不翻瓣种植术与翻瓣种植术对软组织影响的Meta分析

doi:10.7518/hxkq.2024.2023341

摘要/Abstract

摘要：

目的系统比较不翻瓣种植术与翻瓣种植术对种植体周围软组织产生的影响。方法检索PubMed、Embase、Cochrane Library、Web of Science、Clinical Trails、OpenGrey、OpenDoar、Scopus、Ovid等9个数据库，纳入比较不翻瓣种植术与翻瓣种植术修复缺失牙的相关随机对照试验，检索时限为从2013年1月1日到2023 年8月27日，采用软件RevMan 5.3、Stata 14.0对符合纳入标准的研究进行Meta分析。结果共检得1 245篇文献，最终纳入17项研究。Meta分析结果表明：不翻瓣种植术可产生更好的种植体周围软组织愈合，种植体成功率［均数差（MD）=1.06，95%可信区间（CI）（1.02，1.10），P=0.004］、角化龈宽度变化［MD=0.10，95%CI（0.00，0.20），P=0.04］、探诊深度［MD=-0.60，95%CI（-0.67，-0.53），P<0.000 01］均优于翻瓣种植术，差异有统计学意义；改良牙菌斑指数［标准化均数差（SMD）=-0.41，95%CI（-0.81，0.00），P=0.05］、改良龈沟出血指数［SMD=-0.44，95%CI（-0.78，-0.10），P=0.01］最终合并结果显示优于翻瓣种植术；不翻瓣种植术龈乳头指数高于翻瓣种植术；两者间牙菌斑指数、牙龈指数变化的差异无统计学意义。结论与翻瓣种植术相比，不翻瓣种植术能实现更高的种植体成功率、更小的角化龈宽度变化、更小的探诊深度，不翻瓣种植术的改良牙菌斑指数、改良龈沟出血指数、龈乳头指数也存在优势。

关键词: 牙种植体, 不翻瓣, 翻瓣, 软组织, 影响, Meta分析

Abstract:

Objective This study aimed to systematically compare the effects of flapless and flapped implantations on the surrounding soft tissues of dental implants. Methods Nine databases were searched, including PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, OpenGrey, OpenDoar, Scopus, and Ovid, from January 1, 2013, to August 27, 2023. Randomized controlled trials comparing flapless implantation with flapped implantation for restoration of missing teeth were included. Meta-analysis was conducted on studies that met the inclusion criteria by using RevMan 5.3 and Stata 14.0. Results A total of 1 245 articles were retrieved, and 17 studies were ultimately included. The results of Meta-analysis showed that flapless implantation resulted in better healing of the soft tissues around the dental implants than flapped implantation. Moreover, flapless implantation showed superior changes in implant success rate [mean difference (MD)=1.06, 95% confidence interval (CI) (1.02, 1.10), P=0.004], the width of keratinized gingival changes [MD=0.10, 95%CI (0.00, 0.20), P=0.04], and probing depth [MD=-0.60, 95%CI (-0.67, -0.53), P<0.000 01], with statistically significant differences. The final combined results of modified plaque index [standardized mean difference (SMD)=-0.41, 95%CI (-0.81, 0.00), P=0.05] and modified sulcus bleeding index [SMD=-0.44, 95%CI (-0.78, -0.10), P=0.01] showed superiority over flapped implantation. The papillary presence index was higher in the flapless implantation group than in the flapped implantation group. No statistically significant differences were observed in plaque index and gingival indices changes between the two groups. Conclusion Flapless implantation can achieve higher implant success rate, smaller changes in the width of keratinized gingival, and smaller probing depths than flapped implantation. It also has advantages in terms of modified plaque index, modified sulcus bleeding index, and papillary presence index.

Key words: dental implants, flapless, flapped, soft tissure, effects, Meta-analysis

中图分类号:

R783.6

陈韵伊, 孙慈吉, 黎红. 不翻瓣种植术与翻瓣种植术对软组织影响的Meta分析[J]. 华西口腔医学杂志, 2024, 42(3): 382-393.

Chen Yunyi, Sun Ciji, Li Hong. Effects of flapless and flapped implantations on soft tissue: a systematic review and Meta-analysis[J]. West China Journal of Stomatology, 2024, 42(3): 382-393.

图/表 15

表 1

表 2

PubMed检索策略

步骤	检索策略
1	“Dental Implants” [MeSH] OR “Dental Implants, Single-Tooth” [MeSH Terms]
2	“Implant, Dental” [Title/Abstract] OR “Implants, Dental” [Title/Abstract] OR “Dental Implant” [Title/Abstract] OR “Dental Implants, Mini” [Title/Abstract] OR “Dental Implant, Mini” [Title/Abstract] OR “Mini Dental Implant”[Title/Abstract] OR “Mini Dental Implants” [Title/Abstract] OR “Dental Prostheses, Surgical” [Title/Abstract] OR “Dental Prosthesis, Surgical” [Title/Abstract] OR “Surgical Dental Prostheses” [Title/Abstract] OR “Surgical Dental Prosthesis”[Title/Abstract] OR “Prostheses, Surgical Dental” [Title/Abstract] OR “Prosthesis, Surgical Dental” [Title/Abstract]
3	“Dental Implants, Single Tooth” [Title/Abstract] OR “Implant, Single-Tooth Dental” [Title/Abstract] OR “Implant, Single Tooth Dental” [Title/Abstract] OR “Implants, Single-Tooth Dental” [Title/Abstract] OR “Implants, Single Tooth Dental” [Title/Abstract] OR “Single-Tooth Implants” [Title/Abstract] OR “Implant, Single-Tooth” [Title/Abstract] OR “Implants, Single-Tooth” [Title/Abstract] OR “Single Tooth Implants” [Title/Abstract] OR “Single-Tooth Implant” [Title/Abstract] OR “Single-Tooth Dental Implants” [Title/Abstract] OR “Single Tooth Dental Implants” [Title/Abstract] OR “Dental Implant, Single-Tooth” [Title/Abstract] OR “Dental Implant, Single Tooth” [Title/Abstract] OR “Single-Tooth Dental Implant” [Title/Abstract] OR “Single Tooth Dental Implant” [Title/Abstract]
4	1 OR 2 OR 3
5	“Flap” [Title/Abstract] OR “Flapped” [Title/Abstract] OR “No-Flap” [Title/Abstract] OR “Flapless” [Title/Abstract] OR “Minimally Invasive” [Title/Abstract] OR “Open Flap” [Title/Abstract] OR “Conventional Flap” [Title/Abstract] OR “Non-Invasive” [Title/Abstract] OR “Non-Flap” [Title/Abstract] OR “Direct-to” [Title/Abstract] OR “Direct” [Title/Abstract] OR “Soft Tissue Punch” [Title/Abstract] OR “Tissue Punch” [Title/Abstract] OR “Atraumatic” [Title/Abstract] OR “Tissue-Sparing” [Title/Abstract]
6	“Randomized Controlled Trial” [Publication Type] OR “Randomized” [Title/Abstract] OR “Placebo” [Title/Abstract]
7	4 AND 5 AND 6

表 2

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PICOS框架	纳入标准	排除标准
研究对象	患者缺牙需种植修复，无系统性疾病或绝经后妇女，年龄不限	动物实验、纳入研究的样本量过少、基线非均衡、重复发表文献
干预	行FLS	其他方法或手术治疗
对照	行传统FL	其他方法或手术治疗
结果	种植体成功率（Albrekstsson和Zarb标准）、角化牙龈宽度（width of keratinised gingival，WKG）变化、探诊深度（probing depth，PD）、龈乳头指数（Jemt’s papillary presence index，PPI）、牙菌斑指数（plaque index，PLI）、改良牙菌斑指数（modified plaque index，MPLI）、牙龈指数（gingival index，GI）变化、改良龈沟出血指数（modified sulcus bleeding index，MSBI）	研究未报道所需结局指标
研究设计	随机对照试验（randomized controlled trial，RCT），无论是否采用分配隐藏或盲法，不限研究地域，仅限于英文文献	系统评价、非RCT、半RCT、经联系仍无法获取全文者

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