NaOCl冲洗液对纤维桩根管粘接强度影响的Meta分析

摘要

BACKGROUND: Currently, whether the use of sodium hypochlorite (NaOCl) influences the bond strength of fiber posts is still uncertain. OBJECTIVE: To evaluate the influence of NaOCl on the bond strength of fiber posts by Meta-analysis. METHODS: Randomized controlled trials about the impact of NaOCl irrigation to the bond strength of fiber posts were retrieved from PubMed, EMbase, Web Of Science, OVID, CBM, ClinicalKey, CNKI, CqVip and WanFang databases, and other databases through manual retrieval as well. The deadline of the collection was December 31, 2016, with no limit of regions and languages. A Meta-analysis was performed with the bond strength of fiber posts as an indicator. RESULTS: A total of 11 randomized controlled trials were included. In the experimental group (NaOCl group), the root canal was rinsed with NaOCl, and dried followed by fiber post bonding using the total-etching system, the self-etching system and the self-adhesive system. In the control group, the root canal was washed with pure water or normal saline.Meta-analysis showed that weighted mean difference(WMD)(NaOCl group/control group)=-0.90,95% confidence interval(CI)(-1.50,-0.31),Z=2.97,P=0.003.Subgroup analysis showed that WMD(total-etching:NaOCl group/control group)=-2.38,95% CI(-4.86,0.10),Z=1.88,P=0.06;WMD(self-etching:NaOCl group/control group)=-1.22,95% CI(-2.17,-0.28),Z=2.55, P=0.01;WMD(self-adhesive:NaOCl group/control group)=-1.97,95% CI(-2.30,-1.64),Z=11.73,P<0.000 01.As the limited number of enrolled samples in the total-etching group and self-etching group results in a higher heterogeneity, further investigations are warranted. The present data suggests that irrigating the surface of root canals with NaOCl alone has negative impact on the bond strength of fiber posts using the self-adhesive system.%背景:目前临床上对根管冲洗液NaOCl是否会影响纤维桩的粘接强度尚无定论.目的:系统评价临床常用浓度NaOCl冲洗液对纤维桩根管粘接强度的影响.方法:桡骨远端骨折以掌侧锁应用计算机检索建库至 2016年12月31日PubMed、EMbase、Web Of Science、OVID、CBM、ClinicalKey、CNKI、维普、万方等数据库,加以手工检索关于NaOCl冲洗液对纤维桩根管粘接强度影响的随机对照实验,以纤维桩粘接强度为指标进行Meta分析.结果与结论:共纳入11篇文献,均为随机对照实验,实验组采用NaOCl溶液行根管冲洗,纸尖干燥后分别以全酸蚀系统、自酸蚀系统、自粘接系统进行纤维桩粘接;对照组以纯水或生理盐水行根管冲洗.合并效应量WMD结果显示,NaOCl冲洗液会降低纤维桩根管粘接强度[WMD=-0.90,95%CI(-1.50,-0.31),Z=2.97, P=0.003].由于纳入文献异质性较高,故进行亚组分析讨论异质性来源,亚组分析显示:对于全酸蚀系统,尚不能认为NaOCl冲洗液对纤维桩粘接强度有影响[WMD=-2.38,95%CI(-4.86,0.10),Z=1.88,P=0.06];对于自酸蚀与自粘接系统,NaOCl冲洗液会降低纤维桩粘接强度[WMD=-1.22,95%CI(-2.17,-0.28),Z=2.55, P=0.01;WMD=-1.97,95%CI(-2.30,-1.64),Z=11.73,P < 0.00001].由于全酸蚀组与自酸蚀组纳入样本量较小,且异质性较大,其结果可能不具有代表性,尚需更多研究的进一步跟进.现有的数据表明,单独使用NaOCl冲洗液处理根管壁会降低自粘接系统纤维桩的粘接强度.