Báez Viviana, Corcos Lorena, Morgillo Florencia, Imperatrice Lorena, Gualtieri Ariel Félix
Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Endodoncia. Buenos Aires, Argentina.
Centro de Educación Médica e Investigaciones Clínicas CEMIC, Departamento de Odontología. Buenos Aires, Argentina.
J Oral Biol Craniofac Res. 2022 Jan-Feb;12(1):90-98. doi: 10.1016/j.jobcr.2021.11.005. Epub 2021 Nov 10.
The aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening.
Literature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed.
Dentin wall thickening was present in 66% (CI95: 58%-73%) of the cases treated with antibiotic paste, while when Ca(OH) was used, a percentage of 53% (CI95: 26%-78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%-73%) of the regenerative endodontic procedures, while when Ca(OH) was used, 88% (CI95: 80%-93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols.
There could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.
本研究旨在通过荟萃分析评估使用抗生素糊剂和氢氧化钙[Ca(OH)]的再生牙髓治疗与以下四个变量相关的可预测性：牙根牙本质壁增厚、根尖闭合、根尖修复和牙根延长。
在Pubmed - MEDLINE、Scopus和Lilacs - BVS平台上进行文献电子检索，使用适当的检索词、医学主题词（Mesh）、健康科学描述符（DeCS）和布尔运算符，纳入2009年至2020年发表的文章。共纳入32篇原始索引论文，总计758例再生牙髓治疗病例。进行描述性荟萃分析。
使用抗生素糊剂治疗的病例中，66%（95%置信区间：58% - 73%）出现牙本质壁增厚，而使用Ca(OH)时，这一比例为53%（95%置信区间：26% - 78%）。使用抗生素糊剂时，66%（95%置信区间：58% - 73%）的再生牙髓治疗程序实现了根尖闭合，而使用Ca(OH)时，88%（95%置信区间：80% - 93%）的病例实现了根尖闭合。两种消毒方案的牙根延长和根尖修复情况均令人满意。
两种治疗方法可能存在差异，因为使用抗生素糊剂时牙根牙本质壁增厚的比例更高，而使用氢氧化钙时根尖闭合的比例更高。需要开展更多临床研究以证实观察到的差异。所提出的方法可为牙髓病医生在规划再生牙髓治疗程序时提供有用的参考，从而指导决策，选择最佳的选择性治疗方法，并根据术前牙根发育阶段的影像学诊断选择合适的消毒方法，进而提高再生牙髓治疗的可预测性并降低牙根骨折的潜在风险。
