Moreira Maria Stella, Anuar Anuar Sadat Neres-Santiago, Tedesco Tamara Kerber, Dos Santos Marcelo, Morimoto Susana
School of Dentistry, Ibirapuera University, São Paulo, São Paulo, Brazil.
School of Dentistry, Camilo Castelo Branco University, São Paulo, São Paulo, Brazil.
J Endod. 2017 Jun;43(6):864-870. doi: 10.1016/j.joen.2017.01.021. Epub 2017 Apr 27.
The effectiveness of endodontic treatment regarding the number of sessions to complete the therapy is still controversial. The aim of this study was to conduct an overview of published systematic reviews (SRs) comparing endodontic treatment in single and multiple visits.
A systematic search was performed in the electronic databases MEDLINE/PubMed and Cochrane Central Register of Controlled Trials until August 18, 2016, without language restriction. The eligibility criteria were as follows: (1) SRs and (2) a focus on endodontic techniques in single or multiple visits. The phases of eligibility and analysis of risk of bias were conducted by 2 or 3 independent and calibrated examiners, and a fourth examiner was consulted to resolve inconsistencies. Assessment of Multiple Systematic Reviews was used to evaluate the risk of bias of the included SRs, which were assessed according to the risk to develop knowledge and the existing knowledge gap.
The main characteristics including healing rates, success, and clinical complications during and after endodontic treatment were extracted from the SRs. From the 20 SRs initially identified, 8 were included in the analysis. Of these, 6 SRs showed low to moderate risk of bias and were suitable as strong clinical evidence on the topic.
Overall analysis indicated that single and multiple visits showed similar repair or success rates regardless of the precondition of the pulp and periapex. The apical periodontitis subgroup showed a slight positive trend toward a decreased incidence of postoperative complications and a higher effectiveness and efficiency for a single session. Based on the risk of bias, the current level of evidence for this clinical approach is high.
关于完成牙髓治疗所需就诊次数的牙髓治疗效果仍存在争议。本研究的目的是对已发表的比较单次就诊和多次就诊牙髓治疗的系统评价(SRs)进行综述。
在电子数据库MEDLINE/PubMed和Cochrane对照试验中央注册库中进行系统检索,直至2016年8月18日,无语言限制。纳入标准如下:(1)系统评价;(2)关注单次或多次就诊的牙髓治疗技术。由2名或3名独立且经过校准的审查员进行纳入标准和偏倚风险分析阶段,并咨询第四名审查员以解决不一致问题。使用多重系统评价评估法来评估纳入的系统评价的偏倚风险,根据发展知识的风险和现有的知识差距对其进行评估。
从系统评价中提取了牙髓治疗期间及之后的主要特征,包括愈合率、成功率和临床并发症。在最初识别的20篇系统评价中,8篇纳入分析。其中,6篇系统评价显示低至中度偏倚风险,适合作为该主题的有力临床证据。
总体分析表明,无论牙髓和根尖周的前提条件如何,单次就诊和多次就诊的修复率或成功率相似。根尖周炎亚组在术后并发症发生率降低方面呈轻微正向趋势,且单次就诊的有效性和效率更高。基于偏倚风险,这种临床方法目前的证据水平较高。