富血小板血浆与脱矿冻干骨联合应用治疗牙周骨缺损的meta分析

doi:10.19439/j.sjos.2018.05.022

摘要/Abstract

摘要： 目的: 从临床和影像学两方面系统评价富血小板血浆（platelet rich plasma,PRP )与脱矿冻干骨（demineralized freeze-dried bone allografts, DFDBA）联合应用治疗牙周骨内缺损的临床疗效。方法: 计算机检索Pubmed、The Cochrane Library、EMbase、中国知网、万方及维普数据库,检索PRP与DFDBA联合应用与PRP或DFDBA单独使用治疗牙周骨内缺损的随机对照试验（RCT),检索时限均从建库至2016年12月。由2名研究员按照纳入和排除标准独立筛选文献、提取资料,评价纳入研究的方法学质量。采用RevMan 5.2 软件进行统计学分析。结果: 最终纳入6个RCT,205个牙周骨内缺损位点。6个研究结果显示,牙周基础治疗后,PRP与DFDBA联合应用组与PRP或DFDBA组的探诊深度（probing depth, PD）改变量差异无统计学意义[MD=0.35,95%CI（-0.09,0.79),P=0.12],而临床附着丧失（clinical attachment loss,CAL）改变量2组间差异显著[MD= 0.68,95%CI（0.41,0.94）,P<0.00001]。有3个研究从影像学方面评估了治疗后骨充盈的改变量,其中釉-牙骨质界到牙槽骨缺损底部间距离(CEJ-BD)的改变量2组间差异显著[MD=0.71,95%CI（0.46,0.95）,P<0.00001];牙槽嵴缺损顶点到缺损底部间距离(AC-BD)的改变量2组间差异具有显著性[MD=0.64,95%CI（0.41,0.87),P<0.00001];而釉-牙骨质界到牙槽嵴缺损顶点的距离的改变量（CEJ-AC)2组间差异无显著性[MD=0.03,95%CI（-0.10,0.16),P=0.68]。结论: 现有研究证据表明,在牙周基础治疗后,PRP与DFDBA联合应用治疗牙周骨缺损在附着丧失和骨充盈上优于单用PRP或DFDBA组,而探诊深度无显著差异。受纳入研究数量及质量的限制,上述研究需要更多高质量、大样本的研究予以证实。

关键词: 牙周骨缺损, 富血小板血浆, 脱矿冻干骨, Meta分析

Abstract: PURPOSE: The aim of this meta analysis was to assess the influence of platelet-rich plasma (PRP)combined with demineralized freeze-dried bone allografts(DFDBA) on regeneration of periodontal periodontal defects by means of evaluating clinical and radiographic outcomes in prospective human clinical trials. METHODS: The following databases such as PubMed, The Cochrane Library, EMbase, CNKI, Wanfang data and VIP data were searched on computer from inception to December, 2016. According to the inclusion and exclusion criteria, two reviewers independently extracted the data,assessed the methodological quality of the included studies. RevMan 5.2 was applied for meta analysis. RESULTS: Six papers were obtained reviewed which included 205 periodontal bone defect sites. Six articles showed that there was no significant difference in probing depth decrease between PRP combined with DFDBA and PRP or DFBDA group[MD=0.35, 95%CI（-0.09,0.79), P=0.12], but there was significant difference in clinical attachment loss increase between the two groups[MD= 0.68,95%CI（0.41,0.94）,P<0.00001]. Three articles were included for evaluating bone filling, there was significant difference in the distance from the cemento-enamel junction(CEJ) to the vertical bone defect(BD)(CEJ-BD)[MD=0.71,95%CI（0.46,0.95）,P<0.00001]between the two groups; there was also significant difference in the distance from the alveolar crest to the vertical bone defect(AC-BD)[MD=0.64,95%CI（0.41,0.87),P<0.00001]between the two groups. but there was no significant difference in the distance from the cemento-enamel junction(CEJ)to the alveolar crest (AC)(CEJ-AC)[MD=0.03,95%CI（-0.10,0.16）,P=0.68between the two groups. CONCLUSIONS: Within the limitations of this meta analysis, PRP combined with DFDBA is superior to PRP or DFDBA alone in clinical attachment loss and bone filling ,but there was no significant difference in probing depth. However, given the limited sample size and quantity of included studies, the above findings still need to be further proved by conducting more high-quality and large-scale RCTs.

Key words: Periodontal intrabony defects, Platelet-rich plasma, Demineralized freeze-dried bone allografts, Meta analysis

中图分类号:

R781.4.2

胡婷, 叶国, 范小平, 邓雪阳, 李文华, 向学熔. 富血小板血浆与脱矿冻干骨联合应用治疗牙周骨缺损的meta分析[J]. 上海口腔医学, 2018, 27(5): 546-553.

HU Ting, YE Guo, FAN Xiao-ping, DENG Xue-yang, LI Wen-hua, XIANG Xue-rong. Platelet-rich plasma combined with demineralized freeze-dried bone allografts for periodontal regeneration in the treatment of periodontal defects: a meta-analysis[J]. Shanghai Journal of Stomatology, 2018, 27(5): 546-553.

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