Sunlakawit Chayanit, Chaimanakarn Chitpol, Srimaneekarn Natchalee, Osiri Sittichoke
Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
J Endod. 2024 Dec;50(12):1714-1724.e6. doi: 10.1016/j.joen.2024.08.005. Epub 2024 Aug 20.
Bacterial infections necessitate effective root canal disinfection during endodontic therapy. Calcium hydroxide (CH), a widely used intracanal medication, shows conflicting effects on dentine fracture resistance in different studies. This study aimed to perform a comprehensive systematic review and network meta-analysis to evaluate the effects of CH on the fracture resistance of dentine in human teeth across different periods.
PubMed, EMBASE, MEDLINE (EBSCO), Cochrane Library, Scopus, Google Scholar, and ProQuest databases were exhaustively searched to identify studies published until February 29, 2024, with no language restrictions. Laboratory studies that investigated dentine fracture resistance in human permanent teeth following intracanal CH exposure were included. The risk of bias was evaluated using modified criteria derived from previous studies. Network meta-analysis was performed using the frequentist method. Prespecified subgroup analyses focused on simulating immature teeth.
The search yielded 2,265 studies from all databases, and 27 met the inclusion criteria, involving 3,879 teeth or roots. The overall results from network meta-analysis indicated that CH affected the fracture resistance of human dentine. Subgroup analysis revealed that the duration influencing fracture resistance was ≥4 weeks for mature teeth, but no specific time limitation for immature teeth. The overall quality of the evidence showed a moderate to high risk of bias.
Short-term use of CH does not compromise human root dentine strength, supporting its routine application in clinical practice. CH remains a viable treatment strategy for over 4 weeks of medication needs but requires carefully considering the associated risks and benefits emphasizing on preservation and disease resolution.
PROSPERO database (CRD 42024513199).
在牙髓治疗期间，细菌感染需要有效的根管消毒。氢氧化钙（CH）是一种广泛使用的根管内用药，在不同研究中对牙本质抗折性的影响存在矛盾。本研究旨在进行全面的系统评价和网状Meta分析，以评估CH在不同时期对人牙牙本质抗折性的影响。
全面检索了PubMed、EMBASE、MEDLINE（EBSCO）、Cochrane图书馆、Scopus、谷歌学术和ProQuest数据库，以识别截至2024年2月29日发表的研究，无语言限制。纳入了研究根管内暴露CH后人恒牙牙本质抗折性的实验室研究。使用从先前研究中得出的修改标准评估偏倚风险。采用频率学派方法进行网状Meta分析。预先设定的亚组分析重点模拟未成熟牙。
检索所有数据库得到2265项研究，27项符合纳入标准，涉及3879颗牙齿或牙根。网状Meta分析的总体结果表明，CH会影响人牙本质的抗折性。亚组分析显示，影响成熟牙抗折性的持续时间≥4周，但对未成熟牙没有特定的时间限制。证据的总体质量显示存在中度至高偏倚风险。
短期使用CH不会损害人牙根牙本质强度，支持其在临床实践中的常规应用。对于需要用药超过4周的情况，CH仍然是一种可行的治疗策略，但需要仔细考虑相关的风险和益处，强调保存和疾病解决。
PROSPERO数据库（CRD 42024513199）
