直接复合树脂与间接修复体用于根管治疗后磨牙的临床性能：一项系统评价与荟萃分析
Clinical performance of direct composite resin versus indirect restorations on endodontically treated posterior teeth: A systematic review and meta-analysis.
作者信息
de Kuijper Maurits C F M, Cune Marco S, Özcan Mutlu, Gresnigt Marco M M
机构信息
Graduate student, Department of Restorative Dentistry, The University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Groningen, the Netherlands; Dentist, Department of Special Dental Care, Martini Hospital, Groningen, the Netherlands.
Professor, Department of Restorative Dentistry, The University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Groningen, the Netherlands; Dentist, Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, St Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands; Dentist, Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, the Netherlands.
出版信息
J Prosthet Dent. 2023 Sep;130(3):295-306. doi: 10.1016/j.prosdent.2021.11.009. Epub 2021 Dec 31.
STATEMENT OF PROBLEM
High-level evidence concerning the restoration of endodontically treated posterior teeth by means of direct composite resin or indirect restorations is lacking.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the current literature on the direct and indirect restoration of endodontically treated posterior teeth.
MATERIAL AND METHODS
Databases MEDLINE, CENTRAL, and EMBASE were screened. Risk of bias was assessed by using the ROB2 tool for RCTs and the ROBINS-I tool for prospective and retrospective clinical studies. Randomized clinical trials (RCTs) and prospective and retrospective studies comparing direct composite resin and indirect restorations on endodontically treated posterior teeth were included. Outcomes were tooth and restoration survival. A meta-analysis was conducted for tooth retention and restorative success.
RESULTS
Twenty-two studies were included (2 RCTs, 3 prospective, and 17 retrospective). Over the short term (2.5 to 3 years), low-quality evidence suggested no difference in tooth survival. For the prospective and retrospective clinical trials, the overall risk of bias was serious to critical from the risk of confounding because of a difference in restorative indication: Direct restorations were fabricated when one marginal ridge remained or when tooth prognosis was unfavorable. For short-term restorative success, low-quality evidence suggested no difference between the direct and indirect restorations.
CONCLUSIONS
For the short term (2.5 to 3 years), low-quality evidence suggests no difference in tooth survival or restoration quality. To assess the influence of the type of restoration on the survival and restorative success of endodontically treated posterior teeth, clinical trials that control for the amount of coronal tooth tissue and other baseline characteristics are needed.
问题陈述
缺乏关于采用直接复合树脂或间接修复体修复经根管治疗的后牙的高级别证据。
目的
本系统评价和荟萃分析的目的是分析当前关于经根管治疗的后牙直接和间接修复的文献。
材料与方法
检索了MEDLINE、CENTRAL和EMBASE数据库。使用ROB2工具评估随机对照试验的偏倚风险，使用ROBINS-I工具评估前瞻性和回顾性临床研究的偏倚风险。纳入比较经根管治疗后牙直接复合树脂修复和间接修复的随机临床试验（RCT）以及前瞻性和回顾性研究。结局指标为牙齿和修复体的存留情况。对牙齿保留和修复成功进行荟萃分析。
结果
纳入22项研究（2项RCT、3项前瞻性研究和17项回顾性研究）。短期内（2.5至3年），低质量证据表明牙齿存留率无差异。对于前瞻性和回顾性临床试验，由于修复适应证的差异，总体偏倚风险因混杂因素风险而严重至极严重：当一个边缘嵴尚存或牙齿预后不佳时制作直接修复体。对于短期修复成功率，低质量证据表明直接修复和间接修复之间无差异。
结论
短期内（2.5至3年），低质量证据表明牙齿存留率或修复质量无差异。为评估修复类型对经根管治疗后牙存留率和修复成功率的影响，需要进行控制牙冠组织量和其他基线特征的临床试验。
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