通用粘结剂的应用模式是否会影响非龋性颈病变中复合树脂修复体的临床行为？系统评价和荟萃分析。
Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis.
机构信息
Department for Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Department for Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
出版信息
Dent Mater. 2021 Nov;37(11):e503-e521. doi: 10.1016/j.dental.2021.08.017. Epub 2021 Sep 2.
OBJECTIVE
To answer the following PICOS question: "Is the risk of retention loss, marginal discoloration, marginal adaptation and postoperative sensitivity (POS) equal for etch-and-rinse (EAR) compared to self-etch (SE) or selective-enamel etch (SEE) mode when restoring non carious cervical lesions (NCCLs) with universal adhesives?".
METHODS
PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google Scholar™ were searched. Randomized controlled clinical trials in which resin composites and universal adhesives were used for restoration of NCCLs were considered. Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analyses were performed using Revman; random-effects models were applied, and heterogeneity was tested using the I index. The significance level was set at p < 0.05. Certainty of evidence was assessed by GRADE tool.
RESULTS
After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis. Twelve studies ranked as "low", while 8 studies scored as "unclear" for risk of bias. At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups (p = 0.005; RR = 0.22, 95% CI [0.08, 0.63],[moderate certainty of evidence and p = 0.0002; RR = 0.32, 95% CI [0.17, 0.58], moderate certainty of evidence, respectively). No significant differences were observed for marginal discoloration and adaptation (p > 0.05). The probability of POS occurrence was less in SE than in EAR groups (RR = 2.12, 95% CI [1.23, 3.64], moderate certainty of evidence). The certainty of evidence for other outcomes was scored as "low" or "moderate", depending on the follow-up period.
SIGNIFICANCE
Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.
目的
回答以下 PICOS 问题：“在使用通用粘结剂修复非龋性颈壁缺损（NCCL）时，与自酸蚀（SE）或选择性釉质酸蚀（SEE）相比，蚀刻-冲洗（EAR）是否会导致滞留损失、边缘变色、边缘适合度和术后敏感（POS）的风险相等？”
方法
检索了 PubMed、Scopus、Web of Science、Cochrane 中央对照试验注册库、Scientific Electronic Library Online、LILACS、OpenGrey 和 Google Scholar™。纳入使用树脂复合材料和通用粘结剂修复 NCCL 的随机对照临床试验。使用 Cochrane 偏倚风险工具评估偏倚风险。使用 Revman 进行荟萃分析；应用随机效应模型，并使用 I 指数检验异质性。显著性水平设置为 p < 0.05。使用 GRADE 工具评估证据确定性。
结果
经过筛选，20 篇文章进行定性分析，14 篇文章进行定量综合分析。12 项研究的偏倚风险评为“低”，8 项研究评为“不清楚”。在 12 个月和 24 个月时，SE 组的滞留损失风险高于 EAR 组（p = 0.005；RR = 0.22，95%CI [0.08，0.63]，中等确定性证据；p = 0.0002；RR = 0.32，95%CI [0.17，0.58]，中等确定性证据）。边缘变色和适合度无显著差异（p > 0.05）。SE 组的 POS 发生率低于 EAR 组（RR = 2.12，95%CI [1.23，3.64]，中等确定性证据）。其他结局的证据确定性因随访时间而异，评为“低”或“中等”。
意义
在 EAR 或 SEE 模式下使用通用粘结剂可提供更可预测的保留效果，而 SE 策略可降低 POS 发生的风险。
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