背景:ESE先前于2006年发布的牙髓治疗质量指南;但是,不仅在临床牙髓治疗方面,而且在共识和指南制定过程中都发生了重大变化.在制定首届S3级临床实践指南(CPG)时,我们遵循了全面的系统和方法上稳健的指南咨询流程,以便为出现牙髓和根尖疾病的患者提供循证建议.
目的:开发用于牙髓和根尖疾病治疗的S3级CPG,重点是诊断和实施治疗牙髓炎和根尖周炎(AP)患者所需的治疗方法,最终目标是防止牙齿脱落。
方法:该S3级CPG由ESE开发,在德国科学医学会协会提供的独立方法指导的协助下,并利用了GRADE流程。一个健壮的,严格和透明的过程包括14个特别委托的系统综述中相关比较研究的分析,在评估证据的质量和强度之前,在与领先的牙髓专家和广泛的外部利益相关者的结构化共识过程中制定具体证据和基于专家的建议。
结果:用于治疗牙髓和根尖疾病的S3级CPG在一系列临床建议中描述了诊断牙髓炎和AP的有效性,在研究牙髓治疗在管理这些疾病方面的有效性之前。治疗策略包括对患有以下疾病的患者进行深龋管理的有效性,没有,自发性疼痛和牙髓暴露,重要的和不重要的牙齿,根管器械的有效性,灌溉,敷料,根管充填材料和辅助肛内手术在AP管理中的应用。在制定治疗计划之前,历史和案例评估的关键重要性,无菌技术,强调在治疗期间和治疗后进行适当的培训和重新评估。
结论:牙髓学中的第一个S3级CPG为临床实践提供了信息,卫生系统,政策制定者,其他利益相关者和患者对可用和最有效的治疗方法来管理牙髓炎和AP患者,以便在患者的一生中保留牙齿,根据目前可用的最佳比较证据。
BACKGROUND: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease.
OBJECTIVE: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.
METHODS: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders.
RESULTS: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed.
CONCLUSIONS: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient\'s lifetime, according to the best comparative evidence currently available.