Department of Endodontics, New York University College of Dentistry, New York, New York, USA.
Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York, USA.
Int Endod J. 2022 Jul;55(7):714-731. doi: 10.1111/iej.13736. Epub 2022 May 4.
A comprehensive effort to evaluate outcomes of primary root canal therapy (RCT) between 1966 and 2002 was published by Ng et al. (2007, International Endodontic Journal, 40, 921; 2008, International Endodontic Journal, 41, 6). Changes in endodontic materials and treatment methods warrant an updated analysis of outcomes.
This study aimed to (1) quantify the success rates of primary RCT published between 2003 and 2020; and (2) investigate the influence of some characteristics known/suspected to be associated with treatment outcomes.
An electronic search was performed in the following databases (01-01-2003 to 12-31-2020): Pubmed, Embase, CINHAL, Cochrane and Web of Science. Included study designs were longitudinal clinical studies (randomized control trials, cohort studies, retrospective observational studies). Studies with at least twelve-months of post-operative review and success rates based on clinical and radiographic criteria were analysed. The terms 'strict' (complete resolution of periapical lesion) or 'loose' (reduction in size of existing periapical lesion) were used to describe the outcome criteria. Weighted, pooled success rates were calculated. Random effects meta-regression models were used to investigate potential sources of statistical heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate for quality assessment of the included studies.
Forty-two studies were included in the review. Meta-analyses showed that the weighted pooled success rates were estimated to be 92.6% (95% CI: 90.5%-94.8%) under 'loose criteria' and 82.0% (95% CI: 79.3%-84.8%) under 'strict' criteria. The most significant areas of study heterogeneity were year of publication and qualification of operator. The majority (64.29%) of studies were considered to be of low quality of evidence.
Biological factors continue to have the most significant impact on RCT outcomes. The technological method of instrumentation had no significant effect. The quality of evidence was based primarily on study design and only randomized control trials were considered to be 'high' quality of evidence.
The reported success rates show improvement over time. Weighted success rates for studies with a minimum of four-years follow-up had better outcomes, compared to those with less than four years, when 'strict criteria' were used.
PROSPERO database (CRD42021226311).
Ng 等人于 2007 年（国际牙髓学期刊，40，921；2008 年，国际牙髓学期刊，41，6）发表了一项综合评估 1966 年至 2002 年期间原发性根管治疗（RCT）结果的研究。根管治疗材料和治疗方法的变化需要对结果进行更新分析。
本研究旨在：（1）量化 2003 年至 2020 年期间发表的原发性 RCT 的成功率；（2）调查一些已知/怀疑与治疗结果相关的特征的影响。
在以下数据库中进行了电子搜索（2003 年 1 月 1 日至 2020 年 12 月 31 日）：Pubmed、Embase、CINHAL、Cochrane 和 Web of Science。纳入的研究设计为纵向临床研究（随机对照试验、队列研究、回顾性观察研究）。分析了至少有 12 个月术后复查和基于临床和放射学标准的成功率的研究。使用“严格”（根尖病变完全缓解）或“宽松”（现有根尖病变缩小）来描述结果标准。计算加权、汇总的成功率。使用随机效应荟萃回归模型来研究潜在的统计异质性来源。使用推荐评估、制定与评价（GRADE）方法对纳入研究进行质量评估。
综述共纳入 42 项研究。荟萃分析显示，在“宽松标准”下，加权汇总成功率估计为 92.6%（95%CI：90.5%-94.8%），在“严格标准”下为 82.0%（95%CI：79.3%-84.8%）。研究异质性最显著的领域是发表年份和操作人员的资格。大多数（64.29%）研究被认为证据质量低。
生物因素仍然对 RCT 结果有最显著的影响。器械的技术方法没有显著影响。证据质量主要基于研究设计，只有随机对照试验被认为是“高质量”证据。
报告的成功率随着时间的推移有所提高。在使用“严格标准”时，具有至少四年随访的研究的加权成功率优于随访时间少于四年的研究。
PROSPERO 数据库（CRD42021226311）。
