釉基质蛋白衍生物联合植骨材料与单用植骨材料比较治疗牙周骨缺损疗效的Meta分析
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摘要
目的:比较并评价釉基质蛋白衍生物联合植骨材料与单用植骨材料治疗牙周骨缺损的临床效果。方法:在Cochrane Library、EMBASE、Pub Med、CNKI、万方、Google学术等中外文数据库检索2016-05前发表的关于釉基质蛋白衍生物联合植骨材料治疗牙周骨缺损的随机对照临床研究,对纳入的文献进行质量评价,应用RevMan 5.3软件对数据进行Meta分析。结果:最终纳入5篇RCT文献,共145个牙周骨缺损位点。Meta分析结果显示,6月组,试验组较对照组可明显降低牙周袋探诊深度(WMD=0.40,95%CI=[0.01,0.79],P<0.05),增加临床附着水平(WMD=0.50,95%CI=[0.12,0.88],P<0.05);12月组,2指标的临床效果在2组间比较无统计学差异。结论:釉基质蛋白联合植骨材料比单纯使用植骨材料对治疗牙周骨内缺损显示,在短期随访期间,联合疗法的在探诊深度及临床附着水平有显著优势;长期随访期间,各临床结果2组之间差异无显著性。
Objective:To analyze the efficacy of enamel matrix derivative(EMD)combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis.Methods:The randomized controlled trials(RCTs)about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,Pub Med,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS)evaluation tool.Revman 5.3 was used for the Meta-analysis.Results:5 RCTs articles with 145 cases were included.Meta-analysis showed that:at 6 months of follow-up,PD reduction and CAL gain was found more in test group than in control group(WMD=0.40,95%CI=[0.01,0.79],P<0.05)and(WMD=0.50,95%CI=[0.12,0.88],P<0.05)respectively.At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments.Conclusion:The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.
Objective:To analyze the efficacy of enamel matrix derivative(EMD)combined with bone grafts in the treatment of periodontal osseous defects comparied with that of bone grafts alone by Meta-analysis.Methods:The randomized controlled trials(RCTs)about the efficacy of enamel matrix derivative and bone grafts for the treatment of periodontal osseous defects were collected from Cochrane Library,EMBASE,Pub Med,CNKI,Wanfang databases and Google scholar from inception may,2016 by electronic search,scored literatures with the methodological index for non-randomized studies(MINORS)evaluation tool.Revman 5.3 was used for the Meta-analysis.Results:5 RCTs articles with 145 cases were included.Meta-analysis showed that:at 6 months of follow-up,PD reduction and CAL gain was found more in test group than in control group(WMD=0.40,95%CI=[0.01,0.79],P<0.05)and(WMD=0.50,95%CI=[0.12,0.88],P<0.05)respectively.At 12 months of follow-up,there was no statistical significant difference in PD reduction and CAL gain respectively between the 2 treatments.Conclusion:The combined use of EMD and bone grafts may improve PD reduction and CAL gain in the early stage of convalescence following treatment of periodontal osseous deffects.
引文
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[8]D9ri F,Arweiler N,Gera I,et al.Clinical evaluation of an enamel matrix protein derivative combined with either a natural bone mineral or beta-tricalcium phosphate[J].J Periodontol,2005,76(12):2236-2243.
[9]Chitsazi MT,Mostofi Zadeh Farahani R,et al.Efficacy of open flap debridement with and without enamel matrix derivatives in the treatment of mandibular degree II furcation involvement[J].Clin Oral Investig,2007,11(4):385-389.
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[12]Sculean A,Chiantella GC,Windisch P,et al.Clinical evaluation of an enamel matrix protein derivative(Emdogain)combined with a bovine-derived xenograft(Bio-Oss)for the treatment of intrabony periodontal defects in humans[J].Int J Periodontics Restorative Dent,2002,22(3):259-267.
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[14]Aspriello SD,Ferrante L,Rubini C,et al.Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post-surgery[J].Clin Oral Investig,2011,15(2):225-232.
[15]Hoidal MJ,Grimard BA,Mills MP,et al.Clinical evaluation of demineralized freeze-dried bone allograft with and without enamel matrix derivative for the treatment of periodontal osseous defects in humans[J].J Periodontol,2008,79(12):2273-2280.
[16]Jaiswal R,Deo V.Evaluation of the effectiveness of enamel matrix derivative,bone grafts,and membrane in the treatment of mandibular Class II furcation defects[J].Int J Periodontics Restorative Dent,2013,33(2):e58-64.
[17]Peres MF,Ribeiro ED,Casarin RC,et al.Hydroxyapatite/β-tricalcium phosphate and enamel matrix derivative for treatment of proximal class II furcation defects:A randomized clinical trial[J].J Clin Periodontol,2013,40(3):252-259.
[18]Esposito,M,Coulthard P,Thomsen P,et al.Enamel matrix derivative for periodontal tissue regeneration in treatment of intrabony defects:A cochrane systematic review[J].J Dent Educ,2004,68(8):834-844.
[19]Bosshardt DD.Biological mediators and periodontal regeneration:A review of enamel matrix proteins at the cellular and molecular levels[J].J Clin Periodontol,2008,35(8 Suppl):87-105.
[20]张雪洋,赵华,章锦才.Emdogain作用下人牙周膜细胞的差异表达基因[J].实用口腔医学杂志,2009,25(4):556-559.
[21]Miron RJ,Hedbom E,Ruggiero S,et al.Premature osteoblast clustering by enamel matrix proteins induces osteoblast differentiation through up-regulation of connexin 43 and N-cadherin[J].PLo S One,2011,6(8):e23375.
[22]Nery EB,Le Geros RZ,Lynch KL,et al.Tissue response to biphasic calcium phosphate ceramic with different ratios of HA/beta TCP in periodontal osseous defects[J].J Periodontol,1992,63(9):729-735.
[23]Zafiropoulos GG,Hoffmann O,Kasaj A,et al.Treatment of intrabony defects using guided tissue regeneration and autogenous spongiosa alone or combined with hydroxyapatite/betatricalcium phosphate bone substitute or bovine-derived xenograft[J].J Periodontol,2007,78(11):2216-2225.
[24]Gurinsky BS,Mills MP,Mellonig JT.Clinical evaluation of demineralized freeze-dried bone allograft and enamel matrix derivative versus enamel matrix derivative alone for the treatment of periodontal osseous defects in humans[J].J Periodontol,2004,75(10):1309-1318.
[25]Lekovic V,Camargo PM,Weinlaender M,et al.A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans[J].J Periodontol,2000,71(7):1110-1116.
[26]Zucchelli G,Amore C,Montebugnoli L,et al.Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects:A comparative controlled clinical trial[J].J Periodontol,2003,74(12):1725-1735.
[27]Jepsen S,Topoll H,Rengers H,et al.Clinical outcomes after treatment of intra-bony defects with an EMD/synthetic bone graft or EMD alone:A multicentre randomized-controlled clinical trial[J].J Clin Periodontol,2008,35(5):420-428.
[28]Harrel SK,Wilson TG,Nunn ME,et al.Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery[J].J Periodontol,2005,76(3):380-384.
[29]Harrel SK,Wilson TG Jr,Nunn ME,et al.Prospective assessment of the use of enamel matrix derivative with minimally invasive surgery:6-year results[J].J Periodontol,2010,81(3):435-441.
[2]Brookes SJ,Robinson C,Kirkham J,et al.Biochemistry and molecular biology of amelogenin proteins of developing dental enamel[J].Arch Oral Biol,1995,40(1):1-14.
[3]Al-Hezaimi K,Al-Askar M,Al-Rasheed A.Characteristics of newly-formed cementum following Emdogain application[J].Int J Oral Sci,2011,3(1):21-26.
[4]Gestrelius S,Andersson C,Lidstr9m D,et al.In vitro studies on periodontal ligament cells and enamel matrix derivative[J].J Clin Periodontol,1997,24(9 Pt 2):685-692.
[5]He J,Jiang J,Safavi KE,et al.Emdogain promotes osteoblast proliferation and differentiation and stimulates osteoprotegerin expression[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2004,97(2):239-245.
[6]李治邦,高丽娜,毕春升,等.牙周组织再生的临床研究进展[J].实用口腔医学杂志,2015,31(6):855-860.
[7]Venezia E,Goldstein M,Boyan BD,et al.The use of enamel matrix derivative in the treatment of periodontal defects:A literature review and meta-analysis[J].Crit Rev Oral Biol Med,2004,15(6):382-402.
[8]D9ri F,Arweiler N,Gera I,et al.Clinical evaluation of an enamel matrix protein derivative combined with either a natural bone mineral or beta-tricalcium phosphate[J].J Periodontol,2005,76(12):2236-2243.
[9]Chitsazi MT,Mostofi Zadeh Farahani R,et al.Efficacy of open flap debridement with and without enamel matrix derivatives in the treatment of mandibular degree II furcation involvement[J].Clin Oral Investig,2007,11(4):385-389.
[10]Sculean,A,Donos N,Brecx M,et al.Healing of fenestration-type defects following treatment with guided tissue regeneration or enamel matrix proteins.An experimental study in monkeys[J].Clin Oral Investig,2000,4(1):50-56.
[11]Sculean A,Windisch P,Keglevich T,et al.Presence of an enamel matrix protein derivative on human teeth following periodontal surgery[J].Clin Oral Investig,2002,6(3):183-187.
[12]Sculean A,Chiantella GC,Windisch P,et al.Clinical evaluation of an enamel matrix protein derivative(Emdogain)combined with a bovine-derived xenograft(Bio-Oss)for the treatment of intrabony periodontal defects in humans[J].Int J Periodontics Restorative Dent,2002,22(3):259-267.
[13]Scheyer ET,Velasquez-Plata D,Brunsvold MA,et al.Aclinical comparison of a bovine-derived xenograft used alone and in combination with enamel matrix derivative for the treatment of periodontal osseous defects in humans[J].JPeriodontol,2002,73(4):423-432.
[14]Aspriello SD,Ferrante L,Rubini C,et al.Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post-surgery[J].Clin Oral Investig,2011,15(2):225-232.
[15]Hoidal MJ,Grimard BA,Mills MP,et al.Clinical evaluation of demineralized freeze-dried bone allograft with and without enamel matrix derivative for the treatment of periodontal osseous defects in humans[J].J Periodontol,2008,79(12):2273-2280.
[16]Jaiswal R,Deo V.Evaluation of the effectiveness of enamel matrix derivative,bone grafts,and membrane in the treatment of mandibular Class II furcation defects[J].Int J Periodontics Restorative Dent,2013,33(2):e58-64.
[17]Peres MF,Ribeiro ED,Casarin RC,et al.Hydroxyapatite/β-tricalcium phosphate and enamel matrix derivative for treatment of proximal class II furcation defects:A randomized clinical trial[J].J Clin Periodontol,2013,40(3):252-259.
[18]Esposito,M,Coulthard P,Thomsen P,et al.Enamel matrix derivative for periodontal tissue regeneration in treatment of intrabony defects:A cochrane systematic review[J].J Dent Educ,2004,68(8):834-844.
[19]Bosshardt DD.Biological mediators and periodontal regeneration:A review of enamel matrix proteins at the cellular and molecular levels[J].J Clin Periodontol,2008,35(8 Suppl):87-105.
[20]张雪洋,赵华,章锦才.Emdogain作用下人牙周膜细胞的差异表达基因[J].实用口腔医学杂志,2009,25(4):556-559.
[21]Miron RJ,Hedbom E,Ruggiero S,et al.Premature osteoblast clustering by enamel matrix proteins induces osteoblast differentiation through up-regulation of connexin 43 and N-cadherin[J].PLo S One,2011,6(8):e23375.
[22]Nery EB,Le Geros RZ,Lynch KL,et al.Tissue response to biphasic calcium phosphate ceramic with different ratios of HA/beta TCP in periodontal osseous defects[J].J Periodontol,1992,63(9):729-735.
[23]Zafiropoulos GG,Hoffmann O,Kasaj A,et al.Treatment of intrabony defects using guided tissue regeneration and autogenous spongiosa alone or combined with hydroxyapatite/betatricalcium phosphate bone substitute or bovine-derived xenograft[J].J Periodontol,2007,78(11):2216-2225.
[24]Gurinsky BS,Mills MP,Mellonig JT.Clinical evaluation of demineralized freeze-dried bone allograft and enamel matrix derivative versus enamel matrix derivative alone for the treatment of periodontal osseous defects in humans[J].J Periodontol,2004,75(10):1309-1318.
[25]Lekovic V,Camargo PM,Weinlaender M,et al.A comparison between enamel matrix proteins used alone or in combination with bovine porous bone mineral in the treatment of intrabony periodontal defects in humans[J].J Periodontol,2000,71(7):1110-1116.
[26]Zucchelli G,Amore C,Montebugnoli L,et al.Enamel matrix proteins and bovine porous bone mineral in the treatment of intrabony defects:A comparative controlled clinical trial[J].J Periodontol,2003,74(12):1725-1735.
[27]Jepsen S,Topoll H,Rengers H,et al.Clinical outcomes after treatment of intra-bony defects with an EMD/synthetic bone graft or EMD alone:A multicentre randomized-controlled clinical trial[J].J Clin Periodontol,2008,35(5):420-428.
[28]Harrel SK,Wilson TG,Nunn ME,et al.Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery[J].J Periodontol,2005,76(3):380-384.
[29]Harrel SK,Wilson TG Jr,Nunn ME,et al.Prospective assessment of the use of enamel matrix derivative with minimally invasive surgery:6-year results[J].J Periodontol,2010,81(3):435-441.