從組織學及二次翻瓣的角度探討動物和人類以牙周組織引導再生術治療骨內缺損的效果: 系統性回顧和整合分析方法

Exploration of Treatment Effects of GTR on Infrabony Lesions in Animal and Human Studies from Histological and Re-entry aspects: Systematic Review and Meta-Analysis.

顏嘉珍(Chia-Chen Yen)

指導教授 ： 呂炫堃

臺北醫學大學/口腔醫學院/牙醫學系碩博士班/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00049

摘要

背景：
動物實驗與檢體，可以從生物科學的角度，促進我們對某些病因的了解，幫助人類醫療的提升。然而，直接比較動物和人類治療效果的文獻極少，特別是在牙周再生〈periodontal regeneration〉的領域，此外，從組織學〈histological〉及二次翻瓣〈re-entry〉的角度，探討牙周組織引導再生術〈guided tissue regeneration, GTR〉治療牙周骨內缺損〈infrabony lesions〉的效果，系統性回顧及整合分析的文獻依舊缺乏。

目的：
　　本系統性回顧的目的，針對牙周骨內缺損，比較以牙周組織引導再生術，合併或不合併骨粉，動物和人類治療的結果是否可相比擬？同時從組織學及二次翻瓣的角度，分別探討動物和人類治療的效果。

材料和方法：
　　我們使用PubMed電子資料庫，同時結合手動方式，搜尋了西元1960年1月1日，到西元2010年5月1日所有以英文發表的相關文獻。其中涵蓋的條件，主要針對牙周骨內缺損，使用任何種類的再生膜，合併或不合併骨粉材料的方式治療。所有文獻必須有組織學切片或術後二次翻瓣的實驗方法，同時有提及骨缺損初始深度〈initial defect depths〉，能評估骨癒合比率〈bone fill ratio〉或新牙骨質生成比率〈new cementum formation ratio〉，才予以引用。術後追蹤時間，動物實驗至少需4星期，而人類至少需6個月。我們使用整合分析方法〈meta-analysis〉，分別計算人類與動物各術式的骨癒合比率及動物的新牙骨質生成比率；人類組織學部份，則以描述性分析〈descriptive analysis〉的方式呈現。

結果：
從576篇篩選的文獻中，選出21篇〈9篇動物和12篇人類〉做文獻回顧。整合分析的結果顯示，在牙周組織引導再生術合併骨粉組，骨癒合比率的權重平均，動物實驗是52%〈95%信賴區間，18%, 85%〉，人類是58%〈29%, 86%〉，二者並無統計上的差異〈p= 0.790〉。在牙周組織引導再生術不合併骨粉組亦有類似的結果，骨癒合比率的權重平均，在動物與人類分別是54%〈37%, 72%〉與59%〈42%, 77%〉
〈p= 0.692〉。此外，人類二次翻瓣的文獻，可得牙周組織引導再生術合併或不合併骨粉有近似的骨癒合比率，但皆比控制組好。新牙骨質生成比率在動物實驗亦有如此的結果〈p< 0.05〉。無論是動物或人類實驗，以牙周組織引導再生術合併或不合併骨粉的方式治療，多半證實有牙周再生。

結論：
我們的分析顯示，(1)以牙周組織引導再生術合併或不合併骨粉的方式治療牙周骨內缺損，在動物及人類實驗，皆顯示相比擬的骨癒合比率。(2)無論從二次翻瓣的人類文獻，或動物的組織學分析，皆顯示牙周組織引導再生術合併或不合併骨粉有近似的效果，但皆比控制組好。

關鍵字

動物模型 ； 骨內缺損 ； 牙周組織引導再生術 ； 整合分析 ； 系統性回顧

並列摘要

Background:
Biopsies have contributed to our knowledge of the causes and remedies of human diseases in the biological sciences. However, few studies have directly compared dental treatments in humans and animals, especially in the field of periodontal regeneration. Besides, exploring treatment effects of guided tissue regeneration in periodontal infrabony lesions from histology and re-entry aspects by systematic review and meta-analysis are still lack.

Objective:
　　The main objective of this systematic review was to compare the effects of treating periodontal infrabony lesions using guided tissue regeneration (GTR) alone or GTR + bone grafts of animal and human studies, as well as explore the GTR efficacy of animals and humans respectively from histological and re-entry aspects.

Material and methods:
Publications in English were searched using PubMed database combined with hand searching from January 1, 1960 to May 1, 2010. The search included any type of barrier membrane with or without grafting materials for the treatment of periodontal infrabony lesions. All studies with histological or re-entry methodology outcome parameters evaluating bone filling and/or new cementum formation ratio from defect depths were adopted. Follow-up periods of at least 4 weeks in animals and 6 months in humans were required for inclusion. Meta-analysis was used to evaluate bone fill ratio in animals and humans respectively, and new cementum formation ratio in animals. Only descriptive analysis was performed in human histological data.

Results:
Of 576 retrieved studies, 21(9 animal and 12 human studies) were selected for the review. The meta-analysis showed that the weighted average bone fill ratio was 52% (95% confidence interval, [CI]: 18%, 85%) in animals and 58% (CI: 29%, 86%) in humans from GTR + bone graft groups, which was not statistically significant (p = 0.790). Similar results were found in GTR groups where the weighted average bone fill ratio was 54% (CI: 37%, 72%) and 59% (CI: 42%, 77%) in animals and humans, respectively (p = 0.692). Bone fill ratios of human re-entry studies and new cementum formation ratios of animal studies showed GTR and GTR+ bone grafts had comparable outcomes, but both were superior to the control group. Most studies demonstrated periodontal regeneration following GTR or GTR + bone graft approach.

Conclusion:
Our analysis indicated (1) bone fill ratios in animals were comparable to those in humans in infrabony defects treated using GTR alone or with additional bone grafts. (2) regardless of bone fill ratio in human re-entry studies or new cementum formation ratio in animals, comparable outcomes of GTR and GTR + bone grafts were showed, but both were superior to control group.

並列關鍵字

animal models ； infrabony lesions ； guided tissue regeneration ； meta-analysis ； systematic review

參考文獻

104. 陳美燕、季力康（1996）。統合分析在運動研究中之應用。中華體育，9（4），1-9。

109. 黃月嬋（1991）。精密分析在體育研究上之應應運。中華體育，5（1），49-57。

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