富含血小板的纤维蛋白对骨形成的疗效,第2部分:引导骨再生、窦提升和种植治疗。

PubMed ID
发表日期 2021年08月

原始出处 国际口腔种植学杂志(德国柏林)
International journal of oral implantology (Berlin, Germany)
作者 Fujioka-Kobayashi  Masako  Miron  Richard J  Moraschini  Vittorio  Zhang  Yufeng  Gruber  Reinhard  Wang  Hom-Lay 

文献标题 富含血小板的纤维蛋白对骨形成的疗效,第2部分:引导骨再生、窦提升和种植治疗。
Efficacy of platelet-rich fibrin on bone formation, part 2: Guided bone regeneration, sinus elevation and implant therapy.

文献摘要 PURPOSE

通过研究富含血小板的纤维蛋白在引导骨再生、窦提升和种植治疗中的应用,探讨其对骨形成的影响。

MATERIALS AND METHODS

本系统评价和荟萃分析按照系统评价和荟萃分析指南的首选报告项目进行和报告。合格标准包括人类对照临床试验,比较富含血小板的纤维蛋白与其他治疗方式的临床结果。测量结果包括新骨形成百分比、残余骨移植百分比、种植体存活率、骨尺寸变化(水平和垂直)以及种植体稳定性商值。

RESULTS

从确定的320篇文章中,纳入了18项研究。由于研究参数的异质性,荟萃分析仅适用于窦性抬高。评估富含血小板的纤维蛋白用于引导性骨再生程序的比较随机临床试验普遍缺乏数据(只有两项研究),在富含血小板的纤维蛋白组中,在新骨形成或三维骨获得方面没有可量化的优势。对于窦性抬高,荟萃分析表明,对照组(单纯骨移植)与试验组(骨移植和富含血小板的纤维蛋白)相比,在组织学新骨形成方面没有优势。两项研究表明,富含血小板的纤维蛋白可以缩短植入物植入前的愈合期。富含血小板的纤维蛋白也显示出轻微增强一期种植体稳定性(种植体稳定商值<5),这是使用种植体稳定商和共振频率分析参数进行评估的,目前还没有评估骨种植体接触的组织学数据。在一项研究中,富含血小板的纤维蛋白被证明可以改善临床参数,用于种植体周围炎的辅助治疗。

CONCLUSIONS

在大多数研究中,富含血小板的纤维蛋白在引导骨再生和窦提升的各种研究中评估的新骨形成方面,以及在种植体稳定性和种植体周围炎治疗方面,几乎没有或没有明显的优势。关于这一主题的各种作者和系统评论现在对各种研究设计和方案,以及缺乏适当的控制和关于患者选择的可用信息表示批评。需要对这些特定主题进行控制良好的人体研究。


PURPOSE

To investigate the effect of platelet-rich fibrin on bone formation by investigating its use in guided bone regeneration, sinus elevation and implant therapy.

MATERIALS AND METHODS

This systematic review and meta-analysis were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria comprised human controlled clinical trials comparing the clinical outcomes of platelet-rich fibrin with those of other treatment modalities. The outcomes measured included percentage of new bone formation, percentage of residual bone graft, implant survival rate, change in bone dimension (horizontal and vertical), and implant stability quotient values.

RESULTS

From 320 articles identified, 18 studies were included. Owing to the heterogeneity of the investigated parameters, a meta-analysis was only possible for sinus elevation. There is a general lack of data from comparative randomised clinical trials evaluating platelet-rich fibrin for guided bone regeneration procedures (only two studies), with no quantifiable advantages in terms of new bone formation or dimensional bone gain found in the platelet-rich fibrin group. For sinus elevation, the meta-analysis demonstrated no advantage in terms of histological new bone formation in the control group (bone graft alone) compared with the test group (bone graft and platelet-rich fibrin). Two studies demonstrated that platelet-rich fibrin may shorten healing periods prior to implant placement. Platelet-rich fibrin was also shown to slightly enhance primary implant stability (implant stability quotient value < 5) as assessed using implant stability quotients and resonance frequency analysis parameters, with no histological data evaluating bone-implant contact yet available on this topic. In one study, platelet-rich fibrin was shown to improve the clinical parameters when utilised as an adjunct for the treatment of peri-implantitis.

CONCLUSIONS

In the majority of studies, platelet-rich fibrin offered little or no clear advantage in terms of new bone formation as evaluated in various studies on guided bone regeneration and sinus elevation, nor in implant stability and treatment of peri-implantitis. Various authors and systematic reviews on the topic have now expressed criticism of the various study designs and protocols, and the lack of appropriate controls and available information regarding patient selection. Well-controlled human studies on these specific topics are required.