Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue - BCCR 2W, New York, NY, 10010, USA.
Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA.
Clin Oral Investig. 2020 Jul;24(7):2141-2161. doi: 10.1007/s00784-020-03240-5. Epub 2020 May 16.
The aim of this study was to conduct a systematic review and meta-analysis on the efficacy of growth factors (GF) on clinical outcomes after treatment (surgical/non-surgical) of peri-implant diseases (peri-implant mucositis and peri-implantitis).
A protocol was developed to answer the following focused question: Is there any difference for the use of GF for treatment of peri-implant diseases versus comparative GF treatment or without GF? Electronic database and manual searches were independently conducted to identify randomized controlled trials (RCTs). Publications were selected based on eligibility criteria and then assessed for risk-of-bias using the Cochrane Handbook. The primary outcome was probing depth (PD) and bleeding on probing (BOP) reduction along with changes in vertical defect depth (VDD). Changes in clinical attachment level, gingival recession, and plaque index, among others, were studied as secondary outcomes. Based on primary outcomes, random-effects meta-analysis was conducted.
A total of five RCTs were included. GF enhance the reduction of PD (standardized mean difference (SMD) = - 1.28; 95% confidence interval (CI) - 1.75, - 0.79; p = < 0.0001) and BOP (SMD = - 1.23; 95% CI - 1.70, - 0.76; p = < 0.0001) in the management of peri-implant mucositis. For the treatment of peri-implantitis, the use of GF yielded to significantly greater improvement in VDD (SMD = 0.68; 95% CI 0.22, 1.14; p = 0.004); however, there were no significant differences in terms of PD (SMD = 0.08; 95% CI - 1.08, 1.26; p = 0.887) and BOP (SMD = 0.211; 95% CI - 0.20, 0.63; p = 0.317). The overall risk of bias of the included studies was low to unclear.
The results of the present systematic review suggest that the addition of GF might enhance the outcomes in the treatment of peri-implant mucositis. However, there is a lack of evidence for supporting additional benefit of GF managing peri-implantitis.
Within the limitations of the current systematic review and based on the meta-analyses, (1) the addition of GF for the treatment peri-implant mucositis might be associated with better outcomes in terms of PD and BOP, and (2) an additional benefit of GF for the treatment peri-implantitis could not be determined on the basis of the selected evidence.
本研究旨在对生长因子（GF）在治疗（手术/非手术）种植体周围疾病（种植体周围黏膜炎和种植体周围炎）后的临床疗效进行系统评价和荟萃分析。
制定了一个方案来回答以下重点问题：使用 GF 治疗种植体周围疾病与比较 GF 治疗或不使用 GF 治疗相比，是否有任何差异？独立进行电子数据库和手动搜索以确定随机对照试验（RCT）。根据入选标准选择出版物，然后使用 Cochrane 手册评估偏倚风险。主要结局是探诊深度（PD）和探诊出血（BOP）减少以及垂直缺损深度（VDD）的变化。还研究了临床附着水平、牙龈退缩和菌斑指数等次要结局。根据主要结局，进行了随机效应荟萃分析。
共纳入 5 项 RCT。GF 可增强 PD（标准化均数差（SMD）= -1.28；95%置信区间（CI）-1.75，-0.79；p<0.0001）和 BOP（SMD=-1.23；95%CI-1.70，-0.76；p<0.0001）的减少，从而改善种植体周围黏膜炎的治疗效果。对于种植体周围炎的治疗，使用 GF 可显著改善 VDD（SMD=0.68；95%CI 0.22，1.14；p=0.004）；然而，在 PD（SMD=0.08；95%CI-1.08，1.26；p=0.887）和 BOP（SMD=0.211；95%CI-0.20，0.63；p=0.317）方面无显著差异。纳入研究的总体偏倚风险为低至不确定。
本系统评价的结果表明，在治疗种植体周围黏膜炎时添加 GF 可能会改善治疗效果。然而，目前缺乏支持 GF 治疗种植体周围炎额外获益的证据。
根据本系统评价和荟萃分析的局限性，（1）在治疗种植体周围黏膜炎时添加 GF 可能与 PD 和 BOP 更好的结果相关，（2）在所选证据的基础上，不能确定 GF 治疗种植体周围炎的额外获益。
