Cabanillas-Balsera Daniel, Segura-Egea Juan J, Bermudo-Fuenmayor María, Martín-González Jenifer, Jiménez-Sánchez María Carmen, Areal-Quecuty Victoria, Sánchez-Domínguez Benito, Montero-Miralles Paloma, Velasco-Ortega Eugenio
Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.
Materials Science Institute of Sevilla (ICMS), Joint CSIC-University of Sevilla Center, 41092 Sevilla, Spain.
J Clin Med. 2020 Oct 29;9(11):3506. doi: 10.3390/jcm9113506.
This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).
The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.
Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth-4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07-1.26; = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias.
Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.
本系统评价和荟萃分析旨在研究吸烟习惯与根管充填牙（RFT）中透射性根尖周病变（RPLs）患病率之间的关联。
人群、干预措施、对照和结局（PICO）问题为：在患有RFT的成年患者中，吸烟习惯的有无是否会影响与RFT相关的RPLs患病率？使用MEDLINE/PubMed、Wiley在线数据库、科学网、Scopus和PRISMA协议来评估和呈现结果。纳入比较吸烟者与非吸烟对照受试者（包括RFT）并提供RFT伴RPLs患病率数据的研究。使用推荐分级、评估、制定和评价（GRADE）系统来确定证据的确定性。根据Cochrane协作网的偏倚通用方案和ROBINS-I工具评估偏倚风险。采用随机效应模型进行累积荟萃分析。PROSPERO注册号：CRD42020165279。
四项研究报告了纳入标准的数据，代表来自9257颗根管充填牙的数据，其中4465颗来自非吸烟者，4792颗来自吸烟患者。荟萃分析得出的优势比表明吸烟与根管充填牙伴透射性根尖周病变的较高患病率之间存在显著关联（OR = 1.16；95%CI = 1.07 - 1.26；P = 0.0004）。根据GRADE，文献评估的确定性为中等。ROBINS-I工具将三项研究分类为低偏倚风险，第四项为中等偏倚风险。
中等质量的科学证据表明吸烟与RFT中RPLs的患病率之间存在微弱但显著的关系。吸烟可被视为根管治疗结局的不良预后因素。牙髓病治疗人员应意识到吸烟与RFT中被评估为RPLs的持续性根尖周炎之间的关系。
