拔牙后使用异种移植物保存牙槽嵴:一项系统评价和荟萃分析。

Alveolar Ridge Preservation Using Xenograft Following Tooth Extraction: A Systematic Review and Meta-Analysis.

作者信息

Sah Nupur, Sarode Prashasti P, Warang Ayushya, Tarase Tulsi, Gavhale Pandurang, Mirgane Manjiri

机构信息

Periodontology, Dr. G. D. Pol Foundation, YMT Dental College and Hospital, Navi Mumbai, IND.

出版信息

Cureus. 2025 Apr 7;17(4):e81815. doi: 10.7759/cureus.81815. eCollection 2025 Apr.

Abstract

Human extraction socket healing is characterized by a series of cellular and tissue alterations; a blood clot forms inside the extraction socket quickly, which is then replaced by granulation tissue and eventually osteoid tissue. The center of the ridge shifts palatally/lingually as a result of the buccal bone plates in the maxilla and mandible. Alveolar ridge preservation (ARP) procedures were introduced to prevent alveolar ridge atrophy, preserve sufficient bone dimensions to enable implant placement in prosthetically driven positions, and maintain an acceptable ridge contour in areas of aesthetic concern. Different bone grafts have been used for ARP. Hence, this systematic review was carried out to evaluate the existing scientific literature in providing a comprehensive, quantitative analysis on the effectiveness of xenograft as a grafting material for ARP. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020 and was registered in PROSPERO-CRD42024510745. Electronic databases were searched for studies evaluating the effectiveness of xenograft as a grafting material for ARP and reporting outcomes through horizontal ridge width, vertical ridge height, periodontal clinical parameters (like probing pocket depth (PPD), bleeding on probing (BOP), recession, plaque index (PI) and gingival index (GI), radiological evaluations, and associated complications. Quality assessment of included studies was evaluated through the Cochrane risk of bias (ROB)-2 tool. The standardized mean difference (SMD) was used as a summary statistic measure with a random effect model, and value < 0.05 as statistically significant through Review Manager (RevMan) version 5.3 (Released 2014; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen). Two studies were selected for the meta-analysis, and five randomized controlled trials (RCTs) that met the eligibility requirements were included in the qualitative synthesis. There was a low to moderate ROB in the included studies. The pooled estimate showed that vertical ridge height (mid-buccal (SMD = -1.89 (-2.46-1.31), mesial (SMD = -0.18 (-0.65-0.29), and distal (SMD = -0.11 (-0.58-0.36)) decreased more with the Ext. alone group, while BOP (SMD = -0.49 (-0.96-0.01)) was more or less similar in both groups. Horizontal ridge width (SMD = 1.15 (0.97-2.05) was better preserved with ARP. Xenograft was clinically and statistically superior (p < 0.05). The funnel plot did not reveal any asymmetry, indicating the absence of publication bias in the meta-analysis. It was found that an extraction socket filled with xenograft resulted in better preservation of alveolar bone dimension, lesser ridge resorption, and provided better soft and hard tissue healing with better satisfactory results. Further clinical studies with a larger sample size and follow-up period should be carried out to assess the secondary outcomes described to obtain overall good quality evidence.

摘要

人类拔牙创愈合的特点是一系列细胞和组织的改变;拔牙创内很快形成血凝块,随后被肉芽组织取代,最终被类骨质组织取代。由于上颌骨和下颌骨的颊侧骨板,牙槽嵴的中心向腭侧/舌侧移位。牙槽嵴保存(ARP)手术被引入以防止牙槽嵴萎缩,保留足够的骨尺寸以便在修复驱动的位置植入种植体,并在美学关注区域维持可接受的牙槽嵴轮廓。不同的骨移植材料已被用于ARP。因此,本系统评价旨在评估现有科学文献,以对异种移植物作为ARP移植材料的有效性进行全面、定量分析。该评价遵循2020年系统评价和Meta分析的首选报告项目(PRISMA)指南,并在PROSPERO-CRD42024510745中注册。检索电子数据库,查找评估异种移植物作为ARP移植材料的有效性并通过水平牙槽嵴宽度、垂直牙槽嵴高度、牙周临床参数(如探诊深度(PPD)、探诊出血(BOP)、退缩、菌斑指数(PI)和牙龈指数(GI))、影像学评估及相关并发症报告结果的研究。通过Cochrane偏倚风险(ROB)-2工具对纳入研究进行质量评估。采用随机效应模型,将标准化均数差(SMD)用作汇总统计量,通过Review Manager(RevMan)5.3版(2014年发布;北欧Cochrane中心,Cochrane协作网,哥本哈根),P值<0.05为具有统计学意义。两项研究被选入Meta分析,五项符合纳入标准的随机对照试验(RCT)被纳入定性分析。纳入研究的偏倚风险为低到中度。汇总估计显示,单独拔牙组的垂直牙槽嵴高度(颊侧中部(SMD=-1.89(-2.46 - 1.31))、近中(SMD=-0.18(-0.65 - 0.29))和远中(SMD=-0.11(-0.58 - 0.36))下降更多,而两组的BOP(SMD=-0.49(-0.96 - 0.01))大致相似。ARP能更好地保留水平牙槽嵴宽度(SMD = 1.15(0.97 - 2.05))。异种移植物在临床和统计学上更具优势(P < 0.05)。漏斗图未显示任何不对称性,表明Meta分析中不存在发表偏倚。研究发现,填充异种移植物的拔牙创能更好地保留牙槽骨尺寸,减少牙槽嵴吸收,并提供更好的软硬组织愈合,效果更令人满意。应开展样本量更大、随访期更长的进一步临床研究,以评估所描述的次要结局,从而获得总体高质量证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0cd/12056884/cb68afff1209/cureus-0017-00000081815-i01.jpg

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