目的:对文献进行系统综述和荟萃分析,评估使用古塔胶进行根管再治疗的成功率。
方法:使用四个最大的数据库来识别没有日期或语言限制的现有文献。PubMed,科克伦,ScienceDirect,搜索了Scopus和其他其他来源。还回顾了灰色文献。
方法:两位作者,拥有牙髓学硕士学位和丰富的大学教学经验,被选中筛选数据库以确定合适的研究。如果作者在研究选择过程中未能达成一致,咨询了第三位调查员。在研究选择中概述并遵守具体的纳入和排除标准。两项随机对照试验,纳入了2022年12月10日之前发表的7项单臂前瞻性研究和1项单臂两性对照研究.这些研究评估了根管再治疗的成功,用古塔胶填充,至少随访1年。其中9项研究发表于1998年至2022年之间。在欧洲进行了七项研究,一个在北美,一个在亚洲。
方法:使用标准Cochrane方法评估区间有效性。使用纽卡斯尔-渥太华质量评估量表(NOS)进行单臂研究,评估个体研究中的偏倚风险。Cochrane偏倚风险工具(RoB2)用于随机对照试验.结果措施被标准化为根管再治疗的成功或失败。成功分为2种不同的标准:严格的标准=没有临床体征和症状以及放射学上正常的牙周膜间隙;宽松的标准=没有临床体征和症状,并且在对照X线片中没有或减少了根尖的放射不透性。使用R软件进行统计分析,并进行Freeman-Turkey转换。使用森林地块可视化结果。使用CochraneQ检验和I2值测量研究之间的异质性。
结果:虽然遵循严格的标准,1-3年随访(95%CI,0.66-0.77)和4-5年随访(95%CI,0.67-0.86)的非手术根管再治疗成功率为71%。异质性中等(I2=61.4)和低(I2=0.0),分别。在严格的标准下降低根管再治疗成功率的因素是老年患者,下颌牙齿,磨牙,根尖周围的射线可透性的存在,以前有射线可透性的牙齿,大的心尖周围射线可透性,较高的初始根尖周指数评分和多次就诊再治疗。遵循宽松的标准,在1~3年随访期间,牙胶充填的非手术根管再治疗的成功率为87%(95%CI,0.79~0.93),在所有研究中存在显著异质性(I2=88.5%).影响宽松标准下成功率的因素是>5mm的大根尖周病变和较高的初始根尖周指数(PAI)评分。
结论:非手术根管再治疗结果良好。然而,有几个因素可以导致较低的成功率:根尖周放射不透性的存在和大小,较高的初始PAI分数,多次就诊再治疗,以及牙齿的大小和位置。
OBJECTIVE: A systematic review and meta-analysis of the literature was carried out assessing the success rate of root canal retreatment using gutta percha.
METHODS: Four of the largest databases were used to identify existing literature with no date or language restrictions. PubMed, Cochrane, ScienceDirect, Scopus and other additional sources were searched. Grey literature was also reviewed.
METHODS: Two authors, with Master\'s degrees in endodontics and with extensive university teaching experience, were selected to screen the databases to identify suitable studies. In case the authors were not able to agree during the study selection process, a third investigator was consulted. Specific inclusion and exclusion criteria were outlined and adhered to in the study selection. Two randomised controlled trials, seven single arm prospective studies and one single arm ambispective study published before the 10th of December 2022 were included. These studies evaluated the success of root canal re-treatment, obturated with gutta percha with at least a 1-year follow-up. Nine of the studies were published between 1998 and 2022. Seven studies were conducted in Europe, one in North America and one in Asia.
METHODS: Standard Cochrane methods to assess interval validity were used. Risk of bias in individual studies was assessed using The Newcastle-Ottawa quality assessment scale (NOS) for single-arm studies, and the Cochrane risk of bias tool (RoB2) was used for randomised controlled trials. Outcome measures were standardised as either success or failure of root canal retreatment. Success was classified into 2 different criteria: Strict criteria = absence of clinical signs and symptoms and radiographically normal periodontal ligament space; and Loose criteria = absence of clinical signs and symptoms and absence or reduction of apical radiolucency in the control radiograph. Statistical analysis was undertaken using R software and the Freeman-Turkey transformation was performed. Results were visualised using forest plots. Heterogeneity between studies was measured using the Cochrane Q test and I2 values.
RESULTS: Whilst following strict criteria, the success rate of non-surgical root canal retreatment obturated with gutta percha was 71% for 1-3 years follow-up (95% CI, 0.66-0.77) and 77% for 4-5 years follow-up (95% CI, 0.67-0.86). Heterogeneity was moderate (I2 = 61.4) and low (I2 = 0.0), respectively. Factors reducing the success rate of root canal re-retreatment under the strict criteria were older patients, mandibular teeth, molar teeth, the presence of a peri-apical radiolucency, teeth with a previous radiolucency, large peri-apical radiolucency\'s, higher initial periapical index scores and multiple visit-retreatments. Following the loose criteria, the success rate of non-surgical root canal re-treatment obturated with gutta percha was 87% for 1-3 years follow-up (95% CI, 0.79-0.93) with significant heterogeneity across the studies (I2 = 88.5%). Factors influencing the success rate under the loose criteria were large periapical lesions >5 mm and higher initial periapical index (PAI) scores.
CONCLUSIONS: Non-surgical root canal retreatment results in favourable outcomes. However, there are several factors which can result in a lower success rate: the presence and size of a periapical radiolucency, a higher initial PAI score, multiple-visit retreatments, and the size and position of the tooth.