Saletta J M, Garcia J J, Caramês J M M, Schliephake H, da Silva Marques D N
Implant Department, Universidad Europea de Madrid, Madrid, Spain.
Implant Department, Universidad Europea de Madrid, Madrid, Spain; CIRO, Madrid, Spain.
Int J Oral Maxillofac Surg. 2019 Mar;48(3):364-372. doi: 10.1016/j.ijom.2018.07.014. Epub 2018 Aug 21.
The aim of this study was to evaluate and compare the quality of systematic reviews of vertical bone regeneration techniques, using two quality-assessment tools (AMSTAR and ROBIS). An electronic literature search was conducted to identify systematic reviews or meta-analyses that would evaluate at least one of the following outcomes: implant survival, success rates, complications or bone gain after vertical ridge augmentation. Methodological quality assessment was performed by two independent evaluators. Results were compared between reviewers, and reliability measures were calculated using the Holsti's method and Cohen's kappa. Seventeen systematic reviews were included, of which seven presented meta-analysis. Mean ±95% confidence interval AMSTAR score was 6.35 [4.74;7.97], with higher scores being correlated with a smaller risk of bias (Pearson's correlation coefficient=-0.84; P<0.01). Cohen's inter-examiner kappa showed substantial agreement for both checklists. From the available evidence, we ascertained that, regardless of the technique used, it is possible to obtain vertical bone gains. Implant success in regenerated areas was similar to implants placed in pristine bone with results equating between 61.5% and 100% with guided bone regeneration being considered the most predictable technique regarding bone stability, while distraction osteogenesis achieved the biggest bone gains with the highest risk of possible complications.
本研究的目的是使用两种质量评估工具（AMSTAR和ROBIS）评估和比较垂直骨再生技术的系统评价质量。进行了电子文献检索，以识别那些会评估以下至少一项结果的系统评价或荟萃分析：种植体存活率、成功率、并发症或垂直牙槽嵴增高术后的骨增量。由两名独立评估者进行方法学质量评估。比较了评估者之间的结果，并使用霍尔斯特方法和科恩kappa系数计算可靠性指标。纳入了17项系统评价，其中7项进行了荟萃分析。AMSTAR评分的均值±95%置信区间为6.35[4.74；7.97]，得分越高与偏倚风险越小相关（皮尔逊相关系数=-0.84；P<0.01）。科恩评估者间kappa系数显示两个检查表的一致性较高。根据现有证据，我们确定，无论使用何种技术，都有可能实现垂直骨增量。再生区域的种植体成功率与植入原始骨中的种植体相似，结果在61.5%至100%之间，引导骨再生被认为是骨稳定性方面最可预测的技术，而牵张成骨实现了最大的骨增量，但可能出现并发症的风险最高。
