Hinckfuss Susan Elisabeth, Messer Louise Brearley
Paediatric Dentistry, School of Dental Science, University of Melbourne, Melbourne, Australia.
Dent Traumatol. 2009 Feb;25(1):32-42. doi: 10.1111/j.1600-9657.2008.00727.x.
Clinical guidelines for the management of avulsed teeth recommend pulp extirpation (PE) within 10 to 14 days of replantation. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO Question: (P) For a replanted avulsed permanent tooth, (I) is early PE within 10 to 14 days of replantation, (C) compared with delayed pulp extirpation, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation?
A literature search was performed across four internet databases for relevant citations (n = 38,400). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14,729) which were sieved. Relevant titles were selected for abstract assessment (n = 628), and then papers were selected for examination (n = 84). Inclusion criteria were applied and six papers (total 236 teeth) met the final criteria for meta-analysis.
Meta-analyses found a statistically significant association between PE performed after 14 days and the development of inflammatory resorption [common odds ratio (COR) = 0.37, standard error (se) = 0.50, 95% confidence interval (CI): 0.14-0.98]. Pulp extirpation within 10 days of replantation was not significantly associated with a decreased likelihood of developing inflammatory resorption. There were no statistically significant differences in PE times for functional healing, acceptable healing without progressive resorption, or the development of replacement resorption.
There is clinical evidence for an association between PE performed after 14 days following replantation and the development of inflammatory resorption. This investigation supports the current clinical guidelines for PE within 10 to 14 days of replantation.
脱位牙处理的临床指南推荐在再植后10至14天内进行牙髓摘除术（PE）。循证牙科原则可用于根据现有证据评估这是否为最佳方法。本研究的目的是运用循证牙科原则回答PICO问题：（P）对于再植的脱位恒牙，（I）在再植后10至14天内进行早期PE，（C）与延迟牙髓摘除术相比，（O）是否与牙齿再植后牙周成功愈合的可能性增加相关？
在四个互联网数据库中进行文献检索以获取相关引文（n = 38,400）。将引文限制为英文并去除重复项后得到一组标题（n = 14,729），对其进行筛选。选择相关标题进行摘要评估（n = 628），然后选择论文进行审查（n = 84）。应用纳入标准，六篇论文（共236颗牙齿）符合荟萃分析的最终标准。
荟萃分析发现，14天后进行的PE与炎性吸收的发生之间存在统计学上的显著关联[共同比值比（COR）= 0.37，标准误差（se）= 0.50，95%置信区间（CI）：0.14 - 0.98]。再植后10天内进行牙髓摘除术与炎性吸收发生可能性降低无显著关联。在功能愈合、无进行性吸收的可接受愈合或替代性吸收的发生方面，PE时间无统计学上的显著差异。
有临床证据表明再植后14天进行的PE与炎性吸收的发生之间存在关联。本研究支持目前再植后10至14天内进行PE的临床指南。
