Mrinalini Mrinalini, Gupta Alpa, Soi Sonal, Abraham Dax, Bukhari Seema H
Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabad, IND.
Cureus. 2024 Sep 6;16(9):e68796. doi: 10.7759/cureus.68796. eCollection 2024 Sep.
The era of minimally invasive dentistry has led to the development of new access cavity designs. The impact of various access cavity designs on the fracture resistance of teeth has been extensively studied. The primary aim of this systematic review and meta-analysis is to evaluate and compare the effects of recent modifications in endodontic access cavity design- specifically, conventional, conservative, and truss designs on tooth fracture resistance. Three independent reviewers searched studies across six different databases (PubMed, Scopus, EBSCOhost, BVS, Wiley, and Google Scholar) from January 2000 to July 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were then screened using strict inclusion and exclusion criteria. A quality assessment was performed using a modified version of the quality assessment of in-vitro studies according to the QUIN (Quality Assessment Tool For In Vitro Studies) tool, categorizing the selected articles into low, moderate, and high risk of bias. Quantitative data synthesis was conducted to combine equivalent results using STATA. Forest plots were created with the level of significance set at 0.05 (p = 0.05). Out of 243 articles, 14 met the strict inclusion criteria. Among the selected articles, 11 showed a low risk of bias and three showed a moderate risk. The meta-analysis revealed that fracture resistance of conservative and truss access designs is significantly higher than that of conventional endodontic access, with a standardized mean difference (SMD) of 2.61 (95% 1.47 to 3.74; p-values <0.001) and SMD = -1.26 (95% confidence interval (CI): -1.81 to 0-0.71; p<0.001). The heterogeneity (I²) values for these comparisons were 92% and 65.6%, respectively. The extent of the access cavity has a substantial impact on tooth fracture resistance. Newer conservative and truss endodontic access designs offer better fracture resistance compared to conventional endodontic access.
微创牙科时代推动了新型开髓洞形设计的发展。各种开髓洞形设计对牙齿抗折性的影响已得到广泛研究。本系统评价和荟萃分析的主要目的是评估和比较近期牙髓开髓洞形设计的改进效果——具体而言，是传统、保守和桁架式设计对牙齿抗折性的影响。三名独立评审员按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索了2000年1月至2024年7月期间六个不同数据库（PubMed、Scopus、EBSCOhost、BVS、Wiley和谷歌学术）中的研究。然后使用严格的纳入和排除标准对文章进行筛选。根据QUIN（体外研究质量评估工具）工具，使用体外研究质量评估的修改版进行质量评估，将所选文章分为低、中、高偏倚风险类别。使用STATA进行定量数据综合以合并等效结果。创建森林图时显著性水平设定为0.05（p = 0.05）。在243篇文章中，14篇符合严格的纳入标准。在所选文章中，11篇显示低偏倚风险，3篇显示中等偏倚风险。荟萃分析显示，保守和桁架式开髓设计的抗折性显著高于传统牙髓开髓，标准化均数差（SMD）为2.61（95% 1.47至3.74；p值<0.001），SMD = -1.26（95%置信区间（CI）：-1.81至0 - 0.71；p<0.001）。这些比较的异质性（I²）值分别为92%和65.6%。开髓洞形的范围对牙齿抗折性有重大影响。与传统牙髓开髓相比，更新的保守和桁架式牙髓开髓设计具有更好的抗折性。
