Rosa Alessio, Ronsivalle Vincenzo, Fiorillo Luca, Arcuri Claudio
Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, Rome.
Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania.
J Craniofac Surg. 2024 Aug 29. doi: 10.1097/SCS.0000000000010513.
Dental anxiety, linked to avoiding dental treatment and heightened medical and surgical risks, prompted this systematic review. The objective is to synthesize existing evidence on conscious sedation techniques employed for managing dental anxiety in patients scheduled for third molar extraction surgery, aiming to identify optimal approaches and address knowledge gaps. This systematic review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" checklist and the population, investigation, comparation, outcome framework. The protocol still needs to be registered. A thorough search was conducted, incorporating MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews until February 2024. Only randomized controlled trials were considered, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The risk of bias was evaluated following the Cochrane Handbook for Systematic Reviews of Interventions. Eighteen randomized controlled trials involving 2081 patients were included. Certain factors limited the feasibility of a meaningful meta-analysis, leading to a narrative synthesis. Conscious sedation with virtual reality showed an association with improved dental anxiety in 4 studies. One study reported reduced cortisol levels with midazolam compared with a placebo, whereas another noted significant variations in perioperative renin levels with remifentanil versus placebo. This review reveals inconclusive and conflicting findings regarding the role of conscious sedation in managing dental anxiety during third molar extraction surgery. Persistent uncertainties arise due to a need for consistent, standardized outcome measures. Addressing these limitations in study design is crucial for future research.
牙科焦虑与避免牙科治疗以及增加医疗和手术风险相关，这促使了本次系统评价。目的是综合现有证据，探讨用于管理计划进行第三磨牙拔除手术患者牙科焦虑的清醒镇静技术，旨在确定最佳方法并填补知识空白。本系统评价遵循“系统评价和荟萃分析的首选报告项目”清单以及人群、干预措施、对照、结局框架。该方案仍需注册。进行了全面检索，纳入了MEDLINE/PubMed、EMBASE、SCOPUS、clinicaltrials.gov和Cochrane系统评价数据库，检索截至2024年2月。仅考虑遵循“系统评价和荟萃分析的首选报告项目”指南的随机对照试验。按照《Cochrane干预措施系统评价手册》评估偏倚风险。纳入了18项涉及2081名患者的随机对照试验。某些因素限制了有意义的荟萃分析的可行性，导致采用叙述性综合分析。4项研究表明，虚拟现实清醒镇静与改善牙科焦虑有关。一项研究报告称，与安慰剂相比，咪达唑仑可降低皮质醇水平，而另一项研究指出，与安慰剂相比，瑞芬太尼使围手术期肾素水平有显著差异。本评价揭示了关于清醒镇静在第三磨牙拔除手术中管理牙科焦虑作用的不确定且相互矛盾的结果。由于需要一致、标准化的结局指标，仍然存在不确定性。解决研究设计中的这些局限性对未来研究至关重要。
