Department of Oral Biology, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, 75510, Pakistan.
Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah Al Munawwarah 41311, Saudi Arabia; Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan.
Ann Anat. 2022 Feb;240:151877. doi: 10.1016/j.aanat.2021.151877. Epub 2021 Dec 2.
Alveolar bone loss and mobility of teeth is commonly observed in periodontitis patients. Regeneration of periodontal intrabony defects is indicated to restore the lost bone and periodontal tissues. The aim of the present study was to evaluate the clinical outcomes of periodontal intrabony lesions by using nanocrystalline hydroxyapatite (NHA) graft and comparing it with open flap debridement (OFD) alone.
The eligibility criteria encompassed randomized (RCTs) and controlled clinical trials (CCTs). Weighted mean differences were calculated for clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction and gingival recession (REC) change, demonstrated as forest plots. The revised Cochrane Risk of Bias tool for randomized trials (RoB2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool were used for quality assessment of RCTs and non-randomized trials respectively.
From 22 full-text articles identified, three RCTs, one CCT and one retrospective follow-up of RCT were included. All the five papers comprised the quantitative evaluation. The use of NHA graft provided additional CAL gain of 0.96 mm (p = 0.0009) and PPD reduction of 0.97 mm (p < 0.00001) when compared to OFD alone. However, in terms of REC changes, no considerable benefits of NHA graft were demonstrated than OFD alone (p = 0.48).
The bioactive NHA graft showed promising results clinically in regenerative periodontology and can be considered for the management of periodontal intrabony defects. The use of NHA graft considerably provided better clinical outcomes in intrabony defects compared to using the OFD alone. Future research investigating NHA graft against other regenerative materials including specific BGs, at longer follow-up periods and bigger sample sizes and in furcation defects warranted.
牙槽骨丧失和牙齿松动是牙周炎患者常见的问题。牙周骨内缺损的再生旨在恢复丢失的骨和牙周组织。本研究旨在评估纳米晶羟基磷灰石（NHA）移植在牙周骨内缺损治疗中的临床效果，并与单独使用翻瓣清创术（OFD）进行比较。
纳入标准为随机对照试验（RCT）和对照临床试验（CCT）。采用森林图计算临床附着水平（CAL）增加、探诊袋深度（PPD）减少和牙龈退缩（REC）变化的加权均数差。采用修订后的 Cochrane 随机试验偏倚风险工具（RoB2）和非随机干预研究偏倚风险工具（ROBINS-I）分别对 RCT 和非随机试验进行质量评估。
从 22 篇全文文章中确定了 3 项 RCT、1 项 CCT 和 1 项 RCT 的回顾性随访研究。所有 5 篇文章均进行了定量评估。与单独使用 OFD 相比，NHA 移植物的使用可额外增加 0.96mm 的 CAL 增益（p=0.0009）和 0.97mm 的 PPD 减少（p<0.00001）。然而，在 REC 变化方面，NHA 移植物与单独使用 OFD 相比并没有显示出明显的优势（p=0.48）。
生物活性 NHA 移植物在再生牙周学中具有良好的临床效果，可以考虑用于治疗牙周骨内缺损。与单独使用 OFD 相比，NHA 移植物的使用在骨内缺损方面提供了更好的临床效果。需要在更长的随访时间和更大的样本量下，对 NHA 移植物与其他再生材料（包括特定的 BGs）进行进一步研究，并将其应用于分叉缺损。
