Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India.
Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, 110029, India.
Clin Oral Investig. 2023 Nov;27(11):6371-6382. doi: 10.1007/s00784-023-05286-7. Epub 2023 Oct 14.
The purpose of this review is to determine the effectiveness of intracanal medicament (ICM) on periodontal and periapical healing (PH) of concurrent endodontic-periodontal lesions with/without communication in permanent teeth.
The pre-defined protocol was registered in PROSPERO, and a literature search using keywords was conducted on PubMed, Scopus, Cochrane, Embase electronic databases, and Gray literature and was hand-searched until August 2023. Two reviewers independently screened the title and abstracts using the inclusion criteria. Randomized or non-randomized clinical trials, cohort studies, and case-control studies were included in the review. The same reviewers extracted the study-level data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 and the Newcastle-Ottawa Scale (NOS) independently. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence. Random effects meta-analysis was performed on eligible studies using Revman software.
A total of 598 records were identified from the database search; seven studies met the inclusion criteria and were included in the review. Four randomized clinical trials, two prospective cohorts, and one retrospective case-control study with 362 patients were included. Calcium hydroxide (CH) was the most commonly used ICM, followed by using chlorhexidine gel in four studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies, along with open flap debridement (OFD) in three randomized clinical trials. The time lapse between two treatment protocols was variable (ranging from 1 week to 3 months). All studies exhibited a decrease in probing depth (PD) and an increase in clinical attachment level (CAL) after the treatment. Meta-analysis showed insignificant differences between different ICM materials, and the certainty of evidence was low.
In patients with/without concurrent endodontic-periodontal lesions, intracanal medication improved clinical periodontal parameters following endodontic therapy. In terms of influence on periapical healing, the results were inconclusive.
Two-visit RCT may be considered since it allows for the placement of an ICM in endodontic-periodontal lesions with/without communication. Sufficient time should be allowed after endodontic therapy for any potential periodontal regeneration to occur.
本综述旨在确定在伴有/不伴有交通的牙髓牙周联合病变的恒牙中，根管内药物（ICM）对牙周和根尖愈合（PH）的疗效。
本预定义方案已在 PROSPERO 中注册，并使用关键词在 PubMed、Scopus、Cochrane、Embase 电子数据库以及灰色文献中进行了文献检索，检索截至 2023 年 8 月。两名审查员使用纳入标准独立筛选标题和摘要。本综述纳入了随机或非随机临床试验、队列研究和病例对照研究。两位审查员独立提取研究水平数据，并使用 Cochrane 偏倚风险 2.0 工具和纽卡斯尔-渥太华量表（NOS）独立评估偏倚风险。使用推荐、评估、制定和评价（GRADE）方法评估证据的确定性。使用 Revman 软件对符合条件的研究进行随机效应荟萃分析。
从数据库检索中共确定了 598 条记录；有 7 项研究符合纳入标准并被纳入本综述。纳入的研究包括 4 项随机临床试验、2 项前瞻性队列研究和 1 项回顾性病例对照研究，共 362 名患者。氢氧化钙（CH）是最常用的 ICM，其次是 4 项研究中使用的洗必泰凝胶。所有研究均在牙周治疗的初始阶段进行了牙周刮治和根面平整（SRP），其中 3 项随机临床试验还进行了翻开瓣清创术（OFD）。两种治疗方案之间的时间间隔不同（从 1 周到 3 个月不等）。所有研究在治疗后均显示出探诊深度（PD）的降低和临床附着水平（CAL）的增加。荟萃分析显示，不同 ICM 材料之间无显著差异，证据确定性较低。
对于伴有/不伴有牙髓牙周联合病变的患者，根管内用药可改善牙髓牙周联合病变治疗后的临床牙周参数。至于对根尖愈合的影响，结果尚无定论。
由于两阶段 RCT 允许在伴有/不伴有交通的牙髓牙周联合病变中放置 ICM，因此可考虑进行两阶段 RCT。应在牙髓治疗后给予足够的时间，以促进任何潜在的牙周再生。
