Koletsi Despina, Iliadi Anna, Eliades Theodore, Eliades George
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland.
Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Materials (Basel). 2019 Oct 31;12(21):3575. doi: 10.3390/ma12213575.
Tooth wear may be described as a side-effect of occlusal forces that may be further induced by the common use of contemporary prosthetic materials in practice. The purpose of this systematic review was to appraise existing evidence on enamel wear from both in vitro and clinical research and explore whether evidence from these study designs lies on the same direction. Five databases of published and unpublished research were searched without limitations in August 2019 and study selection criteria included in vitro and clinical research on enamel tooth wear. Study selection, data extraction, and risk of bias assessment were done independently and in duplicate. Random effects meta-analyses of standardized mean differences (SMDs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were conducted while a Monte Carlo permutation test for meta-regression on the exploration of the effect of the study design on the reported outcomes was planned. A total of 27 studies (23 in vitro and 4 clinical) were eligible while 12 contributed to meta-analyses. Overall, some concerns were raised for the quality of the existing evidence and the potential for risk of bias. Enamel wear (mm) of antagonist teeth was more pronounced when opposed to conventional porcelain compared to machinable ceramics (SMD = 2.18; 95%CIs: 1.34, 3.02; < 0.001). Polished zirconia resulted in decreased volumetric enamel wear (mm) of opposing teeth compared to pure natural enamel (SMD = -1.06; 95%CIs: -1.73, -0.39; = 0.002). Monolithic zirconia showed evidence of enhanced potential for antagonist wear (μm) compared to natural teeth (WMD = 107.38; 95%CIs: 30.46, 184.30; = 0.01). Study design did not reveal an effect on the tooth wear outcome for the latter comparison when both clinical and in vitro studies were considered (three studies; Monte Carlo test, = 0.66). In conclusion, there is an overriding need for additional evidence from clinical research to substantiate the findings from the already existing laboratory simulation studies.
牙齿磨损可被描述为咬合力量的一种副作用，而在实际应用中，当代修复材料的普遍使用可能会进一步引发这种副作用。本系统评价的目的是评估来自体外研究和临床研究的关于牙釉质磨损的现有证据，并探究这些研究设计的证据是否指向同一方向。2019年8月，对五个已发表和未发表研究的数据库进行了无限制检索，研究选择标准包括关于牙釉质磨损的体外研究和临床研究。研究选择、数据提取和偏倚风险评估均独立进行且重复操作。进行了标准化均数差（SMD）或加权均数差（WMD）的随机效应Meta分析，并给出95%置信区间（CI），同时计划进行蒙特卡洛置换检验以进行Meta回归，探索研究设计对报告结果的影响。共有27项研究（23项体外研究和4项临床研究）符合条件，其中12项纳入Meta分析。总体而言，现有证据的质量以及偏倚风险受到了一些关注。与可加工陶瓷相比，当与传统陶瓷相对时，对颌牙的牙釉质磨损（mm）更为明显（SMD = 2.18；95%CI：1.34，3.02；P < 0.001）。与纯天然牙釉质相比，抛光氧化锆导致对颌牙的牙釉质体积磨损（mm）减少（SMD = -1.06；95%CI：-1.73，-0.39；P = 0.002）。与天然牙相比，整体氧化锆显示出对颌牙磨损（μm）潜力增强的证据（WMD = 107.38；95%CI：30.46，184.30；P = 0.01）。当同时考虑临床研究和体外研究时，对于后一种比较，研究设计并未显示出对牙齿磨损结果的影响（三项研究；蒙特卡洛检验，P = 0.66）。总之，迫切需要来自临床研究的更多证据来证实现有实验室模拟研究的结果。
