齒槽骨維持術的臨床表現統合分析

Abstract

臨床上我們很常會面對到拔牙後齒槽骨縮減狀況。所以我們希望能夠集結許多臨床試驗，利用統合分析(meta-analysis)，找出科學證據來：（1）評估齒槽骨維持術與拔牙後自然癒合的預期結果差別（2）比較各式齒槽骨維持術方法的同異與效益和（3）評估施行齒槽骨維持術後對於將植體植入理想位置的價值。做出一個統整。希望能幫助臨床醫師訂定及執行後續的治療計畫。 我們利用電子資料庫MEDLINE，Scopus Elsevier，Cochrane Library，全國期刊聯合資料庫，中國知識資源總庫、全國博碩士論文資訊加值網、華藝線上圖書館，及Google學術搜尋，全面系統性的搜尋了從西元1990到2014年4月與齒槽骨維持術相關的隨機對照試驗(Randomized controlled trial)，橫段式研究（cross-sectional study），病例-對照研究（case-control study），世代追蹤研究法（cohort study），及有治療組、對照組，兩組以上互相比較的病例系列報告(case series)。然後用統合分析方式比較齒槽骨維持術使用不同材料及方法其臨床表現的優劣。 我們最後篩選出18篇文章。統合分析結果顯示，有做齒槽骨保存術的組別比未做齒槽骨保存術的組別在拔牙後有更少的骨嵴高度減少（加權平均差異，WMD = 1.074±0.291 mm(p<0.05))。更少的骨嵴寬度減少（加權平均差異，WMD = 1.981±0.24 mm(p<0.05))。用再生膜(Membrane) (p<0.001)，異體骨(Xenograft) (p<0.001)，以及島瓣一級縫合(primary closure) (p<0.001)等皆可降低拔牙後骨嵴高度減少。明顯有利於齒槽骨保存。至於在齒槽骨維持術治療對植牙治療長期成果的好處，並沒有足夠資料可用來得出結論。 本研究論證了齒槽骨維持術治療的重要性。但無法明確提供齒槽骨維持術使用的生物材料的類型，或手術過程清晰的指引。

Objective: This systematic review aims to the effect of socket preservation following tooth extraction in humans as compared with natural healing ,to evaluate the scientific evidence on the efficacy in the surgical protocols designed for preserving the alveolar ridge after tooth extraction and to evaluate how these techniques affect the placement of dental implants and the final implant supported restoration. Material and methods: A thorough search in MEDLINE via Pubmed, Scopus Elsevier , MEDLINE (OvidSP), Cochrane Library, STICNET in Taiwan, NDLTD in Taiwan, Airiti library in Taiwan, CNKI in China and hand-searched the relevant journals from 1990 to April 2014. Randomized controlled trial, cross-sectional study. case-control study ,cohort study with a follow-up of at least 4 months reporting changes on both the hard and soft tissues (height and/or width) of the alveolar process (mm or %) after tooth extraction were considered for inclusion. Results: The screening of titles and abstracts resulted in 18 publications meeting the eligibility criteria. Results from the meta-analyses showed a statistically significant greater ridge reduction in bone height & width for control groups as compared to test groups Meta-regression analyses was based on the surgical protocol used for the ridge preservation (Membrane(Yes vs. No); Membrane (Yes(artifical) vs. No); Membrane (artificial vs autogenous); Xenograft (Yes vs. No); Graft (Yes vs. No); Flap (Yes vs. No); Primary Closure(Yes vs. No); Membrane(Yes)+Graft(Yes) vs. Membrane(Yes)+Graft (No)) and on the measurement method utilized to evaluate morphological changes. Meta-regression analyses demonstrated a statistically significant difference favoring the Membrane(Yes), Xenograft (Yes ) Primary Closure (Yes ) subgroup in terms of bone height & width . Conclusions: The potential benefit of socket preservation therapies was demonstrated resulting in significantly less vertical and horizontal contraction of the alveolar bone crest. The scientific evidence does not provide clear guidelines in regards to the type of biomaterial, or surgical procedure, There are no data available to draw conclusions on the consequences of such benefits on the long-term outcomes of implant therapy.