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

摘要

目的:比较一次与多次根管治疗术治疗慢性牙髓炎、根尖周炎的疗效和安全性.方法:采用Cochrane系统评价方法,计算机检索Cochrane图书馆、MEDLINE、EMbase、CBM、CNKI、VIP等数据库.同时手工检索相关期刊和会议论文,收集相关随机对照试验和半随机对照试验.由两名评价者独立评价研究质量和提取数据,对同质研究采用RevMan 5.0软件进行Meta分析.结果:最终纳入16个随机对照试验.其中5个研究发生偏倚的可能性很低,7个研究有发生偏倚的中度可能性,另外4个研究有发生偏倚的高度可能性.Meta分析显示一次法与多次根管治疗术后72 h疼痛发生的差异无统计学意义[RR=1.10,95% CI(0.82,1.49)].影象学:一次法根管治疗与多次根管治疗相比有一些优势,但两者差异无统计学意义[RR=0.89,95% CI(0.64,1.25)].一次法根管治疗术后使用止痛药的病人比多次根管治疗明显增多,差异有统计学意义[RR=2.42,95% CI(1.62,3.62)].多次根管治疗发生肿胀[RR=1.40,95% CI(0.67,2.93)]和术后1周时疼痛[RR=1.25,95% CI(0.99,1.60)]的几率比一次性治疗要低,但差异无统计学意义.结论:一次法根管治疗术后使用止痛药的病人比多次法根管治疗术多,但从总体分析两者疗效差异无统计学意义.由于纳入研究设计的一些缺陷,此结论还需要今后更多高质量、大样本的随机对照试验来验证.%AIM: To assess the effectiveness and safety of single versus multiple-visit root canal treatment(RCT) for treatment of chronic pulpitis and periapical periodontitis. METHODS: The Cochrane Library, MEDLINE, Embase, CBM, CNKI and VIP were searched for randomized controlled trials or quasi-randomized controlled trials. And the reference lists of all papers identified were also checked. Quality assessment and data extraction were performed by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed for the results of homogeneous studies by RevMan 5.0 software. RESULTS: Sixteen randomized controlled trials were included. Five studies had a low risk of bias, seven a moderate risk, and another four had a high risk of bias. Incidence of postoperative pain at 72 hours was not significantly different between single and multiple-visit RCT [RR = 1.10, 95% CI (0.82,1.49)]. Radiologically, single-visit RCT appeared to be slightlymore effective than multiple-visit RCT, but the difference was not statistically significant [RR=0. 89, 95%CI(0.64, 1.25 ) ]. Meta-analysis showed that use of painkillers was significantly more common in patients undergoing single-visit RCT [RR =2.42, 95%CI (1.62,3.62)]. Swelling [RR = 1.40, 95%CI (0.67,2.93)] and one-week postoperative pain [ RR = 1.25, 95%CI(0.99,1.60)] was less common following multiple-visit RCT compared to single-visit treatment, but the difference was not statistical. CONCLUSION; Meta-analysis showed that use of painkillers was signicantly more common in patients undergoing single-visit RCT. The overall difference between single and multiple-visit RCT was not statistically significant. Due to the disadvantage of design of the included studies, further high-quality, large-scale randomized controlled trials are required to assess the available evidence.