自体口腔内块移植是中度至重度水平脊缺乏的金标准增强技术。然而,移植物在愈合过程中经历可变的再吸收,这可能危及手术的结果。一些研究假设用薄膜覆盖移植物减少移植物吸收的量,但这种效果在文献中并不确定。
本研究的目的是评估水平脊增强用膜覆盖口腔内块状移植物的临床价值,以评估移植物吸收(主要结果),移植成功,净骨增益,和并发症(次要结果)。
直到2017年8月,审查小组进行了电子搜索,包括PubMed,EMBASE,科克伦,和LILACS数据库;我们还通过手工搜索确定了其他文章。搜索词包括牙槽脊增加,骨移植,块移植,引导骨再生,膜,可吸收膜,和不可吸收的膜。
该综述包括人体随机对照试验,对照临床试验,队列研究,和英文病例对照研究,比较了自体口腔内块状移植物的膜覆盖和无膜覆盖,并报告了>3个月随访后的移植物吸收量。
两位作者使用Cochrane偏差风险工具独立评估偏差风险,第三个审稿人是冲突时的法官。
两位作者独立填写了用于数据提取的护理表的有效实践和组织,第三审稿人修改了数据。
选择的统计方法是通用逆方差,结果使用随机效应模型进行汇总,效应大小测量为连续结局的平均差(MD)和二分结局的风险比(RR)。
评审成员筛选了2266条记录;我们按标题和摘要排除了2231条记录,筛选了35条符合资格的全文记录,我们出于某些原因排除了32篇文章(最常见的是不同的比较和排除研究设计).本综述的定量和定性分析包括三项随机对照试验。为49个地点的41名参与者提供数据。数据分析显示,膜覆盖在减少口内块状移植物的移植物吸收量方面具有统计学意义的潜在益处(MD:-1.20mm,95%置信区间[CI]:-2.11至-0.30,P=.009)。使用膜对移植成功(RR:1.02,95%CI:0.89-1.17,P=0.79)和净骨增益(MD:0.46,95%CI:-0.16至1.09,P=.15)没有统计学上的显着益处。使用膜的并发症发生率没有统计学上的显着增加(RR:1.80,95%CI:0.55-5.96,P=0.33)。审稿人对所有研究的偏见风险判断为质量合理。
膜的使用减少了移植物的吸收,但是移植成功率和净骨增益没有差异。使用膜没有增加并发症。此外,正确进行的研究应用于证明辅助使用带有块状移植物的屏障膜。
Autogenous intraoral block grafting is the gold standard augmentation technique for moderate-to-severe horizontal ridge deficiency. However, the graft undergoes variable resorption during healing that might jeopardize the outcome of the procedure. Several studies hypothesized that covering the graft with a membrane decreases the amount of graft resorption, but this effect is not established in the literature.
The objective of this study is to assess the clinical value of covering intraoral block grafts with membranes in horizontal ridge augmentation regarding graft resorption (primary outcome), graft success, net bone gain, and complications (secondary outcomes).
Till August 2017, the
review team conducted an electronic search including PubMed, EMBASE, Cochrane, and LILACS databases; we also identified other articles through hand searching. The search terms included alveolar ridge augmentation, bone transplantation, block graft, guided bone regeneration, membranes, resorbable membrane, and nonresorbable membrane.
The
review included human randomized controlled trials, controlled clinical trials, cohort studies, and case-control studies in English that compared membrane coverage to no membrane coverage of autogenous intraoral block grafts and reported the amount of graft resorption after > 3-month follow-up.
Two authors independently assessed the risk of bias using the Cochrane risk of bias tool, and the third reviewer was the judge in case of conflict.
Two authors independently filled the effective practice and organization of care form for data extraction, and the third reviewer revised the data.
The statistical method of choice was the generic inverse variance, and the results were pooled using random-effect models, with the effect size measure being mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes.
The
review members screened 2266 records; we excluded 2231 records by the title and abstract and screened 35 full-text records for eligibility, from which we excluded 32 articles for certain reasons (the most common were a different comparison and excluded study design). Three randomized controlled trials were included in the quantitative and qualitative analyses of this
review, providing the data for 41 participants with 49 sites. Data analysis showed a statistically significant potential benefit of membrane coverage in decreasing the amount of graft resorption of intraoral block grafts (MD: -1.20 mm, 95% confidence interval [CI]: -2.11 to -0.30, P = .009). There was no statistically significant benefit from the use of membranes regarding graft success (RR: 1.02, 95% CI: 0.89-1.17, P = .79) and net bone gain (MD: 0.46, 95% CI: -0.16 to 1.09, P = .15). The use of membranes did not show a statistically significant increase in the incidence of complications (RR: 1.80, 95% CI: 0.55-5.96, P = .33). The reviewers judged all the studies as of fair quality regarding the risk of bias.
The use of membranes decreased the graft resorption, but there was no difference regarding graft success and net bone gain. The use of membranes did not increase complications. Furthermore, properly conducted studies should be used to justify the adjunctive use of barrier membranes with block grafts.