Wang Xiaodong, Shu Xin, Zhang Yingbin, Yang Bin, Jian Yutao, Zhao Ke
Quintessence Int. 2019;50(1):8-20. doi: 10.3290/j.qi.a41499.
This review was undertaken to answer a controversial clinical question with high-quality evidence: When severely damaged teeth are restored, which type of post (metal or fiber) demonstrates superior clinical performance?
The meta-analysis was conducted according to the guidelines in the Cochrane handbook. Electronic databases (MEDLINE, EMBASE, CENTRAL) and gray literatures were screened up to January 2018. Only randomized controlled trials (RCTs) with follow-up of at least 3 years were included. The quality of included studies was assessed by the Cochrane Collaboration's tool. Meta-analysis compared survival, success, post debonding, and root fracture incidence of teeth restored with fiber and metal posts. The GRADE system (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the strength of the evidence. Of 1,511 records, 14 full texts were obtained. Only four RCTs with follow-up times of 3 to 7 years met the selection criteria. The methodologic quality of included RCTs was low risk of bias. Fiber posts presented significantly higher survival rates than did metal posts (RR 0.57, 95% CI: 0.33 to 0.97, P = .04), while no difference was observed in success rates, post debonding rates, or root fracture rates. The GRADE assessment indicated a high quality of evidence for survival rates and a moderate quality for success rates.
It was concluded that fiber posts displayed higher medium-term (3 to 7 years) overall survival rates than did metal posts when used in the restoration of endodontically treated teeth with no more than two coronal walls remaining.
本综述旨在以高质量证据回答一个具有争议性的临床问题：当严重受损的牙齿进行修复时，哪种类型的桩（金属或纤维）表现出更优的临床性能？
根据Cochrane手册中的指南进行荟萃分析。检索了截至2018年1月的电子数据库（MEDLINE、EMBASE、CENTRAL）和灰色文献。仅纳入随访时间至少为3年的随机对照试验（RCT）。采用Cochrane协作网工具评估纳入研究的质量。荟萃分析比较了用纤维桩和金属桩修复牙齿的生存率、成功率、桩脱粘率和牙根骨折发生率。采用GRADE系统（推荐分级、评估、制定与评价）评估证据的强度。在1511条记录中，获取了14篇全文。只有4项随访时间为3至7年的RCT符合入选标准。纳入的RCT的方法学质量为低偏倚风险。纤维桩的生存率显著高于金属桩（RR 0.57，95%CI：0.33至0.97，P = 0.04），而在成功率、桩脱粘率或牙根骨折率方面未观察到差异。GRADE评估表明生存率的证据质量高，成功率的证据质量中等。
得出的结论是，当用于修复剩余不超过两个冠壁的根管治疗牙齿时，纤维桩在中期（3至7年）的总体生存率高于金属桩。
