Department of Public Health, University of Florence, Florence, Italy.
J Clin Periodontol. 2013 Apr;40(4):372-86. doi: 10.1111/jcpe.12028. Epub 2013 Jan 24.
The aim of this work was to conduct a Bayesian network meta-analysis (NM) of randomized controlled trials (RCTs) to establish a ranking in efficacy and the best technique for coronally advanced flap (CAF)-based root coverage procedures.
A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until June 2012 was conducted to identify RCTs on treatments of Miller Class I and II gingival recessions with at least 6 months of follow-up. The treatment outcomes were recession reduction (RecRed), clinical attachment gain (CALgain), keratinized tissue gain (KTgain), and complete root coverage (CRC).
Twenty-nine studies met the inclusion criteria, 20 of which were classified as at high risk of bias. The CAF+connective tissue graft (CTG) combination ranked highest in effectiveness for RecRed (Probability of being the best = 40%) and CALgain (Pr = 33%); CAF+enamel matrix derivative (EMD) was slightly better for CRC; CAF+Collagen Matrix (CM) appeared effective for KTgain (Pr = 69%). Network inconsistency was low for all outcomes excluding CALgain.
CAF+CTG might be considered the gold standard in root coverage procedures. The low amount of inconsistency gives support to the reliability of the present findings.
本研究旨在通过贝叶斯网状 Meta 分析（NM）对随机对照试验（RCT）进行评估，以确定根向复位瓣（CAF）为主的根覆盖术中疗效最佳的技术和方法。
对 PubMed、Cochrane 图书馆、EMBASE 及手工检索的期刊进行了截至 2012 年 6 月的文献检索，以确定对 Miller Ⅰ类和Ⅱ类牙龈退缩（至少随访 6 个月）进行治疗的 RCT 研究。治疗结果为龈退缩减少（RecRed）、临床附着增加（CALgain）、角化组织增加（KTgain）和完全根覆盖（CRC）。
29 项研究符合纳入标准，其中 20 项被归类为高偏倚风险。CAF+结缔组织移植物（CTG）联合治疗在 RecRed（最佳可能性为 40%）和 CALgain（Pr=33%）方面效果最佳；CAF+脱细胞真皮基质（EMD）在 CRC 方面略好；CAF+胶原基质（CM）在 KTgain 方面效果显著（Pr=69%）。除 CALgain 外，所有结果的网络不一致性均较低。
CAF+CTG 可能被认为是根覆盖术的金标准。不一致性低为目前研究结果的可靠性提供了支持。
