Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA.
J Periodontol. 2012 Apr;83(4):453-64. doi: 10.1902/jop.2011.110347. Epub 2011 Aug 23.
The regenerative surgical treatment of intrabony defects caused by periodontal disease has been examined in several systematic reviews and meta-analyses. The use of bioactive glass (BG) as a graft material to treat intrabony defects has been reported, but all data have not been synthesized and compiled. Our objective was to systematically review the literature on the use of BG for the treatment of intrabony defects and to perform a meta-analysis of its efficacy.
A search of PubMed, EMBASE, and Cochrane Database of Systematic Reviews, as well as a manual search of recently published periodontology journals, were conducted to identify randomized controlled trials of the use of BG in the treatment of intrabony and furcation defects. Criteria included publication in English, follow-up duration of ≥6 months, baseline and follow-up measures of probing depth (PD) and clinical attachment levels (CAL) with 95% confidence intervals (CIs), and an appropriate control arm. Twenty-five citations were identified, 15 of which were included in the final analysis. Data, including study methods and results, as well as CONSORT (Consolidated Standards of Reporting Trials) criteria, were extracted from eligible studies and cross-checked by at least two reviewers.
Meta-analyses of eligible studies were performed to ascertain summary effects for changes in PD and CAL among experimental and control groups, using the mean change plus standard deviation for each study. Pooled analyses showed that BG was superior to control for both measures: the mean (95% CIs) difference from baseline to follow-up between BG and controls was 0.52 mm (0.27, 0.78, P <0.0001) in reduction for PD and 0.60 mm (0.18, 1.01, P = 0.005) in gain for CAL. Analyses of CAL revealed heterogeneity across studies (I(2) = 60.5%), although studies reporting PD measures were homogeneous (I(2) = 0.00%). CAL heterogeneity appeared secondary to active controls versus open flap debridement (OFD) alone and to defect-type modifying BG treatment success. Per subgroup analyses, the benefit of BG over control treatment was highly significant only in studies comparing BG to OFD (P <0.0001), with mean difference change in CAL being 1.18 mm (95% CI = 0.74, 1.62 mm) between the BG and OFD group.
Treatment of intrabony defects with BG imparts a significant improvement in both PD and CAL compared to both active controls and OFD.
有几项系统评价和荟萃分析研究了牙周病引起的骨内缺损的再生外科治疗。有报道称，生物活性玻璃（BG）可用作移植物材料来治疗骨内缺损，但所有数据尚未进行综合汇编。我们的目的是系统地回顾关于使用 BG 治疗骨内缺损的文献，并对其疗效进行荟萃分析。
我们对 PubMed、EMBASE 和 Cochrane 系统评价数据库进行了检索，并对最近出版的牙周病学杂志进行了手工检索，以确定使用 BG 治疗骨内和分叉缺损的随机对照试验。纳入标准为：英文发表、随访时间≥6 个月、基线和随访时的探诊深度（PD）和临床附着水平（CAL）测量值均有 95%置信区间（CI）、有适当的对照组。共确定了 25 篇参考文献，其中 15 篇纳入最终分析。我们从合格研究中提取数据，包括研究方法和结果，以及 CONSORT（临床试验报告的统一标准）标准，并由至少两名评审员进行交叉核对。
对合格研究进行了荟萃分析，以确定实验组和对照组在 PD 和 CAL 变化方面的汇总效果，使用每项研究的平均变化值加标准差。汇总分析显示，BG 在两种测量值上均优于对照组：BG 与对照组相比，从基线到随访时 PD 的平均（95%CI）差值为 0.52mm（0.27，0.78，P<0.0001），CAL 的差值为 0.60mm（0.18，1.01，P=0.005）。CAL 分析显示，研究之间存在异质性（I²=60.5%），但报告 PD 测量值的研究具有同质性（I²=0.00%）。CAL 的异质性似乎是由于活性对照与单独的开放式翻瓣清创术（OFD）以及对缺损类型的 BG 治疗效果的影响所致。亚组分析显示，BG 与对照组相比，BG 治疗组在比较 BG 与 OFD 时，CAL 的改善效果具有统计学意义（P<0.0001），BG 与 OFD 组间 CAL 的平均差值变化为 1.18mm（95%CI=0.74，1.62mm）。
与活性对照和 OFD 相比，BG 治疗骨内缺损可显著改善 PD 和 CAL。
