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Abstract：
BACKGROUND: Endodontic therapy in pediatric dentistry is a challenging procedure, especially for special needs, uncooperative, and very young patients. A new conservative approach which is the non-instrumental endodontic treatment (NIET) has been developed to simplify the management of primary teeth requiring pulpectomy. This review aimed to compare the efficiency of NIET and conventional endodontic treatment in primary teeth.
METHODS: Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed.
RESULTS: From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05).
CONCLUSIONS: No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended.
METHODS: Electronic databases including MEDLINE (via PubMed), Cochrane Library (CENTRAL), and Scopus without restrictions on publication year or publication language were searched. Only randomized clinical trials reporting clinical and radiographical outcomes of NIET and conventional pulpectomy on primary teeth were considered eligible. Two reviewers extracted the data according to the PRISMA statement and assessed the bias risk using the revised Cochrane risk-of-bias tool and a meta-analysis was performed.
RESULTS: From 3322 screened articles, seven articles meeting the inclusion criteria were included. The selected studies included 283 primary molars, of 213 children aged between 3 and 9 years, treated by NIET and conventional pulpectomy, and had follow-up periods ranging from 1 month to tooth exfoliation. Two studies reported good success rates for both the NIET technique and endodontic therapy with no statistically significant difference while three studies showed radiographical significant differences with a low success rate for the NIET technique. Only one study reported better outcomes in the pulpectomy group with statistically significant differences. The quantitative grouping of the included studies showed no significant differences between NIET and conventional endodontic therapy regarding clinical and radiographical success (p value > 0.05).
CONCLUSIONS: No difference between the NIET technique and the conventional endodontic therapy in primary molars requiring pulpectomy could be confirmed. Results of the present review need to be interpreted with caution since the quality of evidence according to the GRADE was considered as moderate to very low. Therefore, additional clinical trials on the NIET technique are recommended.
摘要：
背景：儿科牙科牙髓治疗是一个具有挑战性的过程，特别是对于特殊需要，不合作,非常年轻的病人。已经开发出一种新的保守方法，即非器械牙髓治疗（NIET），以简化需要牙髓切除术的乳牙的管理。本文旨在比较NIET和常规牙髓治疗对乳牙的疗效。
方法：电子数据库，包括MEDLINE（通过PubMed），Cochrane图书馆（中央），搜索了不受限制的出版年份或出版语言的Scopus。只有报告NIET和乳牙常规牙髓切除术的临床和影像学结果的随机临床试验被认为是合格的。两名评审员根据PRISMA声明提取数据，并使用修订后的Cochrane偏差风险工具评估偏差风险，并进行荟萃分析。
结果：来自3322篇筛选的文章，纳入了符合纳入标准的七篇文章。选定的研究包括283颗初级磨牙，213名3至9岁的儿童，通过NIET和常规牙髓切除术治疗，随访期从1个月到牙齿剥脱。两项研究报告了NIET技术和牙髓治疗的成功率良好，没有统计学上的显着差异，而三项研究显示了影像学上的显着差异，而NIET技术的成功率较低。只有一项研究报告牙髓切除术组的结局更好，差异具有统计学意义。纳入研究的定量分组显示，NIET和常规牙髓治疗在临床和影像学上的成功率没有显着差异（p值>0.05）。
结论：在需要牙髓切除术的原发性磨牙中，NIET技术与常规牙髓治疗之间没有差异。本综述的结果需要谨慎解释，因为根据GRADE的证据质量被认为是中等到非常低的。因此,建议对NIET技术进行更多的临床试验.
方法：电子数据库，包括MEDLINE（通过PubMed），Cochrane图书馆（中央），搜索了不受限制的出版年份或出版语言的Scopus。只有报告NIET和乳牙常规牙髓切除术的临床和影像学结果的随机临床试验被认为是合格的。两名评审员根据PRISMA声明提取数据，并使用修订后的Cochrane偏差风险工具评估偏差风险，并进行荟萃分析。
结果：来自3322篇筛选的文章，纳入了符合纳入标准的七篇文章。选定的研究包括283颗初级磨牙，213名3至9岁的儿童，通过NIET和常规牙髓切除术治疗，随访期从1个月到牙齿剥脱。两项研究报告了NIET技术和牙髓治疗的成功率良好，没有统计学上的显着差异，而三项研究显示了影像学上的显着差异，而NIET技术的成功率较低。只有一项研究报告牙髓切除术组的结局更好，差异具有统计学意义。纳入研究的定量分组显示，NIET和常规牙髓治疗在临床和影像学上的成功率没有显着差异（p值>0.05）。
结论：在需要牙髓切除术的原发性磨牙中，NIET技术与常规牙髓治疗之间没有差异。本综述的结果需要谨慎解释，因为根据GRADE的证据质量被认为是中等到非常低的。因此,建议对NIET技术进行更多的临床试验.
