牙周微創(chuàng)手術聯(lián)合再生生物材料治療牙周骨內缺損的隨機對照試驗的Meta分析
發(fā)布時間：2018-08-03 16:29
【摘要】：背景:現(xiàn)如今伴隨人們生活質量的提升及對口腔健康認識的增強,更多的成年人希望通過正畸治療實現(xiàn)牙齒的整齊與功能的完善。然而流行病學調查發(fā)現(xiàn)我國絕大部分成年人均存在不同程度的牙周炎,輕中度的牙周炎可通過正畸治療前及治療中的牙周基礎潔治控制炎癥,使患者能夠進行正畸治療,但伴重度牙周炎患者無法單純通過牙周基礎潔治徹底清除牙周有害物質控制炎癥,從而導致無法接受正畸治療。對于這類患者,通過牙周手術治療進一步控制炎癥同時促進牙周組織的再生將使其接受正畸治療成為可能。近幾十年來,微創(chuàng)手術已成為一種常規(guī)的治療手段并在很多醫(yī)學領域得到了廣泛的應用。隨著微創(chuàng)手術在牙周治療領域的不斷發(fā)展,通過微創(chuàng)手術使牙周組織再生能一定程度幫助重度牙周炎患者改善牙周狀況。目前大量臨床文獻對牙周微創(chuàng)手術聯(lián)合再生生物材料與單獨應用牙周微創(chuàng)手術治療牙周骨內缺損的療效進行了對比研究,但是否需要在牙周微創(chuàng)手術中運用再生生物材料仍存在一定爭議�；谏厦嫣岢龅呐R床問題,我們將篩選高質量的隨機對照試驗并采取Meta分析的方法,用于比較牙周微創(chuàng)手術聯(lián)合再生生物材料治療牙周骨內缺損的牙周再生臨床結果是否比單獨應用牙周微創(chuàng)手術更佳。方法:全面檢索相關英文文獻,計算機檢索數(shù)據(jù)庫包括:Cochrane CENTRAL,Pub Med,Medline,Embase,Clinical Evidence以及灰色文獻數(shù)據(jù)庫Clinical Trails.gov。檢索截至日期為2015年6月30號。兩名研究員從檢索數(shù)據(jù)庫中篩選出比較牙周微創(chuàng)手術聯(lián)合再生生物材料與單獨應用牙周微創(chuàng)手術對牙周骨內缺損病人牙周再生效果的隨機對照試驗研究,并對納入的文獻進行文獻質量評價。選取的臨床測量指標分別為臨床附著水平增加量,探診深度降低量,牙齦退縮量以及影像學骨增加量的百分比。選用Cochrane協(xié)作網(wǎng)推薦Meta分析專用的Rev Man5.2軟件對提取的數(shù)據(jù)整合分析,檢測各項臨床測量指標的異質性,平均差及方差,95%可信區(qū)間。結果:初步檢索總共納入464篇文獻,通過查重,閱讀題目及摘要,最后根據(jù)制定的納入排除標準排除不符合要求的文獻后最終納入4篇文獻。Meta分析結果顯示,四項臨床測量指標異質性I2=0,選用固定效應模型進行分析。牙周微創(chuàng)手術聯(lián)合再生生物材料與單獨應用牙周微創(chuàng)手術對牙周骨內缺損病人牙周再生效果在臨床附著水平增加量(P=0.32),探診深度降低量(P=0.40),牙齦退縮量(P=0.81),及影像學骨增加量的百分比(P=0.64)四個臨床檢查指標均無統(tǒng)計學差異。結論:Meta分析結果表明牙周微創(chuàng)手術聯(lián)合再生生物材料與單獨應用牙周微創(chuàng)手術對牙周骨內缺損病人牙周再生的臨床治療效果在四個臨床常用檢測指標上均無統(tǒng)計學差異,表明單獨應用牙周微創(chuàng)手術已能夠達到較好手術效果。這一結果提示我們在決定牙周手術治療方案時應從成本和療效兩方面綜合考慮決定是否需要將再生生物材料常規(guī)應用于牙周微創(chuàng)手術中。同時,研究也提示對于牙周微創(chuàng)手術應用于治療牙周骨內缺損的牙周自愈機制仍需要更深入的探究。
[Abstract]:Background: Nowadays, with the improvement of people's quality of life and the enhancement of understanding of oral health, more adults want orthodontic treatment to achieve the integrity and function of the teeth. However, the epidemiological survey found that most adults in our country have different degrees of periodontitis, and the mild and moderate periodontitis can be treated by orthodontic treatment. Periodontal cleaning before and in treatment controls inflammation to enable patients to perform orthodontic treatment, but patients with severe periodontitis can not simply eliminate periodontal harmful substances to control inflammation simply through periodontal basic cleanup, resulting in unacceptable orthodontic treatment. For these patients, periodontal surgery is used to further control the inflammation and promote the simultaneous promotion of inflammation. The regeneration of the periodontal tissue will make it possible to receive orthodontic treatment. In the past few decades, minimally invasive surgery has become a conventional treatment and has been widely used in many medical fields. With the continuous development of minimally invasive surgery in the field of periodontal treatment, minimally invasive surgery can help the periodontal tissue regeneration to a certain extent. Patients with periodontitis improve periodontal status. A large number of clinical literatures have compared the effects of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery in the treatment of periodontal defects. However, there are still some disputes in the use of recycled biomaterials in minimally invasive surgery. Clinical problems, we will select a high quality randomized controlled trial and adopt a Meta analysis to compare the results of periodontal regeneration between periodontal and regenerative biomaterials for periodontal regeneration compared with the individual periodontal minimally invasive surgery. The library includes: Cochrane CENTRAL, Pub Med, Medline, Embase, Clinical Evidence, and the grey literature database Clinical Trails.gov. retrieval date is June 30, 2015. Two researchers screened the comparative periodontal minimally invasive surgery combined with regenerative biological materials from the retrieval database and the individual periodontal minimally invasive surgery on the periodontal defect. A randomized controlled trial of the effect of periodontal regeneration of the patients and the literature quality evaluation of the included literature. The selected clinical measurements were the increase in clinical attachment level, the depth of detection, the amount of gingival contraction and the percentage of image bone increase. The Cochrane collaborative network was selected to recommend the specific Rev Man5.2 for the Meta analysis. The software integrated analysis of the extracted data to detect the heterogeneity, mean difference and variance of various clinical measurements, and 95% confidence interval. Results: a total of 464 documents were included in the preliminary retrieval, and the titles and abstracts were read through weight checking. Finally, 4 literature.Meta analysis was finally included in the literature after the exclusion criteria were excluded. The results showed that four clinical measurement indexes were heterogeneous I2=0, and the fixed effect model was used to analyze the effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal bone defects, the increase in clinical attachment level (P=0.32), depth reduction (P=0.40) and gingival retraction (P=0.81 There was no statistical difference between the four clinical examination indexes of the percentage of bone increase (P=0.64). Conclusion: the results of Meta analysis showed that the clinical therapeutic effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal defects was no more than four clinical tests. Statistical differences indicate that the use of periodontal minimally invasive surgery has been able to achieve better surgical results. This result suggests that we should consider two aspects of the cost and efficacy of the periodontal surgery to determine whether regenerative biomaterials should be routinely used in periodontal microinvasive surgery. The mechanism of periodontal self-healing in minimally invasive surgery for periodontal bone defects still needs further investigation.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R782.1
本文編號：2162322
[Abstract]:Background: Nowadays, with the improvement of people's quality of life and the enhancement of understanding of oral health, more adults want orthodontic treatment to achieve the integrity and function of the teeth. However, the epidemiological survey found that most adults in our country have different degrees of periodontitis, and the mild and moderate periodontitis can be treated by orthodontic treatment. Periodontal cleaning before and in treatment controls inflammation to enable patients to perform orthodontic treatment, but patients with severe periodontitis can not simply eliminate periodontal harmful substances to control inflammation simply through periodontal basic cleanup, resulting in unacceptable orthodontic treatment. For these patients, periodontal surgery is used to further control the inflammation and promote the simultaneous promotion of inflammation. The regeneration of the periodontal tissue will make it possible to receive orthodontic treatment. In the past few decades, minimally invasive surgery has become a conventional treatment and has been widely used in many medical fields. With the continuous development of minimally invasive surgery in the field of periodontal treatment, minimally invasive surgery can help the periodontal tissue regeneration to a certain extent. Patients with periodontitis improve periodontal status. A large number of clinical literatures have compared the effects of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery in the treatment of periodontal defects. However, there are still some disputes in the use of recycled biomaterials in minimally invasive surgery. Clinical problems, we will select a high quality randomized controlled trial and adopt a Meta analysis to compare the results of periodontal regeneration between periodontal and regenerative biomaterials for periodontal regeneration compared with the individual periodontal minimally invasive surgery. The library includes: Cochrane CENTRAL, Pub Med, Medline, Embase, Clinical Evidence, and the grey literature database Clinical Trails.gov. retrieval date is June 30, 2015. Two researchers screened the comparative periodontal minimally invasive surgery combined with regenerative biological materials from the retrieval database and the individual periodontal minimally invasive surgery on the periodontal defect. A randomized controlled trial of the effect of periodontal regeneration of the patients and the literature quality evaluation of the included literature. The selected clinical measurements were the increase in clinical attachment level, the depth of detection, the amount of gingival contraction and the percentage of image bone increase. The Cochrane collaborative network was selected to recommend the specific Rev Man5.2 for the Meta analysis. The software integrated analysis of the extracted data to detect the heterogeneity, mean difference and variance of various clinical measurements, and 95% confidence interval. Results: a total of 464 documents were included in the preliminary retrieval, and the titles and abstracts were read through weight checking. Finally, 4 literature.Meta analysis was finally included in the literature after the exclusion criteria were excluded. The results showed that four clinical measurement indexes were heterogeneous I2=0, and the fixed effect model was used to analyze the effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal bone defects, the increase in clinical attachment level (P=0.32), depth reduction (P=0.40) and gingival retraction (P=0.81 There was no statistical difference between the four clinical examination indexes of the percentage of bone increase (P=0.64). Conclusion: the results of Meta analysis showed that the clinical therapeutic effect of periodontal minimally invasive surgery combined with regenerative biomaterials and individual periodontal minimally invasive surgery on periodontal regeneration in patients with periodontal defects was no more than four clinical tests. Statistical differences indicate that the use of periodontal minimally invasive surgery has been able to achieve better surgical results. This result suggests that we should consider two aspects of the cost and efficacy of the periodontal surgery to determine whether regenerative biomaterials should be routinely used in periodontal microinvasive surgery. The mechanism of periodontal self-healing in minimally invasive surgery for periodontal bone defects still needs further investigation.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R782.1
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