Iliadi Anna, Koletsi Despina, Eliades Theodore, Eliades George
Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland.
Materials (Basel). 2020 May 31;13(11):2513. doi: 10.3390/ma13112513.
Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330-400 μg/ml for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: -0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices' personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.
在牙科诊疗环境中，复合树脂粉尘的产生很可能是一个持续且日常的过程。本系统评价的目的是识别、汇编和评估现有证据，这些证据涉及与常规牙科操作过程中产生气溶胶化粉尘相关的干预措施和复合材料特性。于2020年4月27日对7个电子数据库进行了无限制检索，并辅以手工检索，以查找已发表和未发表的研究。纳入标准包括任何设计的研究，描述与牙科实践中任何操作的实施相关的复合树脂粉尘产生情况。研究选择、数据提取和偏倚风险（RoB）评估由两名独立人员重复进行，或由第二名审阅者进行确认。在适用的情况下，采用标准化均数差（SMD）及相关95%置信区间（CI）的随机效应荟萃分析。最初共识别出375篇文章，最终13篇文章纳入定性综合分析，其中5篇文章纳入总体荟萃分析。在大多数情况下，偏倚风险记录介于低和高之间，存在不明确/引发一些担忧的情况。所有类型的复合材料，无论填料颗粒如何，在研磨后都会释放大量纳米级颗粒，可能对呼吸道产生破坏性影响。有证据表明，与传统混合型Z100MP（SMD：1.96，95%CI：0.85，3.07；p值：0.001）和纳米混合型Tetric EvoCeram（SMD：1.62，95%CI：0.56，2.68；p值：0.003）相比，纳米复合树脂Filtek Supreme XTE中<100nm颗粒的百分比分布增加。考虑到所产生的气溶胶化颗粒的细胞毒性，纳米复合树脂Filtek Supreme XTE和纳米混合型GradiO对支气管上皮细胞活力均有负面影响，表现为在330 - 400μg/ml浓度下24小时的甲臜减少百分比，两者之间无记录差异（SMD：0.19；95%CI： - 0.17，0.55；p值：0.30）。在当代牙科实践中，应优先对可能产生大量气溶胶化复合树脂粉尘的牙科操作进行有效且更严格的管理。从本质上讲，还应系统地推广针对临床医生和诊所工作人员的防护措施，并根据现有证据考虑额外的干预措施。
