透明质酸作为非手术和手术牙周治疗的辅助手段：系统评价和荟萃分析。
Hyaluronic acid as adjunctive to non-surgical and surgical periodontal therapy: a systematic review and meta-analysis.
机构信息
Department of Periodontology, University of Bern, Bern, Switzerland.
Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany.
出版信息
Clin Oral Investig. 2019 Sep;23(9):3423-3435. doi: 10.1007/s00784-019-03012-w. Epub 2019 Jul 23.
OBJECTIVES
To evaluate the potential added benefit of the topical application of hyaluronic acid (HA) on the clinical outcomes following non-surgical or surgical periodontal therapy.
MATERIALS AND METHODS
A systematic search was performed in Medline, Embase, Cochrane, Web of Science, Scopus and Grey literature databases. The literature search was preformed according to PRISMA guidelines. The Cochrane risk of bias tool was used in order to assess the methodology of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between the treatment and controls were estimated using the random-effect model for amount of bleeding on probing (BOP), probing depth (PD) reduction and clinical attachment level (CAL) gain. In order to minimize the bias and to perform meta-analysis, only randomized clinical studies (RCTs) were selected.
RESULTS
Thirteen RCTs were included: 11 on non-surgical periodontal treatment and two on surgical periodontal treatment. Overall analysis of PD reduction, CAL gain and BOP reduction in non-surgical therapy with adjunctive HA presented WMD of - 0.36 mm (95% CI - 0.54 to - 0.19 mm; p < 0.0001), 0.73 mm (95% CI 0.28 to 1.17 mm; p < 0.0001) and - 15% (95% CI - 22 to - 8%; p < 0.001) respectively, favouring the application of HA. The overall analysis on PD and CAL gain in surgical therapy with adjunctive HA presented WMD of - 0.89 mm (95% CI - 1.42 to - 0.36 mm; p < 0.0001) for PD reduction and 0.85 mm (95% CI 0.08 to 1.62 mm; p < 0.0001) for CAL gain after 6-24 months favouring the treatment with HA. However, comparison presented considerable heterogeneity between the non-surgical studies and a high risk of bias in general.
CONCLUSIONS
Within their limits, the present data indicate that the topical application of HA may lead to additional clinical benefits when used as an adjunctive to non-surgical and surgical periodontal therapy. However, due to the high risk of bias and heterogeneity, there is a need for further well-designed RCTs to evaluate this material in various clinical scenarios.
CLINICAL RELEVANCE
The adjunctive use of HA may improve the clinical outcomes when used in conjunction with non-surgical and surgical periodontal therapy.
目的
评估在非手术或手术牙周治疗后局部应用透明质酸（HA）对临床结果的潜在附加益处。
材料和方法
在 Medline、Embase、Cochrane、Web of Science、Scopus 和灰色文献数据库中进行了系统搜索。文献检索根据 PRISMA 指南进行。为了评估纳入试验的方法学，使用了 Cochrane 偏倚风险工具。使用随机效应模型估计治疗和对照组之间探诊出血（BOP）、探诊深度（PD）减少和临床附着水平（CAL）增加的加权均数差异（WMDs）和 95%置信区间（CI）。为了最大程度地减少偏倚并进行荟萃分析，仅选择了随机临床试验（RCTs）。
结果
共纳入 13 项 RCT：11 项非手术牙周治疗，2 项手术牙周治疗。非手术治疗中 HA 辅助治疗的 PD 减少、CAL 增加和 BOP 减少的总体分析显示 WMD 分别为-0.36mm（95%CI -0.54 至-0.19mm；p<0.0001）、0.73mm（95%CI 0.28 至 1.17mm；p<0.0001）和-15%（95%CI -22 至-8%；p<0.001），有利于 HA 的应用。HA 辅助手术治疗中 PD 和 CAL 增加的总体分析显示，PD 减少的 WMD 为-0.89mm（95%CI -1.42 至-0.36mm；p<0.0001），CAL 增加的 WMD 为 0.85mm（95%CI 0.08 至 1.62mm；p<0.0001），在 6-24 个月后有利于 HA 治疗。然而，比较显示非手术研究之间存在相当大的异质性，并且总体存在高偏倚风险。
结论
在其限制范围内，目前的数据表明，当局部应用 HA 作为非手术和手术牙周治疗的辅助手段时，可能会带来额外的临床益处。然而，由于存在高偏倚风险和异质性，需要进一步设计良好的 RCT 来评估该材料在各种临床情况下的效果。
临床相关性
HA 的辅助使用可能会改善非手术和手术牙周治疗联合应用时的临床结果。
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