Johnson Riya Marie, Tewari Nitesh, Kumar Vijay, Rahul Morankar, Mathur Vijay Prakash, Bhawal Ujjal Kumar
Pediatric & Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
Dent Traumatol. 2023 Jun;39(3):264-275. doi: 10.1111/edt.12810. Epub 2022 Dec 2.
BACKGROUND/AIM: External inflammatory root resorption (EIRR) and external replacement root resorption (ERRR) are the most common adverse outcomes after luxation injuries or dental injuries. They are usually detected radiographically after considerable progression. It can be envisaged that evaluation of inflammatory mediators might serve as an objective and reliable method of predicting the risk of resorption. The aim of this systematic review was to assess the evidence regarding the risk of resorption and to provide future research directions.
An a priori protocol was prepared by a multidisciplinary expert group, as per the Cochrane handbook and PRISMA guidelines. The systematic search was conducted in six databases and grey-literature sources. Scrutiny of titles and abstracts, and later full-text articles was performed, and data were extracted. Risk of bias analysis was done by using the Joanna Briggs Institute's Critical Appraisal Checklist for analytical cross-sectional and cohort studies.
Eight studies were included in the systematic review and could be categorized as per the source of biomarkers, namely epithelial cells from mucosa, gingival crevicular fluid and extracted teeth. The studies utilizing epithelial cells had been conducted between 2015 and 2018 in Brazil and did not find any correlation with EIRR. Two of the studies with extracted teeth found differences in the immunologic profiles of teeth with resorption. Three studies evaluating gingival crevicular fluid found increased levels of dentine sialoprotein and Interleukin-1-α.
Among the three sources, the inflammatory gingival crevicular fluid appeared to be the most non-invasive source of biomarkers for predicting trauma-induced root resorption, although the evidence about this came from two studies with moderate and one study with high risk of bias. The primary studies in this systematic review showed variability in terms of the sample sizes, age of the patients, the grading/classification of trauma-induced resorption and the evaluation methods which must be addressed by future researchers.
背景/目的：外部炎性牙根吸收（EIRR）和外部替代性牙根吸收（ERRR）是牙齿脱位损伤或牙外伤后最常见的不良后果。它们通常在进展到相当程度后才能通过影像学检查发现。可以设想，评估炎症介质可能是预测吸收风险的一种客观可靠的方法。本系统评价的目的是评估关于吸收风险的证据，并提供未来的研究方向。
一个多学科专家组根据Cochrane手册和PRISMA指南制定了一个预先设定的方案。在六个数据库和灰色文献来源中进行了系统检索。对标题和摘要进行了审查，随后对全文进行了审查，并提取了数据。使用乔安娜·布里格斯研究所的分析性横断面和队列研究批判性评价清单进行了偏倚风险分析。
八项研究被纳入该系统评价，可根据生物标志物的来源进行分类，即来自黏膜的上皮细胞、龈沟液和拔除的牙齿。利用上皮细胞的研究于2015年至2018年在巴西进行，未发现与EIRR有任何相关性。两项关于拔除牙齿的研究发现有吸收的牙齿在免疫谱方面存在差异。三项评估龈沟液的研究发现牙本质涎蛋白和白细胞介素-1-α水平升高。
在这三种来源中，炎性龈沟液似乎是预测创伤性牙根吸收的生物标志物最无创的来源，尽管关于这方面的证据来自两项中等偏倚风险的研究和一项高偏倚风险的研究。本系统评价中的原始研究在样本量、患者年龄、创伤性吸收的分级/分类以及评估方法方面存在差异，未来的研究人员必须解决这些问题。
