化学机械去腐技术治疗龋病的系统评价  

Chemomechanical caries removal for caries treatment:a systematic review

作　　者：黄晶洁[1] 张荣德 祁红延[3] 赵媛[1] 陈莉娅[3] 

机构地区：[1]兰州大学口腔医学院,甘肃兰州730000 [2]兰州市城关区人民医院,甘肃兰州730000 [3]兰州大学第一医院口腔科,甘肃兰州730000

出　　处：《牙体牙髓牙周病学杂志》2011年第9期517-521,509,共6页Chinese Journal of Conservative Dentistry

基　　金：中央高校自由探索项目(lzujbky-2009-143);甘肃省第七批科技计划(青年科技基金)(1007RJYA009)

摘　　要：目的:比较并评价化学机械去腐技术和常规机械去腐在龋病治疗中的效果和临床应用价值。方法:计算机检索PubMed、Cochrane图书馆(2010年第10期)、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库、数字化期刊全文数据库,同时追溯纳入研究的参考文献。根据Cochrane系统评价的方法,采用Rev Man 5.0软件进行Meta分析。评价指标包括:去腐效果、去腐时间、去腐过程中麻醉的使用、牙髓暴露发生率、牙科焦虑症发生率、1年成功率、继发龋、充填体折断或脱落以及牙髓并发症的发生率。结果:共纳入22个研究,2 757个病例。Meta分析结果显示:化学机械去腐与常规机械去腐相比,其在去腐效果[OR=0.52,95%CI(0.25,1.07),P=0.08]、牙髓暴露发生率[OR=0.18,95%CI(0.03,1.11),P=0.06]、继发龋[OR=0.86,95%CI(0.53,1.42),P=0.56]及充填体折断或脱落发生率[OR=1.06,95%CI(0.55,2.02),P=0.87]方面的差异无统计学意义;与常规机械去腐相比,化学机械去腐可提高龋病治疗的1年成功率[OR=1.81,95%CI(1.28,2.55),P=0.0008],并且可以降低牙科焦虑症[OR=0.25,95%CI(0.09,0.64),P=0.004]、牙髓并发症[OR=0.09,95%CI(0.03,0.27),P<0.05]的发生率,减少麻醉的使用[OR=0.13,95%CI(0.07,0.24),P<0.05],但是在去腐时间上长于机械去腐组[去腐时间1～10 min:OR=0.03,95%CI(0.01,0.11),P<0.05;去腐时间11～15 min:OR=24.46,95%CI(6.25,95.77),P<0.05;去腐时间>5 min:OR=6.05,95%CI(1.13,32.47),P=0.04]。结论:化学机械去腐与常规机械去腐相比,可以达到常规机械去腐的效果,并且能提高1年成功率、减少麻醉的使用、并发症和牙科焦虑症的发生,使病人承受较小的创伤,是一种有效的、微创的治疗方法。AIM： To compare the effectiveness and investigate the clinical value between chemomechanical and mechnical caries removal for patients with caries.METHODS： PubMed,Cochrane Library,EMBASE,Chinese Biomedical Literature Database,China Journal Full-text Database,Chinese Scientific Journals Full-text Database and WanFang Database were retrieved.We also traced back the references to collect the relevant trails.According to the Cochrane Handbook for systematic reviews of interventions 5.0.Statistic analyses were calculated using Revman 5.0 software.RESULTS： Twenty-two studies were involved and 2757 patients were included.Meta-analysis showed that there was no statistically significant difference in complete caries removal[OR=0.52,95%CI（0.25,1.07）,P=0.08],pulp exposure[OR=0.18,95%CI（0.03,1.11）,P=0.06],secondary caries[OR=0.86,95%CI（0.53,1.42）,P=0.56] and lost or fractured filling[OR=1.06,95%CI（0.55,2.02）,P=0.87] between the two methods.Chemomechanical caries removal could increases 1-year success rate[OR=1.81,95%CI（1.28,2.55）,P=0.0008],decreases dental anxiety[OR=0.25,95%CI（0.09,0.64）,P=0.004] and pulp complications[OR=0.09,95%CI（0.03,0.27）,P〈0.05],and reduce the use of anesthesia[OR=0.13,95%CI（0.07,0.24）,P〈0.05].Chemomechanical method took longer time than mechanical group in removal of caries [caries removal time 1-10 min：OR=0.03,95%CI（0.01,0.11）,P〈0.05;caries removal time 11-15 min：OR=24.46,95%CI（6.25,95.77）,P〈0.05;caries removal time〉5 min：OR=6.05,95%CI（1.13,32.47）,P=0.04].CONCLUSION： Chemomechanical caries removal can achieve the effect of mechanical caries removal.It also can improve 1-year success rate,decrease dental anxiety and reduce the use of anesthesia.Currently available evidence suggests that chemomechanical caries removal is an effective and minimally invasive method for caries treatment.

关 键 词：化学机械去腐 CARISOLV 龋病 随机对照研究 系统评价 

分 类 号：R780.5[医药卫生—口腔医学]