背景:这些临床指南的目的,由意大利牙周病学会委托,并与研究和评估指南(AGREE)合作评估的工具和说明一起编制,是为了确定,就功效而言,并发症,和病人的意见,牙周缺损>或=3mm的患者的最合适的手术技术。
方法:文献中发表的有关开放皮瓣清创(OFD)的结果,使用生物可吸收或不可吸收的膜引导组织再生(GTR),使用牙釉质基质衍生物(EMD)再生牙周组织,和骨或骨替代移植物进行搜索(电子和手动)和比较。分析了以下变量:丢失的牙齿数量,临床依恋水平的变化(CAL增益),探测深度的变化(PD减少),牙龈衰退的变化,骨缺损深度的变化(骨增益),并发症,以及患者的功能和美学满意度。选择2006年12月31日发表的随机对照临床试验(RCTs)和RCTs的系统评价(SRs)进行文献检索,随访时间>或=1年。根据苏格兰校际指南网络(SIGN)方法,使用清单对所选SR和RCT的全文进行了分析,以进行定性评估。
结果:为了起草这些指南,决定接受两个比较OFD和GTR的SR的结果,OFD与EMD,和GTR与EMD。关于功效,在CAL增益方面,GTR和EMD可以比OFD产生更好的结果(1.22mm[P值<0.0001]和1.20mm[P值<0.0001],分别),PD减少(1.21mm[P=0.0004]和0.77mm[P=0.0001],分别),和骨增益(1.39和1.08毫米,分别)在>或=1年的随访后。可用数据不足以评估骨或骨替代移植物。文献中的数据也不足以回答有关并发症和患者意见的问题。
结论:文献报道的证据表明,建议通过OFD治疗>或=3mm的缺陷,GTR,和EMD。应鼓励对这些主题进行进一步研究。需要进行良好的RCT,以报告有关并发症和患者意见的数据。
BACKGROUND: The purpose of these clinical
guidelines, commissioned by the Italian Society of Periodontology and compiled with the tools and instructions of the Appraisal of
Guidelines for Research and Evaluation (AGREE) collaboration, was to determine, in terms of efficacy, complications, and patient opinions, the most appropriate surgical techniques for periodontal patients with infrabony defects > or = 3 mm.
METHODS: Results published in the literature concerning open flap debridement (OFD), guided tissue regeneration (GTR) using a bioabsorbable or non-resorbable membrane, regeneration of periodontal tissues using enamel matrix derivative (EMD), and bone or bone substitute grafts were searched (electronically and manually) and compared. The following variables were analyzed: number of teeth lost, variation in clinical attachment level (CAL gain), variation in probing depth (PD reduction), variation in gingival recession, variation in bony defect depth (bone gain), complications, and the functional and esthetic satisfaction of the patients. Literature searches were performed selecting randomized clinical trials (RCTs) and systematic reviews (SRs) of RCTs published through December 31, 2006 with > or = 1 year of follow-up. The full text of the selected SRs and RCTs were analyzed using checklists for qualitative evaluation according to the Scottish Intercollegiate
Guidelines Network (SIGN) method.
RESULTS: For the drafting of these
guidelines, it was decided to accept the results of two SRs that compared OFD versus GTR, OFD versus EMD, and GTR versus EMD. With regard to efficacy, GTR and EMD can yield better results than OFD in terms of CAL gain (1.22 mm [P value <0.0001] and 1.20 mm [P value <0.0001], respectively), reduction of PD (1.21 mm [P = 0.0004] and 0.77 mm [P = 0.0001], respectively), and bone gain (1.39 and 1.08 mm, respectively) after > or = 1 year of follow-up. The available data are insufficient for an evaluation of bone or bone substitute grafts. The data in the literature are also insufficient for answering questions about complications and patient opinions.
CONCLUSIONS: The evidence reported in the literature indicates that it is advisable to treat infrabony defects > or = 3 mm by OFD, GTR, and EMD. Further studies on these topics should be encouraged. There is a need for well-conducted RCTs that report data on complications and patient opinions.