Dental Research Division, Department of Periodontics, Guarulhos University, Guarulhos, SP, Brazil.
J Periodontol. 2012 Apr;83(4):477-90. doi: 10.1902/jop.2011.110382. Epub 2011 Aug 22.
The aim of this review is to conduct an individual patient data meta-analysis of randomized controlled clinical trials (RCTs) to evaluate whether baseline recession-, patient-, and procedure-related factors can influence the achievement of complete root coverage (CRC).
A literature search with no restrictions regarding status or the language of publication was performed for MEDLINE (for Medical Literature Analysis and Retrieval System Online), EMBASE (for Excerpta Medica Database), CENTRAL (for Cochrane Central Register of Controlled Trials), and the Cochrane Oral Health Group's Specialized Register databases up to and including March 2011. Only RCTs, with a duration of ≥6 months evaluating recession areas (Miller Class I or II) that were treated by means of root coverage procedures were included. Mixed-effects logistic regression analyses were conducted to evaluate associations between five baseline variables and CRC.
Of the 70 potentially eligible trials, 22 were included in the meta-analyses. In total, the data from 320 patients and 16 procedures were evaluated. None of the RCTs were classified as low risk of bias. Of the 602 recessions treated, 310 (51.5%) achieved CRC. Subepithelial connective tissue grafts (SCTGs), matrix grafts, and enamel matrix derivative protein (EMD) procedures were superior in achieving CRC when compared to coronally advanced flap (CAF) alone. For the adjusted covariates, the greater the baseline recession depth, the smaller the chance of achieving CRC (individual procedure analysis [odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.44, 0.70] and grouped procedure analysis [OR = 0.56; 95% CI = 0.45, 0.71]), as well as studies with conflict of interest were more likely to achieve CRC than those without conflict of interest (individual procedure analysis [OR = 6.78; 95% CI = 1.78, 25.86]).
SCTGs, matrix grafts, and EMD were superior to CAF in achieving CRC, but SCTGs showed the best predictability. The impossibility of inclusion of all identified RCTs should be taken into consideration when interpreting the present findings.
本综述的目的是对随机对照临床试验（RCT）进行个体患者数据荟萃分析，以评估基线退缩、患者和手术相关因素是否会影响完全根覆盖（CRC）的实现。
对 MEDLINE（医学文献分析和检索系统在线）、EMBASE（医学文摘数据库）、CENTRAL（Cochrane 对照试验中心注册库）和 Cochrane 口腔健康组专业注册库进行了无限制状态或出版物语言的文献检索，检索时间截至 2011 年 3 月。仅纳入了持续时间≥6 个月、评估退缩区（Miller 分类 I 或 II）并通过根覆盖手术治疗的 RCT。采用混合效应逻辑回归分析评估了 5 个基线变量与 CRC 之间的关联。
在 70 项潜在合格试验中，有 22 项纳入了荟萃分析。共有 320 名患者和 16 项手术纳入数据分析。没有一项 RCT 被归类为低偏倚风险。在治疗的 602 个退缩区中，有 310 个（51.5%）实现了 CRC。与单独使用冠向推进瓣（CAF）相比，黏膜下结缔组织移植（SCTG）、基质移植物和牙骨质衍生蛋白（EMD）手术更有利于实现 CRC。对于调整后的协变量，基线退缩深度越大，实现 CRC 的机会越小（个体手术分析[比值比（OR）=0.55；95%置信区间（CI）=0.44,0.70]和分组手术分析[OR=0.56；95%CI=0.45,0.71]），以及存在利益冲突的研究比没有利益冲突的研究更有可能实现 CRC（个体手术分析[OR=6.78；95%CI=1.78,25.86]）。
SCTG、基质移植物和 EMD 在实现 CRC 方面优于 CAF，但 SCTG 具有最佳的可预测性。在解释本研究结果时，应考虑到无法纳入所有已确定的 RCT。
