McReynolds David, Duane Brett
Dublin Dental University Hospital, Dublin, Eire.
Evid Based Dent. 2016 Jun;17(2):50-1. doi: 10.1038/sj.ebd.6401170.
Data sourcesMedline, Cochrane Oral Health Groups Trials Register, Cochrane Central Register of Controlled Trials, Embase, CINAHL, LILACS.Study selectionThree authors independently assessed the abstracts of studies resulting from the above searches which compared indirect restorations of single endodontically treated teeth (ETT) to direct restoration of single ETT.Data extraction and synthesisTitles and abstracts of all reports identified through the electronic searches were assessed independently by two authors with any disagreements on eligibility resolved by a third reviewing author based on agreed upon inclusion and exclusion criteria. Study quality was assessed using the Cochrane risk of bias tool. Catastrophic failure of the restored tooth or restoration leading directly to extraction was the primary outcome measure. Secondary outcome measures included patient quality of life, incidence of recurring caries, periodontal health status and cost of the use of different interventions. Data analysis was carried out using the, 'treatment as allocated', patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI).ResultsOne trial which was judged to be at high risk of performance, detection and attrition bias was included. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes was judged to be very low. There was no evidence available for any secondary outcomes.ConclusionsInsufficient evidence exists to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.
数据来源
医学期刊数据库（Medline）、Cochrane口腔健康组试验注册库、Cochrane对照试验中央注册库、荷兰医学文摘数据库（Embase）、护理及健康照护领域数据库（CINAHL）、拉丁美洲及加勒比地区健康科学文献数据库（LILACS）。
研究选择
三位作者独立评估上述检索得到的研究摘要，这些研究比较了单颗经根管治疗牙齿（ETT）的间接修复与单颗ETT的直接修复。
数据提取与综合分析
通过电子检索确定的所有报告的标题和摘要由两位作者独立评估，对于纳入资格的任何分歧由第三位审阅作者根据商定的纳入和排除标准解决。使用Cochrane偏倚风险工具评估研究质量。修复牙齿或修复体的灾难性失败直接导致拔牙是主要结局指标。次要结局指标包括患者生活质量、继发龋发病率、牙周健康状况以及不同干预措施的使用成本。使用“按分配治疗”的患者群体进行数据分析，将二分数据的干预效果估计值表示为风险比，并给出95%置信区间（CI）。
结果
纳入了一项被判定在实施、检测和损耗偏倚方面风险较高的试验。在三年时，对于修复体的非灾难性失败（1/54对3/53；RR 为0.33；95%CI为0.04至3.05）或桩的失败（2/54对1/53；RR为1.96；95%CI为0.18至21.01），冠和复合树脂组与仅复合树脂组之间没有明显差异。这些结局的证据质量被判定为非常低。没有任何次要结局的可用证据。
结论
与传统充填相比，目前尚无足够证据评估冠修复对根管治疗后牙齿的效果。在获得更多证据之前，临床医生应继续根据自己的临床经验，并考虑患者的个体情况和偏好，做出关于如何修复根管治疗后牙齿的决策。
