【作者】 刘欣；

【导师】 李慧；

【作者基本信息】 吉林大学 ， 口腔医学硕士（专业学位）， 2025， 硕士

【摘要】 目的:慢性牙周炎作为一种全球广泛流行的口腔疾病,其典型特征在于牙周组织的慢性炎症反应和牙槽骨的渐进性丧失。本研究对伴有骨缺损的慢性牙周炎患者的治疗方法进行了系统评价。评价的范围包括但不限于以下几种治疗策略:常规基础治疗、骨移植材料的应用、富血小板纤维蛋白(PRF)治疗、富血小板血浆(PRP)治疗、生长因子的使用、牙釉质基质衍生物(EMD)治疗、自体骨移植(ABG)、引导组织再生术(GTR),以及这些方法的组合应用。本研究旨在分析并比较这些干预措施在减少临床附着水平丧失、降低探诊深度以及改善骨内缺损等方面的疗效差异,从而综合评估各种治疗手段的临床效果。方法:本研究全面回顾了慢性牙周炎患者治疗方法的疗效,通过系统检索了多个权威数据库,包括Pub Med、Embase、Cochrane Library、Web of Science以及中国知网,以搜集自数据库建立至2024年11月期间发布的所有相关文献。在文献筛选过程中,我们严格遵循研究设计的要求,仅纳入随机对照试验(RCTs)作为研究对象,并对所纳入文献的参考文献进行了细致的手工审查。为确保筛选过程的严谨性,两位研究人员依据预先设定的纳入标准独立进行文献筛选和数据提取,同时进行了质量评估。在筛选过程中出现的任何分歧,均通过与第三位研究人员的讨论来达成一致意见。为了评估所选研究的质量,我们采用了Cochrane协作网的偏倚风险评估工具,并通过Stata软件计算了95%置信区间下的平均差异,以提供更为精确的效果量估计。此外,本研究还运用了高级统计软件对所获得的数据进行了深入的分析与处理,以确保研究结果的有效性和可靠性。通过这些方法,我们旨在为慢性牙周炎的治疗提供科学、严谨的循证医学证据。结果:共检索到相关文献5416篇,经筛选后纳入35项RCT研究,共计1362名慢性牙周炎患者。分析结果显示应用再生疗法治疗的患者各结局指标显著优于仅接受基础治疗方法的患者。其中,骨移植材料与生长因子联合治疗在降低临床附着水平方面表现最优(SUCRA:91.6%),在减小探诊深度方面也位居第一(SUCRA:84.3%);富血小板纤维蛋白联合自体骨移植及他汀类药物治疗在减少骨内缺损方面表现突出(SUCRA:96.1%);在降低菌斑指数方面,自体骨移植术(SUCRA:91.1%)和生长因子治疗(SUCRA:74.3%)表现较好;在降低牙龈指数方面,自体骨移植术表现最佳(SUCRA:93.7%);在降低牙龈边缘水平的排名中,富血小板纤维蛋白联合骨移植材料治疗排名第一(SUCRA:72.7%);在增加骨填充率方面,PRF治疗效果最好(SUCRA:87.7%);在减少牙龈退缩中,生长因子效果最好(SUCRA:85.9%);在降低改良龈沟出血指数方面,富血小板纤维蛋白联合他汀类药物治疗表现最优(SUCRA:71.9%);在缩小骨缺损宽度方面,富血小板纤维蛋白联合自体骨移植及他汀类药物治疗位居首位(SUCRA:100%)。尽管本研究提供了慢性牙周炎治疗方法的初步证据,但值得注意的是,这些发现仍需通过进一步的高质量研究来加以验证,从而为慢性牙周炎患者的临床治疗提供更加精确和可靠的指导建议。结论:1.再生疗法治疗优于仅采取基础治疗:PRF、骨移植材料和生长因子等再生疗法在促进牙周组织再生和修复方面显著优于仅采取基础治疗的病例,能更有效地改善患者临床指标。2.骨移植材料+生长因子效果最佳:网状Meta分析显示,骨移植材料联合生长因子治疗在降低临床附着水平、探诊深度和骨内缺损宽度等方面表现最佳,SUCRA评分最高。3.PRF应用广泛且疗效显著:PRF在慢性牙周炎治疗中应用广泛,无论是单独使用还是与其他材料联合使用,都能有效改善患者的临床指标。更多还原

【Abstract】 Objective:Chronic periodontitis,as a globally prevalent oral disease,is characterized by chronic inflammatory responses in the periodontal tissue and the progressive loss of alveolar bone.The purpose of this study is to systematically evaluate the treatment methods for chronic periodontitis patients with bone defects.The scope of evaluation includes,but is not limited to,the following treatment strategies:conventional basic therapy,the application of bone graft materials,platelet-rich fibrin(PRF)therapy,platelet-rich plasma(PRP)therapy,the use of growth factors,enamel matrix derivative(EMD)treatment,autologous bone grafting(ABG),guided tissue regeneration(GTR),and the combination of these methods.This study aims to analyze and compare the efficacy differences among these interventions in reducing clinical attachment level loss,decreasing probing depth,and improving intraosseous defects,thereby comprehensively assessing the clinical effectiveness of various treatment modalities.Methods:This study aims to comprehensively review the efficacy of treatment methods for patients with chronic periodontitis.It systematically searched multiple authoritative databases,including Pub Med,Embase,Cochrane Library,Web of Science,and CNKI,to collect all relevant literature published from the establishment of the databases up to November 2024.In the literature screening process,we strictly adhered to the requirements of the study design and only included randomized controlled trials(RCTs)as the research subjects,and a detailed manual review of the references of the included literature was conducted.To ensure the rigor of the screening process,two researchers independently screened the literature and extracted data based on pre-established inclusion criteria,while also conducting quality assessments.Any discrepancies that arose during the screening process were resolved through discussion with a third researcher to reach a consensus.To assess the quality of the selected studies,we used the Cochrane Collaboration’s risk of bias assessment tool and calculated the mean difference with a 95%confidence interval using Stata software to provide a more precise estimate of the effect size.Additionally,this study employed advanced statistical software for in-depth analysis and processing of the obtained data to ensure the validity and reliability of the research findings.Through these methods,we aim to provide scientific and rigorous evidence-based medical evidence for the treatment of chronic periodontitis.Results:A total of 5,416 relevant literature were retrieved,and after screening,35 RCT studies were included,involving a total of 1,362 patients with chronic periodontitis.The analysis results showed that patients treated with regenerative therapy had significantly better outcomes in all endpoints compared to those who only received basic treatment.Among them,the combination of bone graft materials and growth factors performed the best in reducing clinical attachment level(SUCRA:91.6%)and was also the top in reducing probing depth(SUCRA:84.3%).The combination of platelet-rich fibrin with autogenous bone graft and statin therapy stood out in reducing intraosseous defects(SUCRA:96.1%).In terms of reducing plaque index,autogenous bone graft(SUCRA:91.1%)and growth factors(SUCRA:87.7%)showed the best results.For reducing gingival recession,growth factors were the most effective(SUCRA:85.9%).In lowering the modified sulcus bleeding index,the combination of platelet-rich fibrin and statin therapy was the most effective(SUCRA:71.9%).In narrowing the width of bone defects,the combination of platelet-rich fibrin with autogenous bone graft and statin therapy ranked first(SUCRA:100%).Although this study provides preliminary evidence for the treatment of chronic periodontitis,it is noteworthy that these findings still need to be validated by further high-quality research to provide more precise and reliable clinical guidance for the treatment of patients with chronic periodontitis.SUCRA stands for Surface Under the Cumulative Ranking Curve,which is a measure used in network meta-analysis to assess the relative efficacy of different treatments.Conclusion:1.Regenerative therapy is superior to basic treatment alone:Regenerative therapies such as PRF,bone graft materials and growth factors are significantly superior to cases with only basic treatment in promoting periodontal tissue regeneration and repair,and can more effectively improve clinical indicators of patients.2.The combination of bone graft materials and growth factors showed the best performance in reducing clinical attachment levels,probe depth,and intrabone defect width,with the highest SUCRA score.3.PRF is widely used and has significant efficacy:PRF is widely used in the treatment of chronic periodontitis,and can effectively improve clinical indicators of patients whether used alone or in combination with other materials.更多还原