Hou Xinshan, Yuan Jingwen, Aisaiti Absijiang, Liu Yuan, Zhao Jin
The Oral Medicine Clinical Center, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China.
Stomatology Disease Institute of Xinjiang Uyghur Autonomous Region, No. 137 South Liyushan Road, Urumqi, 830054, People's Republic of China.
BMC Oral Health. 2016 Aug 17;16(1):71. doi: 10.1186/s12903-016-0261-5.
Studies investigating the use of platelet-rich plasma (PRP) in the treatment of intrabony defects have yielded mixed results. The aim of our study was to evaluate the efficacy of PRP by comparing clinical attachment level (CAL) and pocket depth (PD) for patients who received PRP as an adjunct to periodontal intrabony defect therapy with those for patients who did not. We also analyzed the influence of guided tissue regeneration (GTR) and different study designs (parallel and split-mouth studies) on the clinical outcomes of intrabony defects.
We performed a systematic review of articles published in any language up to June 7, 2015 by searching PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included only randomized controlled clinical trials (RCTs) that compared clinical outcomes between patients who received PRP as an adjunct to periodontal intrabony defect therapy and patients who did not. We combined data from randomized trials to assess clinical outcomes using a random-effects model.
Of the 307 abstracts that were initially identified, 12 RCTs related to the treatment of periodontal intrabony defects were included in the final analysis. Clinically and significantly greater CAL gains and PD reductions were observed in subjects who received PRP as an adjunct to periodontal intrabony defect therapy than in subjects who did not (CAL: WMD 0.76 mm, 95 % CI = 0.34 to 1.18 mm, P = 0.0004; PD: WMD 0.53 mm, 95 % CI = 0.21 to 0.85 mm, P = 0.001). Subgroup meta-analyses of patients who underwent GTR demonstrated that this approach did not significantly affect treatment outcomes (CAL: WMD 0.08 mm, 95 % CI = -0.30 to 0.46 mm, P = 0.67), as indicated by a comparison with patients who did not undergo GTR (CAL: WMD 1.22 mm, 95 % CI = 0.88 to 1.57 mm, P < 0.00001). Univariate meta-regression analyses revealed that the use of GTR explained the heterogeneity among the included studies (P < 0.05).
Within its limitations, this review suggests that PRP may be beneficial as an adjunct to graft materials for the treatment of periodontal intrabony defects, except in cases involving the use of GTR.
关于富血小板血浆（PRP）用于治疗骨内缺损的研究结果不一。我们研究的目的是通过比较接受PRP作为牙周骨内缺损治疗辅助手段的患者与未接受该治疗的患者的临床附着水平（CAL）和牙周袋深度（PD），来评估PRP的疗效。我们还分析了引导组织再生（GTR）和不同研究设计（平行研究和分口研究）对骨内缺损临床结果的影响。
我们通过检索PubMed、Embase、科学网和Cochrane对照试验中央注册库，对截至2015年6月7日以任何语言发表的文章进行了系统评价。我们仅纳入了比较接受PRP作为牙周骨内缺损治疗辅助手段的患者与未接受该治疗的患者临床结果的随机对照临床试验（RCT）。我们合并随机试验的数据，使用随机效应模型评估临床结果。
在最初识别的307篇摘要中，最终分析纳入了12项与牙周骨内缺损治疗相关的RCT。接受PRP作为牙周骨内缺损治疗辅助手段的受试者，其CAL增加和PD降低在临床上显著大于未接受该治疗的受试者（CAL：加权均数差[WMD]为0.76 mm，95%置信区间[CI]=0.34至1.18 mm，P=0.0004；PD：WMD为0.53 mm，95%CI=0.21至0.85 mm，P=0.001）。对接受GTR的患者进行的亚组Meta分析表明，与未接受GTR的患者相比，这种方法对治疗结果没有显著影响（CAL：WMD为0.08 mm，95%CI=-0.30至0.46 mm，P=0.67）（CAL：WMD为1.22 mm，95%CI=0.88至1.57 mm，P<0.00001）。单因素Meta回归分析显示，使用GTR解释了纳入研究之间的异质性（P<0.05）。
在其局限性范围内，本综述表明，PRP作为移植材料的辅助手段，可能有益于治疗牙周骨内缺损，但涉及使用GTR的情况除外。
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