通过日常使用氟化物治疗实现牙釉质侵蚀性病变的再矿化：原位研究集的网络荟萃分析

Remineralisation of enamel erosive lesions by daily-use fluoride treatments: network meta-analysis of an in situ study set.

作者信息

Creeth Jonathan, Smith Gary, Franks Billy, Hara Anderson, Zero Domenick

机构信息

Haleon PLC, St George's Avenue, Weybridge, KT13 0DE, UK.

Oral Health Research Institute, Indiana University School of Dentistry, 415 Lansing Street, Indianapolis, IN, 46202-2876, USA.

出版信息

Clin Oral Investig. 2024 Dec 26;29(1):28. doi: 10.1007/s00784-024-06107-1.

DOI:10.1007/s00784-024-06107-1

PMID:39724489

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11671545/

Abstract

OBJECTIVES

Daily-use fluoride products are first-line protection against enamel wear from dietary-acid exposure (DAE). This study aimed to understand effects of fluoride concentration, fluoride salt, product form and ingredients in daily-use products on remineralisation and demineralisation, via network meta-analysis (NMA) of 14 studies using one well-established in-situ model. Remineralisation (surface-microhardness recovery, SHMR) after treatment, and protection against subsequent demineralisation (acid-resistance ratio, ARR) were measured.

MATERIALS AND METHODS

Healthy participants, wearing intra-oral palatal appliances holding enamel specimens eroded with standardised DAE, used test products once. Enamel hardness was assessed (Knoop microhardness probe) pre-DAE; post-DAE; after 4 h intra-oral remineralisation; and after post-remineralisation DAE. NMA was performed using a mixed-models approach on subject-level data to estimate and compare means.

RESULTS

There was a dose-response for fluoride ion in toothpastes (0-1426ppm F; p < 0.001 for SMHR and ARR). One toothpaste (silica-based, 1150ppm F as NaF) showed a benefit for SMHR versus placebo [mean(standard error)]: 8.8%(0.6%) (33.0% vs. 24.2%; p < 0.001); for ARR: 0.27(0.03) (0.43 vs. 0.15; p < 0.001; 9 mutual studies). Use of fluoride mouthwash after fluoride toothpaste increased SMHR [2.4%(1.1%); p = 0.043; 3 studies]; the effect on ARR [0.08(0.05)] was not significant (p = 0.164). Negative effects of polyvalent metal ions and polyphosphates on SMHR (p < 0.05) were observed.

CONCLUSIONS

NMA proved effective in discriminating between fluoride-based treatments in this in-situ study, highlighting the importance of fluoride ion to enamel protection and showing formulation ingredients can affect its performance.

CLINICAL RELEVANCE

Daily-use fluoride products can protect enamel against dietary acids, but careful formulation is required for optimal performance.

摘要

目的

日常使用的含氟产品是预防饮食酸暴露（DAE）导致牙釉质磨损的一线防护措施。本研究旨在通过对14项研究进行网状Meta分析（NMA），利用一个成熟的原位模型，了解日常用品中氟浓度、氟盐、产品形态和成分对再矿化和脱矿的影响。测量处理后的再矿化（表面显微硬度恢复，SHMR）以及对随后脱矿的防护作用（耐酸比，ARR）。

材料与方法

健康参与者佩戴口腔内腭部装置，该装置中装有经标准化DAE侵蚀的牙釉质标本，使用一次测试产品。在DAE前、DAE后、口腔内再矿化4小时后以及再矿化后DAE后评估牙釉质硬度（努氏显微硬度探头）。使用混合模型方法对个体水平数据进行NMA，以估计和比较均值。

结果

牙膏中氟离子存在剂量反应关系（0 - 1426ppm F；SHMR和ARR的p < 0.001）。一种牙膏（基于二氧化硅，1150ppm F以NaF形式存在）与安慰剂相比，对SHMR显示出益处[均值（标准误差）]：8.8%（0.6%）（33.0%对24.2%；p < 0.001）；对于ARR：0.27（0.03）（0.43对0.15；p < 0.001；9项共同研究）。在使用含氟牙膏后使用含氟漱口水可提高SHMR[2.4%（1.1%）；p = 0.043；3项研究]；对ARR的影响[0.08（0.05）]不显著（p = 0.164）。观察到多价金属离子和多磷酸盐对SHMR有负面影响（p < 0.05）。