Liu Yuan, Wu Long, Meng Fan-Qi, Hou Xin-Shan, Zhao Jin
Dept. of Stomatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
Dept. of Stomatology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;Xinjiang Oral Medical Research Institute, Urumqi 830054, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2018 Jun 1;36(3):301-307. doi: 10.7518/hxkq.2018.03.014.
This systematic review and Meta-analysis aimed to compare the efficacy of calcium sodium phos-phosilicate (CSPS) and potassium nitrate as desensitizing agents for the treatment of dentin hypersensitivity (DH).
A thorough search in The Cochrane Library, PubMed, Embase, Chinese WanFang Data, CBM, and CNKI were conducted for studies published up to June 2017. Randomized controlled trials (RCTs) of the treatment of DH with CSPS and potassium nitrate toothpaste were included. Quality assessment and data extraction were performed by two reviewers independently, and Meta-analysis was performed by using RevMan 5.3 software.
RESULTS: Eight RCTs involving 411 patients were included. Experimental group comprised 203 and control group had 208 patients. The Meta-analysis indicated the superior effect of CSPS dentifrice on air blast sensitivity at 2, 4, 6, and 8 weeks of follow-up [SMD=-1.85, 95%CI (-2.89, -0.81), P=0.000 5, I²=93%], [SMD=-1.61, 95%CI (-1.96, -1.26), P<0.000 01, I²=49%], [SMD=-3.79, 95%CI (-7.18, -0.40), P=0.03, I²=98%], and [SMD=-2.13, 95%CI (-2.69, -1.58), P<0.000 01] , respectively. No significant effects were seen at 12 weeks [SMD=-0.63, 95%CI (-1.47, 0.20), P=0.14, I²=71%]. CSPS dentifrice showed a better desensitizing effect at 2, 4, 6, 8, and 12 weeks of follow-up on cold water sensitivity [SMD=-1.07, 95%CI (-1.48, -0.66), P<0.000 01, I²=69%], [SMD= -1.29, 95%CI (-1.81, -0.76), P<0.000 01, I²=64%], [SMD=-1.20, 95%CI (-1.57, -0.83), P<0.000 01, I²=86%], [SMD=-1.30, 95%CI (-2.51, -0.08), P=0.04, I²=82%], and [SMD=-0.79, 95%CI (-1.27, -0.31), P=0.001], respectively. No significant effects at 1 week of follow-up [SMD=0.00, 95%CI (-0.62, 0.62), P=1]. The favorable effect of CSPS dentifrice on tactile sensitivity was more obvious than the control group at 2, 4, and 8 weeks of follow-up [SMD=-1.31, 95%CI (-2.00, -0.62), P=0.000 2, I²=67%], [SMD=-1.37, 95%CI (-1.74, -0.99), P<0.000 01, I²=23%], and [SMD=-1.33, 95%CI (-1.82,-0.84), P<0.000 01], respectively. No significant effects at 1 week of follow-up [SMD=-0.32, 95%CI (-0.94, 0.31), P=0.32] were observed.
Current evidence indicated that CSPS was more effective than potassium nitrate at reducing DH. The evidence generated by this review was based on a small number of individuals. High-quality and large sample size as well as ideally-designed clinical trials are required in the future before definitive recommendations can be made.
本系统评价和Meta分析旨在比较磷酸硅钙钠（CSPS）和硝酸钾作为脱敏剂治疗牙本质过敏症（DH）的疗效。
全面检索Cochrane图书馆、PubMed、Embase、中国万方数据、CBM和CNKI，纳入截至2017年6月发表的研究。纳入使用CSPS牙膏和硝酸钾牙膏治疗DH的随机对照试验（RCT）。由两名评价员独立进行质量评估和数据提取，并使用RevMan 5.3软件进行Meta分析。
纳入8项RCT，共411例患者。试验组203例，对照组208例。Meta分析表明，在随访2、4、6和8周时，CSPS牙膏对空气喷射敏感性的效果更佳[标准化均数差（SMD）=-1.85，95%可信区间（CI）（-2.89，-0.81），P=0.0005，I²=93%]，[SMD=-1.61，95%CI（-1.96，-1.26），P<0.00001，I²=49%]，[SMD=-3.79，95%CI（-7.18，-0.40），P=0.03，I²=98%]，以及[SMD=-2.13，95%CI（-2.69，-1.58），P<0.00001]。在12周时未见显著效果[SMD=-0.63，95%CI（-1.47，0.20），P=0.14，I²=71%]。在随访2、4、6、8和12周时，CSPS牙膏对冷水敏感性的脱敏效果更好[SMD=-1.07，95%CI（-1.48，-0.66），P<0.00001，I²=69%]，[SMD=-1.29，95%CI（-1.81，-0.76），P<0.00001，I²=64%]，[SMD=-1.20，95%CI（-1.57，-0.83），P<0.00001，I²=86%]，[SMD=-1.30，95%CI（-2.51，-0.08），P=0.04，I²=82%]，以及[SMD=-0.79，95%CI（-1.27，-0.31），P=0.001]。在随访1周时未见显著效果[SMD=0.00，95%CI（-0.62，0.62），P=1]。在随访2、4和8周时，CSPS牙膏对触觉敏感性的良好效果比对照组更明显[SMD=-1.31，95%CI（-2.00，-0.62），P=0.0002，I²=67%]，[SMD=-1.37，95%CI（-1.74，-0.99），P<0.00001，I²=23%]，以及[SMD=-1.33，95%CI（-1.82，-0.84），P<0.00001]。在随访1周时未见显著效果[SMD=-0.32，95%CI（-0.94，0.31），P=0.32]。
目前证据表明，在减轻牙本质过敏症方面，CSPS比硝酸钾更有效。本评价所产生的证据基于少数个体。未来需要高质量、大样本量以及设计理想的临床试验，才能做出明确的推荐。
