インプラントデジタルサージェリーガイドの臨床的正確さ。メタアナリシス

The clinical accuracy of the implant digital surgical guide: A meta-analysis.

抄録

目的:

デジタルガイドの臨床応用の精度を系統的に評価すること。

PURPOSE: To systematically evaluate the accuracy of clinical applications of digital guides.

方法:

まず、PubMedとEmbaseのデータベースをPICO基準で検索した。その結果，適格とされた論文が含まれた。次に、対象論文をタイプ別に分類した。次に、NOSとROB2を評価指標とし、対象論文の偏りを評価した。最後に、アウトカムから感受性の高い要因を除外し、データ解析を行った。

METHODS: First, PubMed and Embase databases were searched using the PICO standard. Eligible articles were included. Second, the eligible articles were classified according to the different types. Next, the NOS and ROB2 as evaluation indicators were used to evaluate the bias of those included articles. Finally, sensitive factors were excluded through the outcomes and data analyses were retrieved.

結果:

1,562 件以上の論文が検索され、主に冠状、頂端、角状インプラントデータの 3 つの側面を挙げた包含基準に従ってスクリーニングし、同種の論文を研究に統合した 38 件の in vivo 研究文書を系統的に解析した。その異質性を検証するため、分析に含めた論文のP値はすべて0.05未満であった。最後に，感受性の高い要因を除いたガイド群とフリーハンド群の比較では，角度の標準化平均差（Std.MD）は1.26（95% CI 1.06, 1.47），頂点のStd.MDは1.38（95% CI 1.12, 1.63），冠点のStd.MDは0.98（95% CI 0.66, 1.29）であり，ガイド群の方が，頂点の標準差が大きいことが示された．感受性の高い因子を除いた上顎群と下顎群の比較では，冠状点のStd.MDは-0.31（95％CI -0.52, -0.09），頂端点のStd.MDは-0.15（95％CI -0.34, 0.03），角部のStd.MDは-0.23（95%CI -0.46, 0.01）であった．喫煙群と非喫煙群、フラップ群とフラップレス群との比較では、信頼性の高い評価を行うには十分なエビデンスがないことが示された。

RESULTS: More than 1,562 articles were retrieved, and 38 in vivo research documents were systematically analyzed after screening according to the inclusion criteria, which mainly listed three aspects of the coronal, apical, and angular implant data, and integrated the same type of articles in the study. To test its heterogeneity, the P-values of those articles included in the analysis were all less than 0.05. Finally, in the comparison between the guide group and the free-hand group after excluding sensitive factors, the standardized mean difference (Std.MD) of the angle was 1.26 (95% CI 1.06, 1.47), the Std.MD of the apical point was 1.38 (95% CI 1.12, 1.63), and the Std.MD of the coronal point was 0.98 (95% CI 0.66, 1.29). Comparing the maxillary and mandibular groups after excluding sensitive factors, the Std.MD of the coronal point was -0.31 (95% CI -0.52, -0.09), the Std.MD of the apical point was -0.15 (95% CI -0.34, 0.03), and the Std.MD of the angle is -0.23 (95% CI -0.46, 0.01). Comparison between the smoking group and the nonsmoking group, and between the flap group and the flapless group showed that there was not enough evidence to make a reliable assessment.

臨床的意義:

フリーハンドオペレーションと比較して，デジタルガイドでは，歯根端，冠状点，角部の精度が高く，角部の精度は非常に高かった．上顎群と下顎群の精度の差は統計学的に有意ではなかった。喫煙習慣やフラップなどの他の要因については、より多くの臨床データが必要である。

CLINICAL SIGNIFICANCE: Compared with free-hand operation, a digital guide is more accurate in the apex, the coronal point and the angle, and the accuracy in the angle was very high. The difference in accuracy between the maxillary and mandibular groups was not statistically significant. Other factors such as smoking habit and flap need more clinical data.