Veitz-Keenan Analia, Keenan James R
NYU College of Dentistry, New York, USA.
Evid Based Dent. 2015 Mar;16(1):29. doi: 10.1038/sj.ebd.6401085.
The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched with no language or date restrictions.
Three reviewers independently selected studies. Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury were considered.
Standard Cochrane methodological procedures were followed.
Two studies considered at high risk of bias, reporting data from 26 analysed patients were included. Both studies investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury. Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating, speaking or taste. No studies reported on quality of life or adverse events.
There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.
检索了Cochrane口腔健康小组试验注册库、Cochrane对照试验中央注册库（CENTRAL）、Medline和Embase数据库，无语言或日期限制。
三名评审员独立选择研究。纳入了涉及干预治疗因医源性损伤后遗症导致下牙槽神经或舌神经或两者神经感觉缺陷患者的随机对照试验（RCT）。
遵循Cochrane标准方法程序。
两项被认为存在高偏倚风险的研究纳入其中，报告了26例分析患者的数据。两项研究均调查了与安慰剂激光治疗相比，低强度激光治疗对医源性损伤导致的下牙槽感觉缺陷的有效性。两项被评估为存在高偏倚风险的研究纳入了本综述，报告了26例分析参与者的数据。参与者年龄范围为17至55岁。两项试验均调查了与安慰剂激光治疗相比，低强度激光治疗对医源性损伤导致的下牙槽感觉缺陷的有效性。一项研究部分报告了患者报告的感觉改变，另一项则完整报告了。激光治疗后，与安慰剂相比，有一些证据表明唇部和下巴区域神经感觉缺陷的主观评估有所改善，尽管估计值不精确：下巴神经感觉缺陷平均变化差异为8.40 cm（95%置信区间（CI）3.67至13.13），唇部神经感觉缺陷平均变化差异为21.79 cm（95%CI 5.29至38.29）。该结果的证据总体质量非常低。没有研究报告该干预对疼痛、进食困难、说话或味觉等其余主要结局的影响。没有研究报告生活质量或不良事件。
显然需要进行随机对照临床试验，以研究手术、药物和心理干预对医源性下牙槽神经和舌神经损伤的有效性。该研究的主要结局应包括：以患者为中心的发病率指标，包括感觉改变和疼痛、疼痛、定量感觉测试以及延迟治疗的影响。
