自体牙本质用于牙槽嵴增量的Meta分析

doi:10.7518/hxkq.2022.05.010

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (5): 566-575.doi: 10.7518/hxkq.2022.05.010

自体牙本质用于牙槽嵴增量的Meta分析

龚佳明¹^,²(), 张启航¹, 苟萍¹, 王辉¹, 余佳颖¹, 余占海¹()

^1.兰州大学口腔医学院/口腔医院种植科，兰州 730000
^2.解放军联勤保障部队第940医院口腔科，兰州 730050

收稿日期:2022-03-28 修回日期:2022-08-03 出版日期:2022-10-01 发布日期:2022-10-17
通讯作者: 余占海 E-mail:gongjm19@lzu.edu.cn;yuzhanhai@lzu.edu.cn
作者简介:龚佳明，医师，硕士，E-mail：gongjm19@lzu.edu.cn
基金资助:
甘肃省科技计划项目(20JR10FA670);兰州大学口腔医院科研基金(071100140)

Meta-analysis of application of autogenous dentin for alveolar ridge augmentation

Gong Jiaming¹^,²(), Zhang Qihang¹, Gou Ping¹, Wang Hui¹, Yu Jiaying¹, Yu Zhanhai¹()

^1.Dept. of Implantology, School of Stomatology, Lanzhou University, Lanzhou 730000, China
^2.Dept. of Stomatology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou 730050, China

Received:2022-03-28 Revised:2022-08-03 Online:2022-10-01 Published:2022-10-17
Contact: Yu Zhanhai E-mail:gongjm19@lzu.edu.cn;yuzhanhai@lzu.edu.cn
Supported by:
Gansu Provincial Science and Technology Planning Project(20JR10FA670);Research Fund of Hospital Stomatology Lanzhou University(071100140);Correspondence: Yu Zhanhai, E-mail: yuzhanhai@lzu.edu.cn

摘要/Abstract

摘要：

目的通过Meta分析方法系统评估在牙槽嵴缺损需要骨增量时使用自体牙本质（ATD）移植的有效性及安全性。方法电子检索2010年1月1日—2022年3月19日PubMed、Embase、Web of Science、Cochrane Library、CNKI、万方数据库有关牙槽嵴增量使用ATD的临床研究。使用Cochrane Tool评估随机对照试验的偏倚风险，使用Newcastle-Ottawa Scale评估队列研究。RevMan 5.4对数据进行合并分析。结果共纳入10项研究，其中5项研究对照组采用自体骨，另5项研究对照组采用脱蛋白牛骨基质（DBBM）。Meta分析结果显示，牙槽嵴增量术后6个月，ATD较自体骨获得更多水平向牙槽嵴增量［MD=2.01，95%可信区间（CI）（1.09，2.93），P<0.000 1］，但在垂直向牙槽嵴增量上效果相似［MD=-0.06，95%CI（-0.21，0.08），P=0.39］。ATD与自体骨或DBBM相比呈现更少的材料吸收［MD=-0.59，95%CI（-1.03，-0.15），P=0.008；MD=-0.63，95%CI（-1.18，-0.07），P=0.03］，而在种植体稳定系数和术后并发症上均无显著差异［MD=-0.76，95%CI（-3.04，1.52），P=0.51；RR=1.01，95%CI（0.33，3.12），P=0.98］。结论有限证据表明，在牙槽嵴缺损中移植ATD可取得与移植自体骨或DBBM类似或更佳的骨增量效果且材料吸收更少，可作为扩增牙槽嵴的植骨材料。但仍需要进行更大样本、更高质量、更长随访时间的临床试验评估ATD在牙槽嵴增量中的疗效。

关键词: 牙本质, 自体骨, 牙槽嵴增量, 骨移植, 种植体, Meta分析

Abstract:

Objective This investigation aimed to systematically evaluate the efficacy and safety of applying autogenous dentin (ATD) in alveolar ridge augmentation. Methods The PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang databases were electronically searched from January 1, 2010 to March 19, 2022 to identify clinical trials and cohort studies that employed ATD in alveolar ridge augmentation. The Cochrane Tool and the Newcastle-Ottawa Scale were employed to assess the risk of bias in randomized controlled trials and cohort studies, respectively. Data were analyzed via RevMan 5.4 software. Results A total of 10 studies were included, 5 of which compared ATD with autologous bone and 5 with deproteinized bovine bone matrix (DBBM). Meta-analysis indicated that ATD had preferable performance [MD=2.01, 95% confidence interval (CI) (1.09, 2.93), P<0.000 1] in horizontal ridge augmentation compared with autologous bone but similar effect in vertical ridge augmentation [MD=-0.06, 95%CI (-0.21, 0.08), P=0.39] at 6 months after alveolar ridge augmentation. In terms of material absorption, ATD was significantly less than autologous bone or DBBM [MD=-0.59, 95%CI (-1.03, -0.15), P=0.008; MD=-0.63, 95%CI (-1.18, -0.07), P=0.03], but no significant difference in implant stability quotient and postoperative complications was observed [MD=-0.76, 95%CI (-3.04, 1.52), P=0.51; RR=1.01, 95%CI (0.33, 3.12), P=0.98]. Conclusion ATD, as a bone grafted material for alveolar ridge augmentation, not only achieves similar or better bone incremental performance than autologous bone or DBBM but also has less absorption. However, further evidence from clinical trials with larger samples, higher quality, and longer follow-up period are needed to evaluate its superiority.

Key words: dentin, autologous bone, alveolar ridge augmentation, bone graft, dental implant, Meta-analysis

中图分类号:

R 783.1

龚佳明, 张启航, 苟萍, 王辉, 余佳颖, 余占海. 自体牙本质用于牙槽嵴增量的Meta分析[J]. 华西口腔医学杂志, 2022, 40(5): 566-575.

Gong Jiaming, Zhang Qihang, Gou Ping, Wang Hui, Yu Jiaying, Yu Zhanhai. Meta-analysis of application of autogenous dentin for alveolar ridge augmentation[J]. West China Journal of Stomatology, 2022, 40(5): 566-575.

图/表 7

表 1

纳入研究的基本特征

作者/年份	研究设计	患者/种植体	移植骨来源	手术程序	随访时间	结局指标
涉及水平向牙槽嵴骨增量
Korsch 2021^[21]	CS	28/38	松动牙或第三磨牙	自体牙预备成1~1.5 mm牙本质壳后骨钉固定，间隙内覆盖ATD颗粒，同期植入种植体	5月	⑤⑥
				自体牙预备成1~1.5 mm牙本质壳后骨钉固定，间隙内覆盖ATD颗粒，同期植入种植体
		31/41	下颌磨牙后区/外斜线	自体骨预备成骨块后骨钉固定，间隙内充填自体骨颗粒，同期植入种植体
			下颌磨牙后区/外斜线	自体骨预备成骨块后骨钉固定，间隙内充填自体骨颗粒，同期植入种植体
Schwarz 2018^[23]	CS	15/15	第三磨牙	自体牙预备成牙本质块后骨钉固定，术后26周植入种植体	26周	①②⑥
		15/15	磨牙后区	自体骨预备成骨块后骨钉固定，术后26周植入种植体
Schwarz 2019^[24]	CS*	13/13	第三磨牙	自体牙预备成牙本质块后骨钉固定，术后26周植入种植体	26周	①⑥
		10/10	磨牙后区	自体骨预备成骨块后骨钉固定，术后26周植入种植体	26周
潘凌峰 2020^[30]	RCT	42/-	第三磨牙	ATD粉碎成0.5~1 mm颗粒后脱矿并混合PRP后充填，覆盖Bio-Gide，同期植入种植体	12月	①⑥
				ATD粉碎成0.5~1 mm颗粒后脱矿并混合PRP后充填，覆盖Bio-Gide，同期植入种植体
		42/-	异种骨	Bio-Oss充填，覆盖Bio-Gide，同期植入种植体
林继超 2019^[26]	CS	5/11	松动牙或阻生齿	ATD粉碎成<1 mm颗粒后脱矿充填，同期植入种植体	（11.86±1.96）月	②⑥
		5/10	异种骨	Bio-Oss充填，同期植入种植体
涉及垂直向牙槽嵴骨增量
Pang 2017^[28]	RCT	15/21	无法保留牙齿	ATD粉碎成300~800 μm颗粒后脱矿充填，术后6个月植入种植体	6月	③⑤⑥
				ATD粉碎成300~800 μm颗粒后脱矿充填，术后6个月植入种植体
		12/12	异种骨	Bio-Oss充填，术后6个月植入种植体
Li 2018^[27]	RCT	19/23	松动牙	ATD粉碎成0.5~1 mm颗粒后脱矿并混合PRF充填，覆盖Bio-Gide，同期植入种植体	18月	⑤⑥
				ATD粉碎成0.5~1 mm颗粒后脱矿并混合PRF充填，覆盖Bio-Gide，同期植入种植体
		19/22	异种骨	Bio-Oss混合PRF充填，覆盖Bio-Gide，同期植入种植体
孙娟斌 2016^[29]	RCT	21/-	松动牙或阻生齿	ATD粉碎成300~1 200 μm颗粒后脱矿充填，覆盖Bio-Gide	12月	③⑥
		21/-	异种骨	Bio-Oss充填，覆盖Bio-Gide
涉及水平和垂直向牙槽嵴骨增量
Schwarz 2022^[25]	CS	14/15	第三磨牙	自体牙预备成牙本质块后骨钉固定，术后26周植入种植体	26周	②③④⑥
		14/17	外斜线	自体骨预备成骨块后骨钉固定，术后26周植入种植体
Xiao 2019^[22]	CS	7/10	第三磨牙	自体牙预备成<2 mm牙本质壳后骨钉固定，间隙内充填Bio-Oss和1 mm CGF膜，覆盖Bio-Gide，术后6个月植入种植体	6月	②③④⑥

		6/11	外斜线	自体骨预备成<2 mm骨壳后骨钉固定，间隙内充填Bio-Oss和1 mm CGF膜，覆盖Bio-Gide，术后6个月植入种植体

表 1

图 1

图 2

图 3

图 4

图 5

图 6

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自体牙本质用于牙槽嵴增量的Meta分析

Meta-analysis of application of autogenous dentin for alveolar ridge augmentation

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