无瓣和有瓣植入对软组织的影响:系统回顾和 Meta 分析。

Yunyi Chen, Ciji Sun, Hong Li
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摘要

研究目的本研究旨在系统比较无瓣种植体和翻瓣种植体对牙科种植体周围软组织的影响:从 2013 年 1 月 1 日至 2023 年 8 月 27 日,检索了九个数据库,包括 PubMed、Embase、Cochrane Library、Web of Science、Clinical Trials、OpenGrey、OpenDoar、Scopus 和 Ovid。纳入的随机对照试验比较了无瓣种植和有瓣种植修复缺失牙的效果。使用 RevMan 5.3 和 Stata 14.0 对符合纳入标准的研究进行了 Meta 分析:结果:共检索到 1 245 篇文章,最终纳入 17 项研究。Meta 分析结果显示,与翻瓣种植相比,无瓣种植能更好地促进种植体周围软组织的愈合。此外,无瓣种植在种植成功率[平均差(MD)=1.06,95% 置信区间(CI)(1.02,1.10),P=0.004]、牙龈角化变化宽度[MD=0.10,95%CI(0.00,0.20),P=0.04],探诊深度[MD=-0.60,95%CI(-0.67,-0.53),PP=0.05]和改良龈沟出血指数[SMD=-0.44,95%CI(-0.78,-0.10),P=0.01]显示优于瓣膜种植。无瓣种植组的乳头存在指数高于翻瓣种植组。两组的牙菌斑指数和牙龈指数变化差异无统计学意义:结论:与翻瓣种植相比,无瓣种植能获得更高的种植成功率、更小的角化牙龈宽度变化和更小的探诊深度。在改良斑块指数、改良龈沟出血指数和乳头存在指数方面也有优势。
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Effects of flapless and flapped implantations on soft tissue: a systematic review and Meta-analysis.

Objectives: This study aimed to systematically compare the effects of flapless and flapped implantations on the surrounding soft tissues of dental implants.

Methods: Nine databases were searched, including PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, OpenGrey, OpenDoar, Scopus, and Ovid, from January 1, 2013, to August 27, 2023. Randomized controlled trials comparing flapless implantation with flapped implantation for restoration of missing teeth were included. Meta-analysis was conducted on studies that met the inclusion criteria by using RevMan 5.3 and Stata 14.0.

Results: A total of 1 245 articles were retrieved, and 17 studies were ultimately included. The results of Meta-analysis showed that flapless implantation resulted in better healing of the soft tissues around the dental implants than flapped implantation. Moreover, flapless implantation showed superior changes in implant success rate [mean difference (MD)=1.06, 95% confidence interval (CI) (1.02, 1.10), P=0.004], the width of keratinized gingival changes [MD=0.10, 95%CI (0.00, 0.20), P=0.04], and probing depth [MD=-0.60, 95%CI (-0.67, -0.53), P<0.000 01], with statistically significant differences. The final combined results of modified plaque index [standardized mean difference (SMD)=-0.41, 95%CI (-0.81, 0.00), P=0.05] and modified sulcus bleeding index [SMD=-0.44, 95%CI (-0.78, -0.10), P=0.01] showed superiority over flapped implantation. The papillary presence index was higher in the flapless implantation group than in the flapped implantation group. No statistically significant differences were observed in plaque index and gingival indices changes between the two groups.

Conclusions: Flapless implantation can achieve higher implant success rate, smaller changes in the width of keratinized gingival, and smaller probing depths than flapped implantation. It also has advantages in terms of modified plaque index, modified sulcus bleeding index, and papillary presence index.

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