Department of Endodontics, Faculty of Dentistry, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Clin Oral Investig. 2018 Sep;22(7):2475-2485. doi: 10.1007/s00784-018-2540-9. Epub 2018 Jun 27.
The purpose of this study was to systematically review and critically analyze the published data of in vitro studies testing the effect of root canal sealers on the fracture resistance of endodontically treated teeth.
A comprehensive literature search was performed by using the Medline, Scopus, Web of Science, Cochrane, and Open Grey databases. A hand search of the reference lists of identified articles was also performed. Two reviewers critically assessed the studies for eligibility against inclusion and exclusion criteria and performed data extraction. Evaluation of the risk of bias of the studies was performed.
A total of 48 studies were assessed for eligibility. Of these, 20 met the inclusion criteria and were included in the systematic review. All studies had a medium or high risk of bias. Although the majority of the studies reported that the use of root canal sealers increased the fracture resistance of endodontically treated teeth, conflicting evidence was found for the reinforcing effect of resin, glass ionomer, and calcium silicate-based sealers while there was moderate evidence for zinc oxide eugenol-based sealers in favor of no reinforcing effect.
On the basis of available evidence, the use of root canal sealer increases the fracture resistance of endodontically treated teeth. However, included studies presented considerable risk of bias. Regarding the comparisons among the sealers, no conclusions could be drawn for the superiority of one sealer type to another.
A considerable heterogeneity was found in the methodologies of included studies. Therefore, this review strongly suggests the development of standardized methods to test the reinforcement effect of root canal filling materials in in vitro studies.
本研究旨在系统回顾和批判性分析已发表的体外研究数据，这些研究测试了根管封闭剂对根管治疗后牙齿抗折能力的影响。
使用 Medline、Scopus、Web of Science、Cochrane 和 Open Grey 数据库进行全面的文献检索。还对手头已确定文章的参考文献进行了搜索。两名评审员根据纳入和排除标准对研究进行了严格评估，并进行了数据提取。对研究的偏倚风险进行了评估。
共评估了 48 项研究的资格。其中，20 项符合纳入标准并被纳入系统评价。所有研究均存在中高度偏倚风险。尽管大多数研究报告称根管封闭剂的使用增加了根管治疗后牙齿的抗折能力，但对于树脂、玻璃离子和硅酸钙基封闭剂的增强效果存在相互矛盾的证据，而对于氧化锌丁香酚基封闭剂则有中等证据支持无增强效果。
根据现有证据，根管封闭剂的使用增加了根管治疗后牙齿的抗折能力。然而，纳入的研究存在相当大的偏倚风险。关于封闭剂之间的比较，不能得出一种封闭剂类型优于另一种的结论。
纳入研究的方法学存在相当大的异质性。因此，本综述强烈建议制定标准化方法，以在体外研究中测试根管填充材料的增强效果。
