一次法与多次法根管治疗术治疗隐裂牙伴牙髓炎的疗效：meta分析

doi:10.19439/j.sjos.2017.06.023

摘要/Abstract

摘要： 目的: 系统评价一次法与多次法根管治疗术治疗隐裂牙伴牙髓炎的效果。方法: 在MEDLINE、CNKI、VIP、万方等数据库中检索从建库至2016年6月1日的一次法及多次法根管治疗术治疗隐裂牙伴牙髓炎的文献,并按纳入标准进行筛选。采用Stata/SE12.1软件对纳入文献进行特征收集、质量评价,并对治疗效果、随访结果（半年、1年）及术后疼痛进行分析。结果: 共纳入24篇中文文献,未搜到符合条件的外文文献,包括3065例病例,其中1608例行一次法根管治疗,1457例行多次法根管治疗。分析显示,一次法根管治疗术的治疗有效率（96.90%）、半年随访成功率（94.90%）、1年随访成功率（94.60%）均高于多次法（分别为84.00%、81.40%和89.00%）,2种方法的术后疼痛率无显著差异[RR=0.96,95%CI（0.82,1.13）]。敏感性检验后结果未发生明显改变。纳入文献在分配方法、根管治疗操作细节等方面存在差异。结论: 现有文献表明,相比多次法,一次法根管治疗术治疗隐裂牙伴牙髓炎的疗效更好、术后疼痛率不高,但有必要进行更全面、规范的临床随机对照试验进行验证。

关键词: 牙裂综合征, 根管治疗, 随机对照试验, 荟萃分析

Abstract: PURPOSE: To compare the treatment effect between one-visit and multiple-visit endodontic treatment for cracked tooth with pulpitis. METHODS: The literatures published before 2016-06-01 regarding to one-visit and multiple-visit root canal treatment for cracked tooth with pulpitis were searched through MEDLINE, CNKI, VIP, Wanfang Database et al. Then the included studies were chosen according to the inclusion criteria. Collection of features, quality evaluation and analysis of treatment effect, follow-up results (half year/1 year) and postoperative pain of the included studies were analyzed using Stata/SE12.1 software. RESULTS: A total of 24 Chinese literatures were included and no eligible foreign literatures were found. There were 3065 cases including 1608 with one-visit endodontic treatment and 1457 with multiple-visit endodontic treatment. Meta analysis showed that the effective rate (96.90%) and follow-up success rate (94.90%,94.60%) of one-visit endodontic treatment were significantly higher than multiple-visit one (84.00%,81.40%,89.00%),while there was no significant difference in postoperative pain [RR=0.96，95%CI (0.82，1.13)].The results did not change after sensitivity analysis. However，there were some differences in assignment methods and operations details among the literatures. CONCLUSIONS: The existing limited evidences show that one-visit endodontic treatment has higher effective rate than multiple-visit endodontic treatment and its postoperative pain is acceptable. However, more standard randomized controlled trials are needed.

Key words: Cracked tooth syndrom, Root canal treatment, Randomized controlled trial, Meta analysis

中图分类号:

R781.05

王雯, 王鹏来, 谢妮娜, 吴翠, 刘宗响. 一次法与多次法根管治疗术治疗隐裂牙伴牙髓炎的疗效：meta分析[J]. 上海口腔医学, 2017, 26(6): 672-679.

WANG Wen, WANG Peng-lai, XIE Ni-na, WU Cui, LIU Zong-xiang. Outcome of one-visit and multiple-visit root canal treatment for cracked tooth with pulpitis: a meta analysis[J]. Shanghai Journal of Stomatology, 2017, 26(6): 672-679.

参考文献

[1] Hasan S, Singh K, Salati N. Cracked tooth syndrome: overview of literature [J]. Int J Appl Basic Med Res, 2015, 5(3): 164-168.
[2] 刘蔚, 王美青. 牙裂综合征[J]. 牙体牙髓牙周病学杂志, 2005, 15(6): 350-353.
[3] Kim SY, Kim SH, Cho SB, et al. Different treatment protocols for different pulpal and periapical diagnoses of 72 cracked teeth [J]. J Endod, 2013, 39(4): 449-452.
[4] 樊明文. 牙体牙髓病学[M]. 第4版. 北京: 人民卫生出版社, 2012: 247.
[5] 孙玉亮, 梁学萍, 赵今. 比较一次法与多次法根管治疗术治疗慢性牙髓炎、根尖周炎疗效的系统评价 [J]. 牙体牙髓牙周病学杂志, 2011, 21(8): 452-458.
[6] 林南雁, 高学军. 感染根管一次性根管治疗的短期疗效分析 [J]. 中华口腔医学杂志, 2006, 41(9): 525-528.
[7] Akbar I, Iqbal A, Al-Omiri MK. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment [J]. J Contemp Dent Pract, 2013, 14(3): 414-418.
[8] Eleazer PD, Eleazer KR. Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment [J]. J Endod, 1998, 24(9): 614-616.
[9] 肖丹, 张德辉. 感染根管一次性根管治疗的疗效观察 [J]. 华西口腔医学杂志, 2010,28(1):57-60.
[10] Nair PN, Henry S, Cano V, et al. Microbial status of apical root canal system of human mandibular first molars with primary apical periodontitis after "one-visit" endodontic treatment [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 99(2): 231-252.
[11] Yoldas O, Topuz A, Isci AS, et al. Postoperative pain after endodontic retreatment: single- versus two- visit treatment [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004, 98(4): 483-487.
[12] 张军. 60例隐裂性牙髓炎根管治疗的临床疗效观察 [J]. 中国现代药物应用, 2015, 9(5): 71-72.
[13] 年丽岩. 84例隐裂性牙髓炎根管临床治疗观察 [J]. 药物与人, 2014, 27(4): 208-209.
[14] 程志贤, 程志伟. 150例隐裂性牙髓炎根管治疗的临床效果分析 [J]. 当代医学, 2012, 18(7): 38-39.
[15] 李文进. 200例隐裂性牙髓炎根管治疗的临床分析 [J].当代医学, 2012, 18(7): 38-39.
[16] 周莹, 李忠. 不同根管治疗法治疗隐裂性牙髓炎临床研究 [J]. 河北医学, 2014, 20(8): 1249-1251.
[17] 孙铸坚. 多次性根管治疗术与一次性根管治疗术在隐裂性牙髓炎治疗中的价值比较 [J]. 中国继续医学教育, 2015, 7(26): 122-123.
[18] 吴艳丽. 根管治疗隐裂性牙髓炎的疗效分析[J].吉林医学, 2012, 33(12): 2510-2511.
[19] 胡芳容. 根管治疗隐裂性牙髓炎的效果观察[J].吉林医学, 2014, 35(18): 3977-3978.
[20] 付瑶. 2种根管治疗法治疗隐裂性牙髓炎的疗效观察 [J]. 工企医刊, 2014, 27(1): 558-559.
[21] 顾明, 王普武. 2种根管治疗法治疗隐裂性牙髓炎的疗效观察 [J]. 海南医学, 2013, 24(17): 2596-2598.
[22] 姜红.2种根管治疗法治疗隐裂性牙髓炎的疗效观察 [J]. 药物与人, 2014, 27(6): 83-84.
[23] 张富兴. 2种根管治疗法治疗隐裂性牙髓炎的疗效观察 [J]. 中国实用医药, 2013, 8(36): 65-66.
[24] 曹晓鹏. 一次性根管充填治疗隐裂牙伴牙髓炎的临床效果 [J]. 当代医学, 2015, 21(30): 20-21.
[25] 韩亚萍, 林晓霞, 林泓兵. 一次性根管充填治疗隐裂牙伴牙髓炎的效果观察 [J]. 中国继续医学教育, 2015, 7(20): 123-124.
[26] 邓晓娟, 崔有足. 一次性根管疗法与多次根管疗法治疗隐裂性牙髓炎的临床疗效对比 [J]. 中国医学工程, 2015, 23(12): 47.
[27] 陆正青. 一次性根管治疗法与多次根管治疗法治疗隐裂性牙髓炎的临床疗效对比 [J]. 大家健康, 2016, 10(3): 8-9.
[28] 沈建华. 一次性根管治疗法治疗隐裂性牙髓炎的临床观察 [J]. 现代养生, 2015, 31(22): 111.
[29] 于占庆. 一次性根管治疗牙隐裂伴牙髓病变49例临床疗效分析 [J]. 大家健康, 2013, 7(9): 98-99.
[30] 崔彩霞. 一次性根管治疗隐裂性牙髓炎临床效果观察 [J]. 中国现代药物应用, 2015, 9(5): 66-67.
[31] 王国平. 一次性与多次性根管治疗隐裂性牙髓炎的临床疗效比较 [J]. 齐齐哈尔医学院学报, 2013, 34(15): 2243-2244.
[32] 宋睿. 一次性与分次性根管治疗老年隐裂性牙髓炎的效果比较 [J]. 中国当代医药, 2015, 22(29): 98-100.
[33] 阳元坝. 隐裂性牙髓炎106例一次性根管治疗分析 [J]. 中外医疗, 2011, 30(16): 37.
[34] 李芬连. 隐裂性牙髓炎应用一次性根管治疗的临床效果观察 [J]. 基层医学论坛, 2014, 18(10) :1301-1302.
[35] 王正红, 祝玉华. 早期隐裂牙采用两种根管治疗法治疗的临床疗效观察[J]. 现代诊断与治疗, 2014, 25(11): 2422-2423.
[36] Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 1: aetiology and diagnosis [J].Br Dent J, 2010, 208(10): 459-463.
[37] Pekruhn RB. The incidence of failure following single-visit endodontic therapy [J]. J Endod, 1986, 12(2): 68-72.
[38] Penesis VA, Fitzgerald PI, Fayad MI, et al. Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation [J]. J Endod, 2008, 34(3): 251-257.
[39] Guntebi BR, DeSchepper EJ, Taylor TS, et al. Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis [J].Oral Surg Oral Med Oral Pathol, 1992, 73(4): 479-483.
[40] Albashaireh ZS, Alnegrish AS. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study [J]. J Dent, 1998, 26(3): 227-232.
[41] Ghoddusi J, Javidi M, Zarrabi MH, et al. Flare-ups incidence and severity after using calcium hydroxide as intracanal dressing [J]. N Y State Dent J, 2006, 72(4): 24-28.
[42] Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. 1985 [J]. J Endod, 2004, 30(7): 476-481.
[43] Harrington GW, Natkin E. Midtreatment flare-ups [J]. Dent Clin North Am, 1992, 36(2): 409-423.
[44] Alves Vde O. Endodontic flare-ups: a prospective study [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 110(5): e68-72.