Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy.
Private Practice, Milan, Italy.
Clin Oral Investig. 2020 Mar;24(3):1125-1135. doi: 10.1007/s00784-020-03229-0. Epub 2020 Feb 12.
The aim of this systematic review was to explore the efficacy of different minimal invasive surgical (MIS) and non-surgical (MINST) approaches for the treatment of intra-bony defect in terms of clinical attachment level (CAL) gain and periodontal pocket depth (PPD) reduction.
A detailed review protocol was designed according to PRISMA guideline. Online search was conducted on PubMed, Cochrane library and Embase. Only randomized clinical trials (RCTs) testing MIS or MINST procedure, with or without the application of a regenerative tool for the treatment of intra-bony defect, were included. Cochrane checklist for risk of bias assessment was used. Network meta-Analysis (NMAs) was used to rank the treatment efficacy.
Nine RCTs accounting for 244 patients and a total of 244 defects were included. Only two studies were at low risk of bias. CAL gain for included treatment ranged from 2.58 ± 1.13 mm to 4.7 ± 2.5 mm while PPD reduction ranged from 3.19 ± 0.71 mm to 5.3 ± 1.5 mm. On the basis of the ranking curve, MINST showed the lowest probability to be the best treatment option for CAL gain. Pairwise comparisons and treatment rankings suggest superiority for regenerative approaches (CAL difference 0.78 mm, (0.14-1.41); P < 0.05) and surgical treatment elevating only the buccal or palatal flap (CAL difference: 0.95 mm, (0.33-1.57); P < 0.05).
Minimally invasive surgical (MIS) and non-surgical (MINST) periodontal therapy show promising results in the treatment of residual pocket with intra-bony defect.
MIS procedures represent a reliable treatment for isolated intra-bony defect.
本系统评价旨在探讨不同微创外科（MIS）和非外科（MINST）方法治疗骨内缺损的疗效，以获得临床附着水平（CAL）的增加和牙周袋深度（PPD）的减少。
根据 PRISMA 指南设计了详细的综述方案。在 PubMed、Cochrane 图书馆和 Embase 上进行了在线搜索。仅纳入测试 MIS 或 MINST 手术的随机临床试验（RCTs），包括或不包括应用再生工具治疗骨内缺损。使用 Cochrane 偏倚风险检查表进行评估。网络荟萃分析（NMAs）用于对治疗效果进行排名。
纳入了 9 项 RCTs，共 244 名患者，244 个缺损。只有两项研究的偏倚风险较低。纳入治疗的 CAL 增加范围为 2.58±1.13mm 至 4.7±2.5mm，而 PPD 减少范围为 3.19±0.71mm 至 5.3±1.5mm。基于排名曲线，MINST 成为 CAL 增加最佳治疗方案的可能性最低。两两比较和治疗排名表明，再生方法具有优势（CAL 差异 0.78mm，0.14-1.41；P<0.05），仅提升颊或腭瓣的手术治疗也具有优势（CAL 差异：0.95mm，0.33-1.57；P<0.05）。
微创外科（MIS）和非外科（MINST）牙周治疗在治疗残留骨内缺损的牙周袋方面具有良好的效果。
MIS 程序是治疗孤立性骨内缺损的可靠方法。
