Part I: 統合分析比較再生膜導合併骨移植物引牙周再生對大臼齒二級牙根分岔治療效果之系統性回顧 Part II: 系統性回顧比較單純清創手術, 牙釉質基衍生物及再生膜導引手術對動物大臼齒三級牙根分岔之治療效果

Abstract

Aim: In the last two decades, several techniques have been proposed to achieve the goal of improving the prognosis of furcation involved teeth, such as open flap debridement, resective/inductive osseous surgery, guided tissue regeneration and growth factors combined into the surgeries. This study aim to systemic review the efficacy of guided tissue regeneration with membrane technique (with/without osseous grafting), enamel matrix derivative and open flap debridement along with meta-analysis to establish the evidences and guidelines in clinical therapy of periodontal furcation defects. Materials and methods: Randomized controlled clinical trials (RCTs) of at least 6 months’ follow up comparing open flap debridement (OFD), guided tissue regeneration with membrane technique (GTR), and combined approach of GTR and osseous grafting are searched from the data sources including electronic databases (the Cochrane Oral Health Group specialist trials register and MEDLINE and PubMed up to and including March 2012) and hand-searched journals. Through the question format “PICOS”, data from the including articles are extracted and processed for meta-analysis. The outcomes measure are furcation closure rate, vertical/ horizontal bone fill (re-entry) and vertical/horizontal attachment level gain. On the seconed part, animal studies were searched with regard to comparison of OFD, GTR, enamel matrix derivative (EMD), and GTR+EMD in treatment of class III furcation defects. After the PICOS procedure, the data were extract for meta-analysis. The outcomes measure are new bone formation and new cementum formation in percentage. Results: The meta-analysis showed that the GTR and GTR+OG groups achieved better clinical results than OFD group in all the outcome measurement (P < 0.001). The GTR+OG group obtained greater clinical benefits than GTR group (P < 0.001). The outcomes of animal studies systemic review showed that the heterogeneities among the included studies are too high to conduct a meta-analysis. Conclusion: According to this systemic review of RCTs, the GTR technique seemed to be more effective than OFD for resolving class II periodontal furcation defects, and the GTR+OG technique showed even better clinical results. The outcomes were better for mandibles molars than for maxillary molars. However, the data indicated that complete resolution of mandible furcation still did not occur consistently. In the second part, there were great heterogeneities among animal studies and meta-analysis was not possible. The outcomes of each study couldn’t show any successful resolution of furcation defects. Further comprehensive studies should be made to establish a more predictable therapy of class III furcation defects.