釉基质衍生物应用在治疗上颌第一类和第二类牙龈退缩中是否提供了额外的临床益处？系统评价和荟萃分析。
Does enamel matrix derivative application provide additional clinical benefits in the treatment of maxillary Miller class I and II gingival recession? A systematic review and meta-analysis.
机构信息
Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil.
Stomatology Department, School of Medicine and Dentistry, University of Valencia, Valencia, Spain.
出版信息
Clin Oral Investig. 2021 Apr;25(4):1613-1626. doi: 10.1007/s00784-021-03782-2. Epub 2021 Jan 21.
OBJECTIVE
This review aimed to evaluate the effects of enamel matrix derivative (EMD) in association with coronally advanced flap (CAF) or CAF + connective tissue graft (CTG) when compared with CAF alone or CAF + CTG for the treatment of gingival recessions (GR) in maxillary teeth.
METHODS
Five databases and gray literature were searched up to April 2020, to find randomized clinical trials comparing the clinical effects of CAF + EMD versus CAF alone (first group) or CAF + CTG + EMD versus CAF + CTG (second group) in the treatment of Miller class I and II or Cairo type I gingival recessions (GR). Random effects model of mean differences was used to determine the GR reduction, gain in keratinized tissue width (KTW), and gain in clinical attachment level (CAL). The trial sequential analysis (TSA) was implemented to determine the optimal information size (OIS) and imprecision using the GRADE approach. Bayes factors were calculated as complementary statistical evidence of p value.
RESULTS
From 1349 titles identified, 9 trials representing 336 GR were included. The meta-analysis showed a statistically significant difference for GR reduction and CAL gain in favor CAF + EMD (p ≤ 0.05). The additional effect of EMD showed a statistically significant difference in GR reduction in favor CAF + CTG + EMD (p ≤ 0.05). The differences in KTW gain proved to be not statistically significant in both comparison groups. The OIS were not met among meta-analyses. Evidence certainty according the GRADE approach proved to be moderate for GR reduction and gain in CAL, but very low for gain in KTW.
CONCLUSION
The adjunctive application of EMD in the treatment of GR in maxillary teeth either with CAF or CTG provided moderate certainty evidence in favor of their use for reduction in GR and gain in CAL at 6 and 12 months. However, their effect on the increase in keratinized tissue band height showed very low evidence certainty for its use.
CLINICAL RELEVANCE
To know if EMD could improve the results for root coverage.
目的
本综述旨在评估 enamel matrix derivative（EMD）与 coronally advanced flap（CAF）或 CAF+connective tissue graft（CTG）联合应用时的效果，与单独应用 CAF 或 CAF+CTG 治疗上颌牙齿的牙龈退缩（GR）相比。
方法
截至 2020 年 4 月，我们检索了五个数据库和灰色文献，以寻找比较 CAF+EMD 与单独 CAF（第一组）或 CAF+CTG+EMD 与 CAF+CTG（第二组）治疗 Miller Ⅰ类和Ⅱ类或 Cairo Ⅰ型牙龈退缩（GR）的临床效果的随机临床试验。使用均数差的随机效应模型来确定 GR 减少、角化组织宽度（KTW）增加和临床附着水平（CAL）增加。使用 GRADE 方法实施试验序贯分析（TSA）以确定最佳信息大小（OIS）和不精确性。贝叶斯因子被计算为补充的 p 值统计证据。
结果
从 1349 个标题中，确定了 9 项试验，共 336 个 GR 被纳入。荟萃分析显示，GR 减少和 CAL 增加有利于 CAF+EMD（p≤0.05），具有统计学意义。EMD 的附加效应显示，GR 减少有利于 CAF+CTG+EMD（p≤0.05），具有统计学意义。在这两个比较组中，KTW 增加的差异没有统计学意义。荟萃分析中的 OIS 未达到。根据 GRADE 方法，GR 减少和 CAL 增加的证据确定性被证明是中度的，但 KTW 增加的证据确定性非常低。
结论
在治疗上颌牙齿的 GR 中，CAF 或 CTG 联合应用 EMD 提供了中度确定性证据，支持其在 6 个月和 12 个月时减少 GR 和增加 CAL 的使用。然而，其对增加角化组织带高度的影响的证据确定性非常低，不支持其使用。
临床相关性
了解 EMD 是否可以改善根覆盖的效果。
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