Fedorowicz Zbys, Carter Ben, de Souza Raphael Freitas, Chaves Carolina de Andrade Lima, Nasser Mona, Sequeira-Byron Patrick
UKCC (Bahrain Branch), College of Medicine, AMA International University of Bahrain, Awali,
Cochrane Database Syst Rev. 2012 May 16(5):CD009109. doi: 10.1002/14651858.CD009109.pub2.
Endodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth which may influence long term survival and cost. The comparative in service clinical performance of crowns or conventional fillings used to restore root filled teeth is unclear.
To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials.
We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME and the reference lists of articles as well as ongoing trials registries.There were no restrictions regarding language or date of publication. Date of last search was 13 February 2012.
Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth which have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration, as well as indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any.
Two review authors independently assessed trial quality and extracted data.
One trial judged to be at high risk of bias due to missing outcome data, was included. 117 participants with a root filled premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. At 3 years there was no reported difference between the non-catastrophic failure rates in both groups. Decementation of the post and marginal gap formation occurred in a small number of teeth.
AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of conventional fillings over crowns for the restoration of root filled teeth. Until more evidence becomes available clinicians should continue to base decisions on how to restore root filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.
牙髓治疗包括去除牙髓并用根管充填物进行替代。由于活髓牙和无髓牙根管充填后的结构差异，对根管充填牙进行修复具有挑战性。直接修复是将修复材料（如汞合金或复合树脂）直接放置在牙齿中。间接修复包括铸造金属或陶瓷（瓷）冠。修复方式的选择取决于剩余牙体组织的量，这可能会影响长期存留率和成本。用于修复根管充填牙的冠修复或传统充填物在临床使用中的比较性能尚不清楚。
评估用冠修复与传统充填材料修复牙髓治疗后的牙齿（有无桩核）的效果。
我们检索了以下数据库：Cochrane口腔健康组试验注册库、CENTRAL、通过OVID检索的MEDLINE、通过OVID检索的EMBASE、通过EBSCO检索的CINAHL、通过BIREME检索的LILACS以及文章的参考文献列表和正在进行的试验注册库。对语言或出版日期没有限制。最后一次检索日期为2012年2月13日。
针对接受过牙髓治疗的恒牙参与者进行的随机对照试验（RCT）或半随机对照试验。单全冠修复与任何类型的直接修复充填材料以及间接部分修复（如嵌体和高嵌体）进行比较。比较时考虑所使用的桩核类型（铸造桩或预成桩）（如有）。
两位综述作者独立评估试验质量并提取数据。
纳入了一项因结局数据缺失而被判定存在高偏倚风险的试验。117名根管充填的前磨牙用碳纤维桩修复后，被随机分为全冠金属烤瓷修复组或直接粘结复合树脂修复组。3年后，两组间非灾难性失败率未见报道差异。少数牙齿出现桩松动和边缘间隙形成。
对于根管充填牙的修复，没有足够的证据支持或反驳传统充填物优于冠修复的有效性。在获得更多证据之前，临床医生应继续根据自身临床经验，同时考虑患者的个体情况和偏好，来决定如何修复根管充填牙。
