Rojas Mariana A, Marini Lorenzo, Sahrmann Philipp, Pilloni Andrea
Section of Periodontics, Department of Oral and Maxillo-Facial Sciences, Sapienza, University of Rome, 00161 Rome, Italy.
Department of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine, University of Basel, 4058 Basel, Switzerland.
J Pers Med. 2022 Sep 19;12(9):1539. doi: 10.3390/jpm12091539.
Previous systematic reviews have reported that coronally advanced flap (CAF) + connective tissue graft (CTG) are the gold standard in root coverage procedures (RCP). Nevertheless, adjunctive treatment with hyaluronic acid (HA) has been proposed to aim at improving clinical outcomes and reducing patient morbidity. The aim of this systematic review and meta-analysis is to compare the use of HA as an adjunctive treatment to CAF procedures in Miller class I and II (recession type 1; RT1) gingival recession (GR) defects treatment with no adjunctive/other treatments. MEDLINE, The Cochrane Central Register of Controlled Trials, Web of Science, Scopus databases and gray literature were searched up to April 2022. The primary outcome variables were mean recession coverage (MRC) and reduction of the recession depth (RecRed). Weighted mean differences and 95% confidence intervals between treatments were estimated using a random-effect mode. From 264 titles identified, 3 RCTs reporting 90 GR defects in 60 patients were included. Overall analysis of MRC and RecRed were 0.27% ( = 0.01) and 0.40 mm ( = 0.45) in favor of CAF + HA compared to CAF alone/CAF + subepithelial connective tissue graft (SCTG), respectively, with a statistically significant difference only for MRC values. Nevertheless, due to the limited number and heterogeneity of the included studies, well-performed RCTs are needed to clarify a potential advantage of HA in RCPs in the future.
以往的系统评价报告称，冠向复位瓣（CAF）+结缔组织移植（CTG）是牙根覆盖术（RCP）的金标准。然而，有人提出使用透明质酸（HA）进行辅助治疗，旨在改善临床效果并降低患者的发病率。本系统评价和荟萃分析的目的是比较在治疗米勒I类和II类（退缩1型；RT1）牙龈退缩（GR）缺损时，使用HA作为CAF手术的辅助治疗与不进行辅助/其他治疗的效果。检索了截至2022年4月的MEDLINE、Cochrane对照试验中央注册库、科学网、Scopus数据库和灰色文献。主要结局变量为平均退缩覆盖量（MRC）和退缩深度减少量（RecRed）。采用随机效应模型估计治疗组之间的加权平均差和95%置信区间。从识别出的264篇标题中，纳入了3项随机对照试验，报告了60例患者的90处GR缺损。与单独使用CAF/CAF+上皮下结缔组织移植（SCTG）相比，CAF+HA组的MRC和RecRed总体分析分别为0.27%（ = 0.01）和0.40 mm（ = 0.45），仅MRC值有统计学显著差异。然而，由于纳入研究的数量有限和异质性，未来需要开展完善的随机对照试验来阐明HA在RCP中的潜在优势。
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