis

doi:10.3969/j.issn.2095-4344.2017.04.025

Abstract

Abstract:

Abstract
BACKGROUND: Guided tissue regeneration and bone grafting are a hot spot in the treatment of periodontal bone defect caused by severe periodontitis, but a small sample size in clinical research will lead to bias.
OBJECTIVE: To systematically evaluate the effect of guided tissue regeneration combined with bone grafting in the treatment of periodontal bone defect, and explore its feasibility, thus providing evidence for clinical application.
METHODS: A computer-based search of PubMed, Cochrane Library, EMbase, CNKI, CqVip and WanFang databases was performed for articles about the guided tissue regeneration and bone graft for periodontal bone defects, published from 2000 to 2016. The keywords were “guided tissue regeneration, bone grafts, periodontal bone defects” in English and Chinese, respectively. The literature selection, data collection and evaluation of bias were conducted by two researchers independently, and then quality assessment of the included 12 randomized controlled tests was conducted, followed by Meta-analysis using Revman 5.3 software.
RESULTS AND CONCLUSION: A total of 12 studies were enrolled, including 414 teeth (228 of which in the experimental group and 216 in the control group). Meta-analysis results showed that compared with the single flap surgery, guided tissue regeneration combined with bone graft could reduce periodontal probing depth by 1.18 mm gingival, make a gingival recession by 0.23 mm, reduce alveolar bone defect depth by 1.57 mm, and increase clinical attachment level by 2.03 mm (P < 0.05). Compared with guided tissue regeneration technique, guided tissue regeneration combined with bone graft made probing depth increase by 0.34 mm, alveolar bone defect depth reduce by 0.73 mm, gingival recession reduce 0.35 mm and clinical attachment level increase by 0.63 mm (P < 0.05). Compared with bone graft, guided tissue regeneration combined with bone graft made periodontal probing depth reduce by 0.11 mm, clinical attachment levels increase by 0.04 mm and gingival recession increase by 0.13 mm (P > 0.05). These results reveal that for moderate to severe chronic periodontitis with periodontal bone defects, guided tissue regeneration combined with bone graft has better clinical effects than simply flap surgery and guided tissue regeneration, but has no significant differences from the bone graft surgery. Herein, we have not yet classified the membrane materials, bone materials and bone substitutes, and there is still a lack of high-quality and large-sample randomized controlled trials.

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: Tissue Engineering, Periodontitis, Bone Transplantation

CLC Number:

R318

Shen Yue, He Pan-long, Wei Yi-ru, Reyila•Jureti, Gulinuer•Awuti . Effects of guided tissue regeneration combined with bone graft in the repair of periodontal bone defects: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(4): 641-649.

Figures/Tables 6

2.3.2 引导组织再生术联合植骨术与单纯翻瓣术后的临床附着水平比较共有7项研究报道了临床附着水平在引导组织再生术联合植骨术与单纯翻瓣术术后相比较的结果[8，10，13-16，18]，其中观察组107例，对照组119例。异质性检验结果：I2=58%，说明各研究组间有异质性，因此选用随机效应模型进行Meta分析，结果显示：MD=2.03，95%CI：1.39-2.67，P < 0.000 01，差异有显著性意义，表明在术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组的附着水平增加了2.03 mm，见图3。 2.3.3 引导组织再生术联合植骨术与单纯翻瓣术后的牙龈退缩的比较共有5项研究对引导组织再生术联合植骨术与单纯翻瓣术术后的牙龈退缩(GR)进行了比较[8，10，14-15，18]，观察组84例，对照组84例。异质性检测结果：I2=0%，说明各研究组间有同质性，选用固定效应模型进行Meta分析，结果显示：MD=0.23，95%CI：0.02-0.43，P < 0.05，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组牙龈退缩减少0.233 mm，见图4。 2.3.4 引导组织再生术联合植骨术与单纯翻瓣术后的牙槽骨缺损深度的比较共有3项研究对引导组织再生术联合植骨术与单纯翻瓣术后的牙槽骨缺损深度(DD)进行了比较[8，10，13]，观察组34例，对照组29例。异质性检验结果I2=0%，说明各研究组间无异质性，选用固定效应模型进行Meta分析，结果显示：MD=1.57，95%CI：1.15-1.99，P < 0.000 01，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组在牙槽骨缺损深度方面减少1.57 mm，见图5。 2.3.5 引导组织再生术联合植骨术与引导组织再生术术后探诊深度的比较共有6项研究报道了探诊深度(PD)在引导组织再生术联合植骨术与引导组织再生术术后相比较的结果[7-9，13-14，17]，其中观察组116 例，对照组118例。异质性检验结果：I2=63%，说明各研究组间有异质性，选用随机效应模型进行Meta分析，结果显示：MD=-0.34，95%CI：-0.90-0.21，P=0.22，差异无显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较术组附着引导组织再生术在探诊深度方面无明显差异，见图6。"

2.3.6 引导组织再生术联合植骨术与引导组织再生术术后的临床附着水平的比较共有6项研究对引导组织再生术联合植骨术与引导组织再生术术后的临床附着水平进行了比较[7-9，13-14，17]，观察组116例，对照组118例。异质性检验结果I2=47%，说明各研究组间有同质性，选用随机效应模型进行Meta分析，结果显示：MD=0.63，95%CI：0.27-1.00，P=0.000 7，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组附着水平增加0.62 mm，见图7。 2.3.7 引导组织再生术联合植骨术与引导组织再生术术后的牙龈退缩比较共有5项研究对引导组织再生术联合植骨术与引导组织再生术术后的牙龈退缩(GR)进行了比较[7-9，13-14，17]，观察组106例，对照组106例。异质性检测结果：I2=75%，说明各研究组间存在异质性，选用随机效应模型进行Meta分析，结果显示：MD=0.35，95%CI：0.28-0.41，P < 0.000 01，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组牙龈退缩减少0.35 mm，见图8。 2.3.8 引导组织再生术联合植骨术与引导组织再生术术后牙槽骨的缺损深度的比较共有4项研究对引导组织再生术联合植骨术与引导组织再生组术后牙槽骨的缺损深度(DD)进行了比较[7-9，13]，观察组45例，对照组47例。异质性检验结果I2=78%，说明各研究组间存在异质性，选用随机效应模型进行Meta分析，结果显示：MD=0.73，95%CI：0.35-1.80)，P=0.19，P < 0.05，差异无显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组在牙槽骨缺损深度方面无明显差异，见图9。 2.3.9 引导组织再生术联合植骨术与植骨术术后探诊深度的比较共有2项研究报道了探诊深度在引导组织再生术联合植骨术与植骨术术后相比较的结果[11-12]，其中观察组32例，对照组32例。异质性检验结果：I2=52%，说明各研究组间有异质性，选用随机效应模型进行Meta分析，结果显示：MD=0.11，95%CI：-0.47-0.68)，P=0.71，差异无显著性意义，表明在术后6个月到1年的时间里，引导组织再生联合植骨术组与植骨术在探诊深度方面无明显差异，见图10。 2.3.10 引导组织再生术联合植骨术与植骨术术后的临床附着水平的比较共有2项研究对引导组织再生术联合植骨术与引导组织再生术术后的临床附着水平进行了比较[11-12]，观察组32例，对照组32例。异质性检验结果I2=47%，说明各研究组间有同质性，选用随机效应模型进行Meta分析，结果显示：MD=-0.04，95%CI：-0.33-0.25，P=0.80，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较单纯翻瓣术组的附着水平增加 0.62 mm，见图11。 2.3.11 引导组织再生术联合植骨术与植骨术术后的牙龈退缩的比较共有2项研究对引导组织再生术联合植骨术与植骨术术后的牙龈退缩进行了比较[11-12]，观察组32例，对照组32例。异质性检验结果I2=36%，说明各研究组间有同质性，选用随机效应模型进行Meta分析，结果显示：MD=-0.13，95%CI：-0.33-0.06，P=0.17，差异有显著性意义，表明术后6个月到1年的时间里，引导组织再生联合植骨术组较植骨术组牙龈退缩无明显差异，见图12。 2.4 发表偏倚分析通过漏斗图对文献进行发表偏倚分析，显示漏斗图两侧基本对称，说明无发表偏倚，Mate分析结果真实可靠，见图13。"

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