Kouhi Monireh, Yousefi Saba, Sajadi-Javan Zahra Sadat, Sadeghi Erfan, Savabi Omid, Shirani Mohammadjavad
Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran.
Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran.
J Evid Based Dent Pract. 2024 Dec;24(4):102022. doi: 10.1016/j.jebdp.2024.102022. Epub 2024 Jul 25.
The objective of this systematic review is to assess the clinical outcomes of intrabony and furcation defects treated using a regenerative approach with calcium phosphate (CP) grafts combined plus guided tissue regeneration (GTR) membrane in comparison to open flap debridement (OFD).
A review protocol was created under PRISMA checklist to find randomized clinical trials (RCTs) in English that compared CPs plus GTR with OFD in humans with intrabony and/or furcation defects. Both electronic and manual searches were conducted. The studied outcomes were probing pocket depth (PD) and clinical attachment level (CAL). To evaluate the treatment effect, a random effects model using restricted maximum likelihood method was performed to estimate the pooled effect size and corresponding 95% confidence interval. The quality assessment of the included studies was performed using Cochrane risk of bias tools version 5.1.0.
Out of the 451 records identified, 7 studies were subjected to meta-analysis after discarding duplicates and excluding the studies that did not meet the inclusion criteria. While treated sites were intrabony defects in 5 papers, 2 studies focused on furcation defects. Based on the findings of the meta-analysis, the weighted mean difference (WMD) of 1.536 mm (95% CI -0.933 to 2.139) and 1.601 mm (95% CI -0.727 to 2.474) was obtained for CAL gain and PD reduction, respectively, in intrabony defects. The differences between CP grafts plus GTR groups and OFD groups for CAL gain and PD reduction were statistically significant. Similarly, for furcation defects, the application of CP grafts with GTR resulted in adjunctive advantages over OFD in terms of CAL gain (WMD of 1.807 mm; 95% CI 0.346-3.268), and PD reduction (WMD of 1.519 mm, 95% CI 1.215-4.253). The analysis on the limited number of study on furcation treatment revealed a statistically significant difference in CAL gain between CP grafts plus GTR groups and OFD groups, but a nonsignificant difference for PD reduction.
The results revealed that calcium phosphate grafts combined with GTR are superior to OFD in the healing of periodontal intrabony and furcation defects, considering the limitations of the present systematic review.
本系统评价的目的是评估采用磷酸钙（CP）移植联合引导组织再生（GTR）膜的再生方法治疗骨内和根分叉缺损与开放瓣清创术（OFD）相比的临床疗效。
根据PRISMA清单制定了一项综述方案，以查找英文随机临床试验（RCT），这些试验比较了CP联合GTR与OFD在患有骨内和/或根分叉缺损的人类中的疗效。进行了电子和手动检索。研究的结局指标是探诊深度（PD）和临床附着水平（CAL）。为了评估治疗效果，采用限制最大似然法的随机效应模型来估计合并效应量和相应的95%置信区间。使用Cochrane偏倚风险工具5.1.0对纳入研究进行质量评估。
在识别出的451条记录中，在剔除重复记录并排除不符合纳入标准的研究后，7项研究进行了荟萃分析。5篇论文中的治疗部位为骨内缺损，2项研究关注根分叉缺损。基于荟萃分析的结果，在骨内缺损中，CAL增加和PD减少的加权平均差（WMD）分别为1.536mm（95%CI -0.933至2.139）和1.601mm（95%CI -0.727至2.474）。CP移植联合GTR组与OFD组在CAL增加和PD减少方面的差异具有统计学意义。同样，对于根分叉缺损，在CAL增加方面（WMD为1.807mm；95%CI 0.346 - 3.268）以及PD减少方面（WMD为1.519mm，95%CI 1.215 - 4.253），CP移植联合GTR的应用相对于OFD具有附加优势。对有限数量的根分叉治疗研究的分析显示，CP移植联合GTR组与OFD组在CAL增加方面存在统计学显著差异，但在PD减少方面差异不显著。
考虑到本系统评价的局限性，结果显示磷酸钙移植联合GTR在牙周骨内和根分叉缺损的愈合方面优于OFD。
