Aichelmann-Reidy Mary Elizabeth, Reynolds Mark A
Department of Periodontics, Dental School, University of Maryland, 650 West Baltimore Street, Baltimore, MD 21201, USA.
J Periodontol. 2008 Mar;79(3):387-93. doi: 10.1902/jop.2008.060521.
Demineralized bone matrix (DBM) and guided tissue regeneration (GTR) support substantial gains in clinical attachment level (CAL), reductions in probing depth (PD), and gains in defect fill compared to open flap debridement (OFD) in intrabony defects. Although these regenerative therapies support improvements in mean clinical parameters, it is unclear whether the procedures improve the predictability of clinical outcome. The purpose of this study was to examine the relative variability in clinical outcome measures, independent of the magnitude of gains, in regenerative studies comparing DBM or GTR to OFD therapy for the management of intrabony defects. For comparative purposes, a similar analysis was performed evaluating the consistency of clinical outcomes with other (non-DBM) bone replacement graft (BRG) materials relative to OFD alone.
Fifty-five randomized controlled clinical trials comparing regenerative therapy (seven DBM, 22 BRG, and 26 GTR) to OFD and meeting inclusion criteria provided mean change scores (pretreatment to post-treatment) and variance estimates for CAL, PD, and bone fill, allowing for calculation of a coefficient of variability (CV) for each measure within studies. The mean CV for each measure was submitted to an analysis of variance or covariance with repeated measures (P < or =0.05) to compare relative variation in treatment outcomes.
DBM was associated with a significantly lower relative variability (mean +/- SE) in CAL gain (96.3 +/- 38.6 versus 137.7 +/- 30.9) and defect fill (69.1 +/- 11.2 versus 133.1 +/- 15.3) compared to OFD alone. As a group, other BRGs were found to support significant reductions in variation in CAL and defect fill. GTR therapy was associated with significantly lower CV for CAL compared to OFD (50.6 +/- 5.0 versus 68.7 +/- 8.2, respectively). Variability in defect fill was similar for GTR and OFD.
DBM and GTR therapy support more consistent improvements in clinical parameters; however, with the exception of defect fill following bone grafting, the reduction in variability in clinical outcomes was relatively modest compared to OFD alone. Overall, the treatment of intrabony defects is associated with a relatively high degree of variability in clinical outcome, regardless of therapeutic approach.
与骨内缺损的开放翻瓣清创术（OFD）相比，脱矿骨基质（DBM）和引导组织再生（GTR）能使临床附着水平（CAL）显著增加、探诊深度（PD）降低以及缺损填充增加。尽管这些再生疗法能改善平均临床参数，但尚不清楚这些手术是否能提高临床结果的可预测性。本研究的目的是在比较DBM或GTR与OFD治疗骨内缺损的再生研究中，检查临床结果测量的相对变异性，而不考虑增加的幅度。为了进行比较，进行了类似的分析，评估了其他（非DBM）骨替代移植物（BRG）材料相对于单独OFD的临床结果一致性。
55项将再生疗法（7项DBM、22项BRG和26项GTR）与OFD进行比较并符合纳入标准的随机对照临床试验提供了平均变化分数（治疗前至治疗后）以及CAL、PD和骨填充的方差估计值，从而能够计算每项测量在各研究中的变异系数（CV）。将每项测量的平均CV进行重复测量的方差分析或协方差分析（P≤0.05），以比较治疗结果的相对变异。
与单独的OFD相比，DBM在CAL增加（96.3±38.6对137.7±30.9）和缺损填充（69.1±11.2对133.1±15.3）方面的相对变异性显著更低。作为一个整体，发现其他BRG能显著降低CAL和缺损填充的变异性。与OFD相比，GTR疗法的CAL的CV显著更低（分别为50.6±5.0对68.7±8.2）。GTR和OFD在缺损填充方面的变异性相似。
DBM和GTR疗法能使临床参数得到更一致的改善；然而，除了骨移植后的缺损填充外，与单独的OFD相比，临床结果变异性的降低相对较小。总体而言，无论采用何种治疗方法，骨内缺损的治疗在临床结果方面都具有相对较高的变异性。
