不同位点保存材料对拔牙后牙槽嵴宽度及高度变化影响:基于随机对照研究网状系统评价  

Comparative effects of different alveolar ridge preservation materials on alveolar width and height changes after tooth extraction:a network meta-analysis of randomized controlled trials

作　　者：罗妍彦 赵雪莹 宁博 杨露 崔琳 朱敏 孟繁彤 曹灿 孙淏海 LUO Yan-yan;ZHAO Xue-ying;NING Bo;YANG Lu;CUI Lin;ZHU Min;MENG Fan-tong;CAO Can;SUN Hao-hai(Department of Stomatology,The 79th Group Army Hospital of PLA,Liaoyang 111000,China;Department of Medical Service,The 79th Group Army Hospital of PLA,Liaoyang 111000,China;Department of Stomatology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]陆军第79集团军医院口腔科,辽宁辽阳111000 [2]陆军第79集团军医院卫勤处,辽宁辽阳111000 [3]北部战区总医院口腔内科,辽宁沈阳110016

出　　处：《临床军医杂志》2025年第3期256-261,共6页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金面上项目(2022-MS-043);北部战区总医院自主科研面上项目(ZZKY2024053)。

摘　　要：目的通过网状系统评价分析,比较不同拔牙后牙槽嵴位点保存材料对牙槽嵴宽度和高度变化的影响。方法系统检索PubMed、Cochrane Library、Embase、CNKI、万方和维普6个数据库,收集自2014年1月至2024年12月的相关文献。研究分为观察组和常规组,观察组干预措施为拔牙后植入矿化牛骨矿物质(DBBM)、DBBM+富血小板纤维蛋白(PRF)膜或DBBM+可吸收胶原膜(CM),常规组为拔牙后自然愈合(SH)。采用Stata 17软件进行网状系统评价分析,结局指标采用均数差(MD)及95%可信区间作为效应量进行分析。干预效果通过累计概率排名曲线下面积(SUCRA)值排序,通过比较校正漏斗图检测小样本效应。结果最终纳入了17篇符合标准的文献,涉及849例患者的861个拔牙窝。DBBM+CM组在牙槽嵴高度变化方面显著优于SH组(MD=-1.15,95%可信区间:-2.23~-0.06,P<0.05);SUCRA排序显示,牙槽嵴高度变化的效果从高到低依次为:DBBM+PRF组(71.7%)、DBBM+CM组(68.6%)、DBBM组(47.6%)、SH组(12.1%)。DBBM+PRF组(MD=2.03,95%可信区间:1.01~3.04)和DBBM+CM组(MD=1.77,95%可信区间:1.08~2.46)在牙槽嵴宽度变化方面显著优于SH组(P<0.05);SUCRA排序显示,牙槽嵴宽度变化的效果从高到低依次为:DBBM+PRF组(83.3%)、DBBM+CM组(64.9%)、DBBM组(49.6%)、和SH组(2.2%)。漏斗图的对称性表明小样本效应或发表偏倚的风险较低,进一步增强了研究结果的可靠性。结论不同干预材料在拔牙后牙槽嵴位点保存中的效果存在差异,DBBM+PRF在牙槽嵴高度和宽度变化方面优于DBBM+CM、DBBM和SH。Objective The effects of different materials on the width and height of alveolar ridge after tooth extraction were compared through mesh system evaluation.Methods Six databases including PubMed,Cochrane Library,Embase,CNKI,Wanfang and VIP were systematically searched to collect relevant literature from January 2014 to December 2024.The study was divided into observation group and conventional group.The intervention measures of observation group were implantation of deproteinized bovine bone mineral(DBBM),DBBM+platelet-rich fibrin(PRF)membrane or DBBM+absorbable collgan membrane(CM)after tooth extraction,and the conventional group was natural healing after tooth extraction(SH).Stata 17 software was used to evaluate the mesh system,and the outcome indicators were analyzed using mean difference(MD)and 95%confidence interval as effect sizes.Intervention effects were ranked by the cumulative probability ranking area under the curve(SUCRA)value,and small sample effects were detected by comparing corrected funnel plots.Results Finally,17 articles meeting the criteria were included,involving 861 extractions in 849 patients.DBBM+CM group was significantly better than SH group in terms of alveolar ridge height(MD=-1.15,95%confidence interval:-2.23 to-0.06,P<0.05),and SUCRA sequencing showed that the effect of alveolar ridge height change from high to low was as follows:DBBM+PRF group(71.7%),DBBM+CM group(68.6%),DBBM group(47.6%),SH group(12.1%).DBBM+PRF group(MD=2.03,95%confidence interval:1.01 to 3.04)and DBBM+CM group(MD=1.77,95%confidence interval:1.08 to 2.46)had significantly better changes in alveolar ridge width than SH group(P<0.05),and SUCRA sequencing showed that the effect of alveolar ridge width change from high to low was as follows:DBBM+PRF group(83.3%),DBBM+CM group(64.9%),DBBM group(49.6%),and SH group(2.2%).The symmetry of the funnel plot indicates a low risk of small sample effects or publication bias,further enhancing the reliability of the findings.Conclusion The effect of different intervention materia

关 键 词：拔牙 牙槽嵴位点保存 随机对照试验 网状系统评价 

分 类 号：R783[医药卫生—口腔医学]