哪种管理策略对乳磨牙咬合面近中龋损的成功率最高？一项系统评价和网状Meta分析。
Which management strategy has the highest success rate for occlusoproximal caries lesions in primary molars? A systematic review and network meta-analysis.
作者信息
Garbim Jonathan Rafael, Oliveira Livia da Rosa, Oliveira Rodolfo de Carvalho, Tedesco Tamara Kerber, Raggio Daniela Prócida
机构信息
Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
出版信息
Evid Based Dent. 2025 May 29. doi: 10.1038/s41432-025-01164-1.
AIM
Managing occlusoproximal lesions remains a challenge for dental professionals. The aim of this systematic review was to identify the best strategy to treat occlusoproximal caries lesions in primary molars.
METHODS
A systematic search was conducted in MEDLINE/PubMed, Web of Science, Scopus, EMBASE, and ProQuest up to 7th February 2024. Randomized controlled trials comparing different management strategies for occlusoproximal caries lesions with at least 12 months of follow-up were included. Network meta-analyses were carried out considering the success rate of the treatments as the outcome. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence with the GRADE tool.
RESULTS
Seven studies were included, evaluating five treatment modalities: Hall Technique (HT), non-restorative cavity control (NRCC), conventional restorative treatment (CRT), silver diamine fluoride application (SDF), and Atraumatic Restorative Treatment (ART). HT had the highest success rate (80.8%). There was no statistical difference between other strategies. Only two studies showed a low risk of bias; the others had a high risk, primarily due to selective reporting bias.
DISCUSSION
The HT had the highest success rate at 80.8%, making it the most effective treatment for occlusoproximal caries in primary molars. However, no significant difference was found between other treatment strategies. The certainty of evidence is limited by the high risk of bias, particularly selective reporting bias. Future research should also consider factors like patient preference and cost-effectiveness to better assess treatments in a patient-centered context.
CONCLUSION
HT is the most effective option for managing occlusoproximal caries in primary molars in terms of success rate. However, the evidence is based on studies with a high risk of bias, and the certainty of evidence ranges from very low to moderate.
PROSPERO
CRD42021281085.
目的
对于牙科专业人员而言，处理牙合邻面病变仍然是一项挑战。本系统评价的目的是确定治疗乳磨牙牙合邻面龋损的最佳策略。
方法
截至2024年2月7日，在MEDLINE/PubMed、科学网、Scopus、EMBASE和ProQuest中进行了系统检索。纳入了比较牙合邻面龋损不同管理策略且随访至少12个月的随机对照试验。以治疗成功率为结局指标进行网状Meta分析。使用RoB 2工具评估偏倚风险，使用GRADE工具评估证据确定性。
结果
纳入7项研究，评估了5种治疗方式：霍尔技术（HT）、非修复性龋洞控制（NRCC）、传统修复治疗（CRT）、应用氟化银氨（SDF）和非创伤性修复治疗（ART）。HT的成功率最高（80.8%）。其他策略之间无统计学差异。仅有两项研究显示偏倚风险较低；其他研究存在高风险，主要是由于选择性报告偏倚。
讨论
HT的成功率最高，为80.8%，使其成为治疗乳磨牙牙合邻面龋的最有效方法。然而，其他治疗策略之间未发现显著差异。证据确定性受到高偏倚风险的限制，尤其是选择性报告偏倚。未来研究还应考虑患者偏好和成本效益等因素，以便在以患者为中心的背景下更好地评估治疗方法。
结论
就成功率而言，HT是治疗乳磨牙牙合邻面龋的最有效选择。然而，证据基于偏倚风险较高的研究，证据确定性从极低到中等不等。
国际前瞻性系统评价注册库
CRD42021281085。
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