侵襲的な骨再建を回避するための隆起保存技術：システマティックレビューとメタアナリシス：ナポリコンセンサスレポートワーキンググループC

Ridge preservation techniques to avoid invasive bone reconstruction: A systematic review and meta-analysis: Naples Consensus Report Working Group C.

抄録

目的:

非手術抜歯窩の寸法変化を歯槽骨リッジ温存法（ARP）により分析・比較し、歯槽骨の吸収に影響する因子を調査すること。

PURPOSE: To analyse and compare the dimensional changes of unassisted extraction sockets with alveolar ridge preservation (ARP) techniques and investigate any factors that impact the resorption of the alveolar bone.

材料と方法:

無作為化臨床試験（RCT）を特定するために系統的検索を行った。All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area.

MATERIALS AND METHODS: A systematic search was conducted to identify randomised clinical trials (RCTs). All data were extracted, and a meta-analysis was performed for the changes in all buccolingual ridge width, midbuccal and midlingual ridge height, and mesial and distal ridge height, and horizontal width at reference points apical to the crestal area.

結果:

14件のRCTに基づき、抜歯後の歯槽窩の寸法を縮小するARPの有効性が確認された。この効果の臨床的な大きさは、頬舌側稜幅で1.95mm、頬舌側中間稜高で1.62mm、舌舌側中間稜高で1.26mmであった。さらに、顎堤の先端3mmと5mmの地点では、顎堤の高さが0.45mmと0.34mm、顎堤の幅が1.21mmと0.76mm変化した。メタ回帰分析により、ARP中のフラップの反射と一次創傷被覆は、骨再形成に有害な影響を及ぼす可能性があることが明らかになったが、いずれの骨移植代替物や臼歯部ソケットの割合にも統計的有意性は観察されなかった。

RESULTS: Based on 14 RCTs, the effectiveness of ARP in reducing the dimensions of the postextraction alveolar socket was confirmed. The clinical magnitude of this effect was 1.95 mm in the buccolingual ridge width, 1.62 mm in the midbuccal ridge height, and 1.26 mm on the midlingual ridge height. Additionally, 0.45 mm and 0.34 mm for mesial and distal ridge height, and 1.21 mm, and 0.76 mm for ridge width changes at points 3 and 5 mm apical to the crest were noted. Meta-regression analyses revealed that the reflection of flaps and primary wound coverage during ARP may have detrimental effects on bone remodelling, while no statistical significance was observed for any of the bone graft substitutes or the percentage of molar sockets.

結論:

プロトコールに関わらず、ARPは顎堤の吸収を最小化す るのみである。ARPは水平的な稜幅に最も効果的であり、冠状（顎堤に近接） に最も効果があり、次いで頬側中間部の稜高が効果的である。

CONCLUSIONS: Regardless of the protocol, ARP can only minimise ridge resorption. ARP is most effective on horizontal ridge width, providing the most benefit coronally (approximating the crest), followed by the midbuccal ridge height.