脱细胞真皮基质与上皮下结缔组织瓣治疗牙龈退缩效果的系统评价

目的系统评价脱细胞真皮基质(ADM)与上皮下结缔组织瓣(sCTG)治疗牙龈退缩(GR)的效果。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、WanFang Data和VIP数据库,搜集有关ADM和sCTG比较治疗GR疗效的随机对照试验(RCT),检索时限均从建库至2019年7月11日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3和Stata 12.1软件进行Meta分析。结果共纳入9个RCT。Meta分析结果显示:术后两组探诊深度(PD)[MD(3月)=-0.04,95%CI(-0.18,0.11),P=0.63]、[MD(6月)=-0.01,95%CI(-0.13,0.12),P=0.90]和GR程度[MD(3月)=-0.10,95%CI(-0.37,0.18),P=0.48]、[MD(6月)=-0.02,95%CI(-0.33,0.29),P=0.89]的差异均无统计学意义。但sCTG组术后3个月的临床附着丧失(CAL)偏少[MD=0.33,95%CI(0.00,0.66),P=0.05]、术后6个月的角化龈宽度(KTW)更大[MD=-0.48,95%CI(-0.76,-0.20),P=0.000 7],差异均有统计学意义。结论现有证据表明,ADM与sCTG术后3个月及6个月的PD、GR程度无差异;sCTG组术后3个月CAL和术后6个月KTW较ADM组更具优势。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Efficacy of acellular dermal matrix and subepithelial connective tissue flap on gingival recession: a systematic review

Objectives To systematically review the efficacy of acellular dermal matrix(ADM)and subepithelial connective tissue flap(sCTG)on patients with gingival recession(GR).Methods PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)on the efficacy of ADM and sCTG on patients with GR from inception to August 11st,2019.Two reviewers indepeudently screened literature,extracted data and assessed risk of bias of included studies.Meta-analysis was then performed using RevMan 5.3 software and Stata 12.1 software.Results A total of 9 RCTs were included.The results of meta-analysis showed that:there were no significant differences in probing depth(PD)(MD3m=-0.04,95%CI-0.18 to 0.11,P=0.63;MD6m=-0.01,95%CI-0.13 to 0.12,P=0.90)and GR degree(MD3m=-0.10,95%CI-0.37 to 0.18,P=0.48;MD6m=-0.02,95%CI-0.33 to 0.29,P=0.89)in 3 and 6 months after operative between two groups.However,the clinical attachment loss(CAL)in 3 months after operation(MD=0.33,95%CI 0.00 to 0.66,P=0.05)and width of keratinized tissue(KTW)in 6 months after operation(MD=-0.48,95%CI-0.76 to-0.20,P=0.0007)of sCTG group were superior to ADM group.The differences were statistically significant.Conclusion Current evidence shows that there are no differences in PD and GR degree in 3 months and 6 months after operation between ADM and sCTG group.However,the CAL in 3 months after operation and KTW in 6 months after operation of sCTG group is superior to ADM group.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusion.