比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析

doi:10.7518/hxkq.2023.2023045

华西口腔医学杂志 ›› 2023, Vol. 41 ›› Issue (4): 450-462.doi: 10.7518/hxkq.2023.2023045

比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析

程小明¹^,²(), 唐睿², 葛自力²()

^1.上海交通大学医学院附属上海儿童医学中心口腔科，上海 200127
^2.苏州大学附属第一医院口腔科，苏州 215006

收稿日期:2023-02-10 修回日期:2023-06-06 出版日期:2023-08-01 发布日期:2023-07-21
通讯作者: 葛自力 E-mail:1441821514@qq.com;gezl@163.com
作者简介:程小明，住院医师，硕士，E-mail：1441821514@qq.com
基金资助:
国家自然科学基金(81671028)

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis

Cheng Xiaoming¹^,²(), Tang Rui², Ge Zili²()

^1.Dept. of Stomatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Dept. of Stomatology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China

Received:2023-02-10 Revised:2023-06-06 Online:2023-08-01 Published:2023-07-21
Contact: Ge Zili E-mail:1441821514@qq.com;gezl@163.com
Supported by:
The National Natural Science Foundation of China(81671028);Correspondence: Ge Zili, E-mail: gezl@163.com

摘要/Abstract

摘要：

目的系统评价隧道术（TUN）和冠向复位瓣（CAF）联合结缔组织移植术（CTG）治疗牙龈退缩的疗效及长期稳定性。方法通过计算机检索PubMed、Web of Science、Embase、CNKI数据库，搜集相关的临床随机对照试验（RCT），只有用于比较CAF与TUN的RCT才被纳入本篇Meta分析。检索时间自建库至2022年9月1日。结果本研究共纳入8项RCT，包括305位受试者的454个退缩位点。Meta分析结果显示：在主要指标平均根面覆盖率（MRC）长期稳定性方面，CAF组、TUN组在短期和长期结果比较上差异无统计学意义，分别是［MD：1.45%，95% CI（-2.93%，5.82%），P=0.52］、［MD：-0.70%，95%CI（-6.41%，5.00%），P=0.81］，但CAF组在术后MRC长期结果上较TUN组表现更佳［MD：5.69%，95%CI（0.87%，10.50%），P=0.02］，其中完全根面覆盖率（CRC）分析结果与MRC结果大致相同。次要指标角化龈宽度（KTW）增长量，短期内TUN组显著优于CAF组［MD：-0.38 mm，95%CI（-0.67 mm，-0.10 mm），P=0.008］，长期结果显示两组差异无统计学意义［MD：-0.26 mm，95%CI（-0.94 mm，0.43 mm），P=0.46］。次要指标根面覆盖美学评分（RES），TUN组优于CAF组，差异具有统计学意义［MD：0.62，95%CI（0.28，0.96），P=0.000 3］。术后VAS疼痛指数评分，由于纳入文献统计的结果较少，且异质性太大，分析的结果未见显著性差异［MD：0.53，95%CI（-1.96，3.03），P=0.68］。结论本研究发现CAF+CTG和TUN+CTG在治疗牙龈退缩均可取得良好CRC，且CAF比TUN表现更佳，两组均能取得良好的长期稳定性。在术后RES，TUN组较CAF组评分更高。考虑到本研究存在一定的局限性，未来仍需要更大样本、更高质量、更长随访时间的临床试验评估TUN在牙龈退缩手术的疗效。

关键词: 隧道术, 冠向复位瓣术, 牙龈退缩, 根面覆盖术, 结缔组织移植术, Meta分析

Abstract:

Objective This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. Methods Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. Results There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group’s secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group’s [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. Conclusion This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

Key words: tunnel technique, coronally advanced flap, gingival recession, root coverage, connective tissue graft, Meta-analysis

中图分类号:

R 781.4⁺4

程小明, 唐睿, 葛自力. 比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析[J]. 华西口腔医学杂志, 2023, 41(4): 450-462.

Cheng Xiaoming, Tang Rui, Ge Zili. Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis[J]. West China Journal of Stomatology, 2023, 41(4): 450-462.

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纳入研究	研究设计	年龄/岁	受试人数（男/女）	纳入位点	试验组（位点）	对照组（位点）	牙龈退缩类型	退缩位点	退缩深度
Salhi等^[40]	半口对照	22~63	40（14/26）	40	TUN+CTG（20）	CAF+CTG（20）	MillerⅠ类	上颌切牙、尖牙、前磨牙	2~5 mm
Santamaria等^[29]	平行对照	24~59	42（15/27）	42	TUN+CTG（21）	CAF+CTG（21）	MillerⅠ、Ⅱ类	上颌尖牙、前磨牙	≥2 mm
Neves等^[30]	平行对照	>18	39（11/28）	39	TUN+CTG（20）	CAF+CTG（19）	MillerⅠ、Ⅱ类	上颌尖牙、前磨牙	NR
Salem等^[28]	平行对照	18~32	38（13/25）	38	TUN+CTG（19）	CAF+CTG（19）	MillerⅠ类	上颌切牙、尖牙、前磨牙	2~5 mm
Bherwani等^[39]	平行对照	18~55	20（NR）	75	TUN+CTG（36）	CAF+CTG（39）	MillerⅠ、Ⅱ类	上颌切牙、尖牙、前磨牙	NR
Bhatavadekar等^[45]	平行对照	22~54	36（20/16）	99	TUN+CTG（45）	CAF+CTG（54）	MillerⅠ、Ⅱ类	上颌切牙、尖牙、前磨牙	NR
Azaripour等^[38]	平行对照	19~64	40（15/25）	71	TUN+CTG（42）	CAF+CTG（29）	MillerⅠ、Ⅱ类	上下颌切牙、尖牙、前磨牙	NR
Gobbato等^[44]	平行对照	20~37	50（26/24）	50	TUN+CTG（25）	CAF+CTG（25）	MillerⅠ、Ⅱ类	上下颌切牙、尖牙、前磨牙	2~5 mm

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比较隧道术及冠向复位瓣术治疗牙龈退缩的疗效及长期稳定性的Meta分析

Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis

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