Growth and amelogenin-like factors in periodontal wound healing. A systematic review.
Growth and amelogenin-like factors in periodontal wound healing. A systematic review.
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DOI：
10.1902/annals.2003.8.1.193
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发表时间：
2003-12-01
期刊：
影响因子：
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通讯作者：
Somerman, Martha J
中科院分区：
文献类型：
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作者：
Giannobile, William V;Somerman, Martha J
背景：被牙周炎破坏的牙齿支持结构的再生是牙周治疗的主要目标。利用生长因子和牙釉蛋白样因子 (GAF) 的牙周组织工程应用材料科学和生物学的进步来再生牙槽骨、牙周膜和牙骨质。牙釉蛋白样因子（例如牙釉质基质衍生物 [EMD]）和生长因子（例如血小板衍生生长因子 [PDGF] 和骨形态发生蛋白 [BMP，也被认为是形态发生素]）已证明对刺激组织再生所需的几个关键事件（包括 DNA 合成、趋化性、分化和基质合成）具有多效作用。 理由：GAF 已用于治疗牙周病，如图所示临床前和临床研究。本系统综述评估了支持使用 EMD 和生长因子 (GF) 进行与天然牙齿相关的牙周修复和再生的证据。重点问题：在牙周骨缺损患者中，与对照组相比，GAF 对临床、放射学、组织学、不良和以患者为中心的结果有何影响？搜索方案：两名研究人员搜索了 MEDLINE、pre-MEDLINE 和 Cochrane 口腔健康小组以英文发表的临床和临床前研究试验注册。在《国际牙周病学和修复牙科杂志》、《临床牙周病学杂志》、《牙科研究杂志》、《牙周病学杂志》和《牙周病研究杂志》上进行了手工检索。对截至 2002 年 4 月发表的文章进行了检索。此外，研究人员联系了 GAF 产品的制造商，以获取相关未发表的数据和正在进行的研究。 选择标准：纳入标准：随机对照临床试验 (RCT)、队列研究、病例对照研究、病例报告和临床前（动物）随机对照研究，其中包括诊断患有牙周病并提供骨内/邻间缺陷数据的队列人群排除标准：不包括体外研究或不包括临床或骨测量方面的量化数据的研究。数据收集和分析：对满足以下连续变量资格标准的研究进行荟萃分析：临床附着水平（CAL）、探诊深度（PD）或骨水平（放射学、折返或组织学）。评估异质性以确定治疗方法之间的差异是否是由于系统混杂因素造成的（如研究质量评估中所述）。 主要结果： 1. 8 项研究（代表 7 项随机对照试验和 1 项准实验研究），代表总共 511 名受试者，对 EMD 进行了分析。 2. 其余大部分论文的证据评级较低。 3. 大多数报告是案例研究或案例系列，没有对照。 4. 没有足够的数据来对牙齿周围牙周修复中使用的生长因子的效果进行荟萃分析。 评审者的结论： 1. 有证据支持使用 EMD 治疗牙周骨缺损，以改善 CAL 并减少 PD，尽管长期效益尚未确定。 2. EMD 已证明所调查的研究在优于对照方面具有显着的一致性（总体上与开皮瓣清创术 [OFD] 相比）。 3. 就缺乏引发抗体反应或其他局部/全身炎症事件而言，EMD 对于单次和多次给药似乎是安全的。 4. 生长因子的临床前和初始临床数据似乎很有希望，但目前不足以得出明确的结论。
BACKGROUND: Regeneration of tooth-supporting structures destroyed by periodontitis is a major goal of periodontal therapy. Periodontal tissue engineering utilizing growth and amelogenin-like factors (GAFs) applies advances in materials science and biology to regenerate alveolar bone, periodontal ligament, and cementum. Amelogenin-like factors (e.g., enamel matrix derivative [EMD]) and growth factors (e.g., platelet-derived growth factor [PDGF] and bone morphogenetic proteins [BMPs, also considered morphogens]) have demonstrated pleotrophic effects on the stimulation of several key events required for tissue regeneration including DNA synthesis, chemotaxis, differentiation, and matrix synthesis.RATIONALE: GAFs have been used for the treatment of periodontal disease as shown in preclinical and clinical studies. This systematic review evaluates the evidence to support the utilization of EMD and growth factors (GFs) for periodontal repair and regeneration associated with natural teeth.FOCUSED QUESTION: In patients with periodontal osseous defects, what is the effect of GAFs compared with controls on clinical, radiographic, histologic, adverse, and patient-centered outcomes?SEARCH PROTOCOL: Two investigators searched MEDLINE, pre-MEDLINE, and the Cochrane Oral Health Group trials register for clinical and preclinical studies published in English. Hand searches were performed on the International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. In addition, investigators contacted manufacturers of GAF products for related unpublished data and studies in progress.SELECTION CRITERIA:INCLUSION CRITERIA: Randomized controlled clinical trials (RCTs), cohort studies, case-control studies, case reports, and preclinical (animal) randomized controlled investigations that included a cohort population diagnosed with periodontal disease and presenting data on intrabony/interproximal defects and/or furcation defects were screened.EXCLUSION CRITERIA: In vitro studies or those that did not include quantifiable data with respect to clinical or bone measures were not included.DATA COLLECTION AND ANALYSIS: Meta-analyses were performed for studies that fulfilled the eligibility criteria for the following continuous variables: clinical attachment level (CAL), probing depth (PD), or bone level (radiographic, re-entry, or histologic). Heterogeneity was assessed to determine whether the differences among therapies were due to systematic confounding factors (as noted in study quality assessments).MAIN RESULTS: 1. Eight studies, representing 7 RCTs and 1 quasi-experimental study, representing a total population of 511 subjects were analyzed with respect to EMD. 2. The majority of the remaining papers had a low evidence rating. 3. Most reports were case studies or case series without controls. 4. There were insufficient data to conduct a meta-analysis on the effect of growth factors used in periodontal repair around teeth.REVIEWERS' CONCLUSIONS: 1. There is evidence supporting the use of EMD for periodontal osseous defects to improve CAL and reduce PD, although long-term benefits have not been established. 2. EMD has demonstrated notable consistency among the studies investigated in terms of superiority to controls (in general compared to open flap debridement [OFD]). 3. EMD appears to be safe for single and multiple administrations in terms of lack of elicitation of antibody responses or other local/systemic inflammatory events. 4. Preclinical and initial clinical data for growth factors appear promising but are insufficient to draw definitive conclusions at this time.