Mehrotra Deepshikha, Kodical Sanjana R, Naik Shilpa Shetty
Department of Pediatric and Preventive Dentistry, D. Y. Patil University School of Dentistry, Navi Mumbai, Maharashtra, India.
J Indian Soc Pedod Prev Dent. 2024 Oct 1;42(4):257-266. doi: 10.4103/jisppd.jisppd_308_24. Epub 2025 Jan 11.
Smart burs and chemo-mechanical caries removal (CMCR) systems are considered viable alternatives to traditional cavity preparation techniques. Numerous clinical studies have been conducted to assess and compare the impact of these two techniques; nevertheless, these studies have demonstrated considerable variability in their findings. The objectives of the present systematic review and meta-analysis were to compare the efficacy, efficiency, and patient comfort of CMCR systems and smart burs in primary molars.
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Ten electronic databases up to May 30, 2024 were searched for in vivo clinical studies comparing at least one CMCR system with smart burs in terms of clinical and/or microbiological efficacy, efficiency (time taken for complete caries removal), and patient comfort in primary molars. Reviews, abstracts, case series and reports, letters to the editor, animal studies, and unpublished data were excluded. The risk of bias (ROB) assessment was conducted using the ROBINS-I and Cochrane ROB tools for nonrandomized and randomized clinical studies, respectively. The analysis was performed using Review Manager version 5.4.1 provided by the Cochrane Collaboration. The standardized mean difference served as the summary with a random effects model (P < 0.05).
A total of 154 studies were identified and screened out of which five were included in the qualitative synthesis and four studies were deemed suitable for a meta-analysis. The overall quality assessment revealed a presence of moderate-to-low ROB. The data extracted from the five studies were tabulated. The summary odds ratio for clinical efficacy (0.43 [95% confidence interval (CI) = 0.13-1.49]) showed no statistically significant difference between CMCR systems and Smart burs (Z = 1.33 and P = 0.18). A statistically significant difference ([Z = 5.85 and P < 0.00001] and [Z = 2.84 and P = 0.005]) in terms of microbiological efficacy (446.46 [95% CI = 296.89-596.02]) and efficiency (-0.68 [95% CI = -1.16--0.21]) was observed between CMCR systems and smart burs. Smart burs performed better in terms of microbiological efficacy and efficiency. Due to variability in the scales used to evaluate patient comfort, meta-analysis was not possible.
Within the limitations of this study, Smart burs performed better in terms of microbiological efficacy and efficiency and hence can be used as an alternative to CMCR systems in primary molars.
智能车针和化学机械去龋（CMCR）系统被认为是传统窝洞预备技术的可行替代方案。已经进行了大量临床研究来评估和比较这两种技术的影响；然而，这些研究的结果显示出相当大的差异。本系统评价和荟萃分析的目的是比较CMCR系统和智能车针在乳磨牙中的疗效、效率和患者舒适度。
本评价遵循《系统评价和荟萃分析的首选报告项目2020》指南。检索了截至2024年5月30日的10个电子数据库，以查找关于乳磨牙临床和/或微生物学疗效、效率（完全去除龋坏所需时间）以及患者舒适度方面比较至少一种CMCR系统与智能车针的体内临床研究。综述、摘要、病例系列和报告、致编辑的信、动物研究以及未发表的数据均被排除。分别使用ROBINS-I和Cochrane ROB工具对非随机和随机临床研究进行偏倚风险（ROB）评估。使用Cochrane协作网提供的Review Manager 5.4.1版本进行分析。标准化均数差作为随机效应模型的汇总指标（P<0.05）。
共识别并筛选出154项研究，其中5项纳入定性综合分析，4项研究被认为适合进行荟萃分析。总体质量评估显示存在中度至低度的ROB。从这5项研究中提取的数据制成表格。临床疗效的汇总比值比为0.43[95%置信区间（CI）=0.13-1.49]，表明CMCR系统和智能车针之间无统计学显著差异（Z=1.33，P=0.18）。在微生物学疗效（446.46[95%CI=296.89-596.02]）和效率（-0.68[95%CI=-1.16--0.21]）方面，CMCR系统和智能车针之间观察到统计学显著差异（[Z=5.85，P<0.00001]和[Z=2.84，P=0.005]）。智能车针在微生物学疗效和效率方面表现更好。由于用于评估患者舒适度的量表存在差异，无法进行荟萃分析。
在本研究的局限性范围内，智能车针在微生物学疗效和效率方面表现更好，因此可作为乳磨牙CMCR系统的替代方案。
