自体血小板浓缩物对上颌窦底提升的临床效果影响：基于随机对照试验的Meta分析

doi:10.12337/zgkqzzxzz.2023.08.011

摘要/Abstract

摘要： 目的通过Meta分析方法系统评估在上颌窦底提升（maxillary sinus floor elevation,MSFE）中使用自体血小板浓缩物（autologous platelet concentrates,APC）的疗效。方法电子检索2000年1月1日至2022年9月30日PubMed、Embase、Web of Science、Cochrane Library、CNKI、万方数据库有关MSFE使用 APC的随机对照试验（randomized controlled trials,RCT）。使用Cochrane Tool评估RCT的偏倚风险,使用RevMan 5.4对数据进行合并分析。结果共纳入16篇 RCT。Meta分析结果显示,MSFE术后6个月,与上颌窦底单独放置骨增量材料相比,联合 APC的骨增量材料在上颌窦底新骨形成比例、促进材料吸收、提升上颌窦底高度、新骨密度上具有一定优势（P<0.05）,而在结缔组织比例、骨-材料接触率、垂直骨吸收、种植体稳定系数上均无统计学差异（P>0.05）;术后12个月,联合APC的骨增量材料较单独骨增量材料能获得更佳的窦底提升高度（P<0.05）,但后者表现出更稳定的垂直骨高度（P<0.05）。结论有限证据表明,在MSFE术后中短期随访,联合APC和骨增量材料可取得与骨增量材料移植相比更佳的新骨形成比例、窦底提升高度、新骨密度,且促进材料降解效果,但在结缔组织形成比例、骨-材料接触率、垂直骨吸收和种植体的稳定性上益处不大。仍需要进行更高同质性、更长随访时间的RCT评估APC在MSFE的中短期疗效。

关键词: 自体血小板, 生长因子, 上颌窦底提升, 骨增量, 随机对照试验, Meta分析

Abstract: Objective To systematically evaluate efficacy in the application of autologous platelet concentrates (APC) for maxillary sinus floor elevation (MSFE). Methods The databases of PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang from 1 January 2000 to 30 September 2022, were electronically searched to identify randomized controlled trials (RCTs) involving MSFE employing APC. The Cochrane Tool was employed to assess the risk of bias. Data were analyzed via RevMan 5.4 software. Results In total 16 RCTs were included. Meta-analyses showed that at 6 months after MSFE, APC presented significant advantages in the proportion of new bone formation, grafted materials absorption, vertical bone augmentation, and bone density except for the proportion of connective tissue, bone-to-bone graft contact rate, vertical bone resorption, and implant stability quotient; At 12 months after MFSE, employing APC mixed grafted materials resulted in a significantly better vertical sinus-bone height than employing bone grafted materials alone, but the latter presented a more stable vertical sinus-bone height. Conclusion Limited evidence implied that during a medium-short follow-up period, employing APC mixed bone grafted materials achieves better performance than sole bone grafted materials in terms of the proportion of new bone formation, sinus-bone height, bone density, and materials degradation, thus, no positive efficacy on the proportion of connective tissue, bone-to-bone graft contact rate and the stability of vertical sinus-bone resorption and implant. Further evidence from RCTs with higher homogeneity and longer follow-up period is needed to evaluate its superiority in MSFE.

Key words: Autologous platelet, Growth factors, Maxillary sinus floor elevation, Bone grafting, Randomized controlled trial, Meta-analysis

赵瑞敏,龚佳明,李健学,等. 自体血小板浓缩物对上颌窦底提升的临床效果影响：基于随机对照试验的Meta分析[J]. 中国口腔种植学杂志, 2023, 28(4): 270-278. DOI: 10.12337/zgkqzzxzz.2023.08.011

Zhao Ruimin, Gong Jiaming, Li Jianxue, Su Linhan. The autologous platelet concentrates for maxillary sinus floor elevation: a meta-analysis of randomized controlled trials[J].Chinese Journal of Oral Implantology, 2023, 28(4): 270-278.DOI: 10.12337/zgkqzzxzz.2023.08.011.

参考文献

[1] Khehra A, Levin L.Maxillary sinus augmentation procedures: a narrative clinical review[J]. Quintessence Int, 2020,51(7):578-584. DOI: 10.3290/j.qi.a44632.
[2] Demirkol M, Demirkol N.The effects of posterior alveolar bone height on the height of maxillary sinus septa[J]. Surg Radiol Anat, 2019,41(9):1003-1009. DOI: 10.1007/s00276-019-02271-2.
[3] Boyne PJ, James RA.Grafting of the maxillary sinus floor with autogenous marrow and bone[J]. J Oral Surg, 1980,38(8):613-616.
[4] Tatum H Jr.Maxillary and sinus implant reconstructions[J]. Dent Clin North Am, 1986,30(2):207-229.
[5] Stumbras A, Krukis MM, Januzis G, et al.Regenerative bone potential after sinus floor elevation using various bone graft materials: a systematic review[J]. Quintessence Int, 2019,50(7):548-558. DOI: 10.3290/j.qi.a42482.
[6] Trimmel B, Gede N, Hegyi P, et al.Relative performance of various biomaterials used for maxillary sinus augmentation: a bayesian network meta-analysis[J]. Clin Oral Implants Res, 2021,32(2):135-153. DOI: 10.1111/clr.13690.
[7] Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, et al.Complications in bone-grafting procedures: classification and management[J]. Periodontol 2000, 2022,88(1):86-102. DOI: 10.1111/prd.12413.
[8] Meng Y, Huang X, Wu M, et al.The effect of autologous platelet concentrates on maxillary sinus augmentation: a meta-analysis of randomized controlled trials and systematic review[J]. Biomed Res Int, 2020,2020(2):1-14. DOI: 10.1155/2020/7589072.
[9] Adalı E, Yüce MO, Günbay T, et al.Does concentrated growth factor used with allografts in maxillary sinus lifting have adjunctive benefits?[J]. J Oral Maxillofac Surg, 2021,79(1):98-108. DOI: 10.1016/j.joms.2020.07.217.
[10] Pichotano EC, de Molon RS, de Souza RV, et al. Evaluation of L-PRF combined with deproteinized bovine bone mineral for early implant placement after maxillary sinus augmentation: a randomized clinical trial[J]. Clin Implant Dent Relat Res, 2019,21(2):253-262. DOI: 10.1111/cid.12713.
[11] de Almeida Barros Mourão CF, Lourenço ES, Nascimento J, et al. Does the association of blood-derived growth factors to nanostructured carbonated hydroxyapatite contributes to the maxillary sinus floor elevation? A randomized clinical trial[J]. Clin Oral Investig, 2019,23(1):369-379. DOI: 10.1007/s00784-018-2445-7.
[12] Attia S, Narberhaus C, Schaaf H, et al.Long-term influence of platelet-rich plasma (PRP) on dental implants after maxillary augmentation: retrospective clinical and radiological outcomes of a randomized controlled clinical trial[J]. J Clin Med, 2020,9(2):355.DOI: 10.3390/jcm9020355.
[13] Trimmel B, Gyulai-Gaál S, Kivovics M, et al.Evaluation of the histomorphometric and micromorphometric performance of a serum albumin-coated bone allograft combined with A-PRF for early and conventional healing protocols after maxillary sinus augmentation: a randomized clinical trial[J]. Materials (Basel), 2021,14(7):1810.DOI: 10.3390/ma14071810.
[14] Taschieri S, Testori T, Corbella S, et al.Platelet-Rich plasma and deproteinized bovine bone matrix in maxillary sinus lift surgery: a split-mouth histomorphometric evaluation[J]. Implant Dent, 2015,24(5):592-597. DOI: 10.1097/ID.0000000000000293.
[15] Higgins JP, Altman DG, Gøtzsche PC, et al.The cochrane collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011,343:d5928. DOI: 10.1136/bmj.d5928.
[16] Bettega G, Brun JP, Boutonnat J, et al.Autologous platelet concentrates for bone graft enhancement in sinus lift procedure[J]. Transfusion, 2009,49(4):779-785. DOI: 10.1111/j.1537-2995.2008.02036.x.
[17] Kiliç SC, Güngörmüş M.Cone beam computed tomography assessment of maxillary sinus floor augmentation using beta-tricalcium phosphate alone or in combination with platelet-rich plasma: a randomized clinical trial[J]. Int J Oral Maxillofac Implants, 2016,31(6):1367-1375. DOI: 10.11607/jomi.5205.
[18] Cömert Kılıç S, Güngörmüş M, Parlak SN.Histologic and histomorphometric assessment of sinus-floor augmentation with beta-tricalcium phosphate alone or in combination with pure-platelet-rich plasma or platelet-rich fibrin: a randomized clinical trial[J]. Clin Implant Dent Relat Res, 2017,19(5):959-967. DOI: 10.1111/cid.12522.
[19] Consolo U, Zaffe D, Bertoldi C, et al.Platelet-rich plasma activity on maxillary sinus floor augmentation by autologous bone[J]. Clin Oral Implants Res, 2007,18(2):252-262. DOI: 10.1111/j.1600-0501.2006.01330.x.
[20] Khairy NM, Shendy EE, Askar NA, et al.Effect of platelet rich plasma on bone regeneration in maxillary sinus augmentation (randomized clinical trial)[J]. Int J Oral Maxillofac Surg, 2013,42(2):249-255. DOI: 10.1016/j.ijom.2012.09.009.
[21] Yilmaz S, Karaca EO, Ipci SD, et al.Radiographic and histologic evaluation of platelet-rich plasma and bovine-derived xenograft combination in bilateral sinus augmentation procedure[J]. Platelets, 2013,24(4):308-315. DOI: 10.3109/09537104.2012.695033.
[22] Ali H a A, Thair A L H, Heba Basim M. Evaluation of implant stability following sinus augmentation utilizing bovine bone mixed with platelet-rich fibrin[J]. Indian Journal of Forensic Medicine & Toxicology, 2021, 15(4): 390-399.DOI:10.37506/ijfmt.v15i4.16734
[23] Cinar IC, Gultekin BA, Saglanmak A, et al.Histologic, histomorphometric, and clinical analysis of the effects of growth factors in a fibrin network used in maxillary sinus augmentation[J]. Int J Environ Res Public Health, 2020,17(6):1918.DOI: 10.3390/ijerph17061918.
[24] Meimandi M, Moghaddam A A, Gholami G A, et al.Histomorphometric and histologic evaluation of nano-HA with and without PRGF in bilateral sinus lift augmentation: a randomized clinical trial[J]. J of Rese in Medi and Dent Sci, 2017, 5: 69-81.DOI: 10.24896/jrmds. 20175312
[25] Nizam N, Eren G, Akcalı A, et al.Maxillary sinus augmentation with leukocyte and platelet-rich fibrin and deproteinized bovine bone mineral: a split-mouth histological and histomorphometric study[J]. Clin Oral Implants Res, 2018,29(1):67-75. DOI: 10.1111/clr.13044.
[26] Zhang Y, Tangl S, Huber CD, et al.Effects of Choukroun's platelet-rich fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: a histological and histomorphometric study[J]. J Craniomaxillofac Surg, 2012,40(4):321-328. DOI: 10.1016/j.jcms.2011.04.020.
[27] 谢慧, 解永富, 刘勤, 等. 注射型富血小板纤维蛋白在上颌窦外提升术中的应用效果[J].上海口腔医学, 2019, 28(1):71-75. DOI: 10.19439/j.sjos.2019.01.014.
[28] 张建全, 高丽荣, 王毅军, 等. 注射型富血小板纤维蛋白在上颌提升术中的应用效果[J].实用医药杂志, 2020,37(9):831-833,836. DOI: 10.14172/j.issn1671-4008. 2020.09.019.
[29] 程扬, 刘敏. 浓缩生长因子在上颌窦侧壁开窗窦底提升即刻种植中的成骨效果:单中心、随机对照临床试验方案[J].中国组织工程研究,2017,21(4):574-579. DOI: 10.3969/j.issn.2095-4344.2017.04.014.
[30] 杜玉叶. 不同材料在上颌窦底内提升术中行同期种植的临床观察[D]. 广西百色:右江民族医学院, 2020.
[31] 申龙朵, 林炬, 李平, 等. 浓缩生长因子联合Bio-Oss骨粉在经牙槽嵴顶上颌窦提升术后种植中的应用[J].海南医学,2018,29(2):253-255. DOI: 10.3969/j.issn.1003-6350. 2018.02.033.
[32] Suárez-López Del Amo F, Monje A. Efficacy of biologics for alveolar ridge preservation/reconstruction and implant site development: an American Academy of Periodontology best evidence systematic review[J]. J Periodontol, 2022,93(12):1827-1847. DOI: 10.1002/JPER.22-0069.
[33] Bae JH, Kim YK, Myung SK.Effects of platelet-rich plasma on sinus bone graft: meta-analysis[J]. J Periodontol, 2011,82(5):660-667. DOI: 10.1902/jop.2010.100529.
[34] Kassolis JD, Reynolds MA.Evaluation of the adjunctive benefits of platelet-rich plasma in subantral sinus augmentation[J]. J Craniofac Surg, 2005,16(2):280-287. DOI: 10.1097/00001665-200503000-00015.
[35] Fennis JP, Stoelinga PJ, Jansen JA.Mandibular reconstruction: a histological and histomorphometric study on the use of autogenous scaffolds, particulate cortico-cancellous bone grafts and platelet rich plasma in goats[J]. Int J Oral Maxillofac Surg, 2004,33(1):48-55. DOI: 10.1054/ijom.2003.0452.
[36] Kim TH, Kim SH, Sándor GK, et al.Comparison of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) in rabbit-skull defect healing[J]. Arch Oral Biol, 2014,59(5):550-558. DOI: 10.1016/j.archoralbio.2014.02.004.
[37] Thor A, Franke-Stenport V, Johansson CB, et al.Early bone formation in human bone grafts treated with platelet-rich plasma: preliminary histomorphometric results[J]. Int J Oral Maxillofac Surg, 2007,36(12):1164-1171. DOI: 10.1016/j.ijom.2007.05.023.
[38] Weibrich G, Hansen T, Kleis W, et al.Effect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration[J]. Bone, 2004,34(4):665-671. DOI: 10.1016/j.bone.2003.12.010.
[39] Wang X, Zhang Y, Choukroun J, et al.Behavior of gingival fibroblasts on titanium implant surfaces in combination with either injectable-PRF or PRP[J]. Int J Mol Sci, 2017,18(2):331.DOI: 10.3390/ijms18020331.
[40] Dohan Ehrenfest DM, Pinto NR, Pereda A, et al.The impact of the centrifuge characteristics and centrifugation protocols on the cells, growth factors, and fibrin architecture of a leukocyte- and platelet-rich fibrin (L-PRF) clot and membrane[J]. Platelets, 2018,29(2):171-184. DOI: 10.1080/09537104.2017.1293812.
[41] Neiva RF, Gil LF, Tovar N, et al.The synergistic effect of leukocyte platelet-pich fibrin and micrometer/nanometer surface texturing on bone healing around immediately placed implants: an experimental study in dogs[J]. Biomed Res Int, 2016,2016(25):1-9. DOI: 10.1155/2016/9507342.
[42] Galindo-Moreno P, de Buitrago JG, Padial-Molina M, et al. Histopathological comparison of healing after maxillary sinus augmentation using xenograft mixed with autogenous bone versus allograft mixed with autogenous bone[J]. Clin Oral Implants Res, 2018,29(2):192-201. DOI: 10.1111/clr.13098.
[43] Alayan J, Ivanovski S.A prospective controlled trial comparing xenograft/autogenous bone and collagen-stabilized xenograft for maxillary sinus augmentation-Complications, patient-reported outcomes and volumetric analysis[J]. Clin Oral Implants Res, 2018,29(2):248-262. DOI: 10.1111/clr.13107.
[44] Ortega-Mejia H, Estrugo-Devesa A, Saka-Herrán C, et al.Platelet-rich plasma in maxillary sinus augmentation: systematic review[J]. Materials (Basel), 2020,13(3):622.DOI: 10.3390/ma13030622.
[45] Liu R, Yan M, Chen S, et al.Effectiveness of platelet-rich fibrin as an adjunctive material to bone graft in maxillary sinus augmentation: a meta-analysis of randomized controlled trails[J]. Biomed Res Int, 2019,2019(4):1-10. DOI: 10.1155/2019/7267062.
[46] 包明哲, 刘伟, 余树容, 等. 富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析[J].华西口腔医学杂志, 2021,39(5):605-611. DOI: 10.7518/hxkq. 2021. 05.017.
[47] Perini A, Viña-Almunia J, Carda C, et al.Influence of the use of a collagen membrane placed on the bone window after sinus floor augmentation-an experimental study in rabbits[J]. Dent J (Basel), 2021,9(11): 131.DOI: 10.3390/dj9110131.
[48] Soni R, Priya A, Yadav H, et al.Bone augmentation with sticky bone and platelet-rich fibrin by ridge-split technique and nasal floor engagement for immediate loading of dental implant after extracting impacted canine[J]. Natl J Maxillofac Surg, 2019, 10(1): 98-101.DOI: 10.4103/ njms. NJMS_37_18
[49] Mu Z, He Q, Xin L, et al.Effects of injectable platelet rich fibrin on bone remodeling in combination with DBBM in maxillary sinus elevation: a randomized preclinical study[J]. Am J Transl Res, 2020,12(11):7312-7325.
[50] H H, G W, E H.The clinical significance of implant stability quotient (ISQ) measurements: a literature review[J]. J Oral Biol Craniofac Res, 2020,10(4):629-638. DOI: 10.1016/j.jobcr.2020.07.004.
[51] Jepsen S, Schwarz F, Cordaro L, et al.Regeneration of alveolar ridge defects. Consensus report of group 4 of the 15th European Workshop on Periodontology on bone regeneration[J]. J Clin Periodontol, 2019,46(Suppl 21):277-286. DOI: 10.1111/jcpe.13121.
[52] Pjetursson BE, Tan WC, Zwahlen M, et al.A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation[J]. J Clin Periodontol, 2008,35(8 Suppl):216-240. DOI: 10.1111/j.1600-051X.2008.01272.x.
[53] Sanz M, Dahlin C, Apatzidou D, et al.Biomaterials and regenerative technologies used in bone regeneration in the craniomaxillofacial region: consensus report of group 2 of the 15th European Workshop on Periodontology on bone regeneration[J]. J Clin Periodontol, 2019,46(Suppl 21):82-91. DOI: 10.1111/jcpe.13123.