氢氧化钙作为一种根管内封药用于一次性根管治疗术后疼痛的疗效评价：一项随机对照试验的系统评价和 Meta 分析，包含试验序贯分析。

Calcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials.

机构信息

Restorative Dentistry Department, College of Dentistry in Ar Rass, Qassim University, Ar Rass, Saudi Arabia; University of Oxford, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, UK.

University of Oxford, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Woodstock Road, Oxford, UK.

出版信息

J Evid Based Dent Pract. 2022 Mar;22(1):101680. doi: 10.1016/j.jebdp.2021.101680. Epub 2021 Dec 3.

DOI:10.1016/j.jebdp.2021.101680

PMID:35219466

Abstract

OBJECTIVE

To evaluate the effectiveness of CH as an intracanal medicament compared to no dressing and / or other intracanal medicaments to control postoperative pain in patients with apical periodontitis requiring primary root canal therapy.

MATERIALS AND METHODS

We conducted electronic searches in PubMed, EMBASE, Scopus and Cochrane Library, Open Gray, and Google Scholar. A structured Population-Intervention-Comparison-Outcome of the review was as follows: Population: adults who presented with apical periodontitis requiring primary root canal therapy; Intervention: CH intracanal medicament; Comparison: no dressing/other intracanal medicaments; Main Outcome: Postoperative pain. We assessed the risk of bias using Cochrane criteria. Our outcome measures were intensity of pain on a validated scale reported as mean and standard deviation. We performed meta-analysis using the random-effects model. We rated the quality of evidence using GRADE.

RESULTS

We included 18 studies with 1192 participants. The overall risk of bias was moderate. We found a significant improvement in postoperative pain at 24 hours in favor of CH over no intracanal medication (4 trials, n = 226: standardised mean difference: -0.71; [95% confidence interval: -1.38, -0.03]; P = .04; I= 78%; moderate certainty evidence). Ledermix (Lederle Germany) (steroid-antibiotic) and chlorhexidine were significantly more effective than CH for controlling pain at 72 hours postprocedure (low certainty evidence). Silver nanoparticles were more effective than CH at 6 and 24 hours and combinations of CH with dexamethasone or lidocaine HCl were significantly more effective than CH alone at improving postoperative pain. Substantial heterogeneity limits the robustness of findings.

CONCLUSION

Limited evidence suggests that CH may be an effective intracanal medicament for controlling interappointment pain. Combination therapies appear to be more effective than using CH alone. Further research assessing the comparative effectiveness of interventions for managing postoperative pain following root canal therapy is warranted.

摘要

目的

评估 CH 作为根管内药物在控制需要初次根管治疗的根尖周炎患者术后疼痛方面的有效性，与不封药和/或其他根管内药物相比。

材料和方法

我们在 PubMed、EMBASE、Scopus 和 Cochrane 图书馆、Open Gray 和 Google Scholar 进行了电子检索。综述的 PICO 如下：人群：患有根尖周炎需要初次根管治疗的成年人；干预措施：CH 根管内药物；比较：不封药/其他根管内药物；主要结局：术后疼痛。我们使用 Cochrane 标准评估偏倚风险。我们的结局测量指标是使用验证量表报告的疼痛强度，以平均值和标准差表示。我们使用随机效应模型进行荟萃分析。我们使用 GRADE 评估证据质量。

结果

我们纳入了 18 项研究，共 1192 名参与者。整体偏倚风险为中度。我们发现，与不使用根管内药物相比，CH 在 24 小时时术后疼痛明显改善（4 项试验，n=226：标准化均数差：-0.71；[95%置信区间：-1.38，-0.03]；P=0.04；I=78%；中等确定性证据）。Ledermix（Lederle Germany）（皮质类固醇-抗生素）和洗必泰在控制术后 72 小时疼痛方面明显优于 CH（低确定性证据）。纳米银比 CH 在 6 小时和 24 小时更有效，CH 与地塞米松或盐酸利多卡因的联合应用在改善术后疼痛方面明显优于 CH 单独应用。存在大量异质性，限制了结果的稳健性。