复合树脂间接修复和直接充填对后牙缺损修复临床疗效的Meta分析  

Efficacy of indirect and direct resin composite restorations in permanent posterior teeth: a meta-analysis

作　　者：刘媛[1] 侯鑫山 张婉婷[1] 赵今[1,2] 

机构地区：[1]新疆医科大学第一附属医院牙体牙髓科,乌鲁木齐830054 [2]新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054

出　　处：《中国循证医学杂志》2017年第6期685-691,共7页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金(编号:81360167)

摘　　要：目的系统评价复合树脂间接修复和直接充填方法对后牙缺损患者修复的临床疗效。方法计算机检索The Cochrane Library(2016年12期)、PubMed、EMbase、WanFang Data、CBM和CNKI数据库,查找复合树脂间接修复和直接充填方法对后牙缺损患者修复疗效的随机对照试验(RCT),检索时限均为从建库至2016年12月。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入9个RCT,包括671例患者,1 012例患牙,其中间接修复组544例,直接充填组468例。Meta分析结果显示:复合树脂间接修复和直接充填对后牙缺损患者总修复失败率差异无统计学意义[RR=0.91,95%CI(0.52,1.58),P=0.73]。按修复失败原因进一步分析,两组因修复体折裂[RR=1.71,95%CI(0.76,3.84),P=0.19]和因剩余牙尖折裂[RR=1.27,95%CI(0.62,2.59),P=0.52]导致的修复失败率差异均无统计学意义。直接充填组发生继发龋的可能性高于间接修复组[RR=0.33,95%CI(0.13,0.85),P=0.02]。按前磨牙和磨牙修复牙位进行亚组分析,两组修复失败率差异均无统计学意义。结论复合树脂间接修复和直接充填对后牙缺损患者修复的临床疗效相当。受纳入研究的数量和质量限制,上述结论尚需更多高质量、大样本的随机对照试验予以验证。Objective To systematically review the clinical efficacy of indirect and direct resin composite restorations in permanent posterior teeth. Methods The Cochrane Library （Issue 12, 2016）, PubMed, EMbase, WanFang Data, CBM and CNKI databases were searched for randomized controlled trials （RCTs） about indirect and direct resin composite restorations in permanent posterior teeth from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. Results Nine RCTs involving 671 patients and 1 012 teeth （544 in indirect restorations group and 468 in direct restorations group） were included. The results of meta-analysis indicated that： there was no significant difference in the overall failure rate between direct and indirect resin composite restorations （RR=0.91, 95%CI 0.52 to 1.58, P=0.73）. In further analysing the reasons of failure, there were no significant differences between both groups on fractured restorations （RR=1.71, 95%CI 0.76 to 3.84, P=0.19） and fractured remaining cusp （RR=1.27, 95%CI 0.62 to 2.59, P=0.52）. In addition, the secondary caries in the direct composite restorations group was higher than that in the indirect group （RR=0.33, 95%CI 0.13 to 0.85, P=0.02）. Subgroup analysis according to molars and premolars restored indicated that there was no statistical difference in the restorations failure rate between two groups. Conclusion The clinical efficacy of indirect and direct resin composite restorations in permanent posterior teeth are equivalent. Due to the limitation of quality and quantity of the included RCTs, the above conclusions are needed to be verified by more high quality and large sample RCTs.

关 键 词：复合树脂 间接修复 直接修复 后牙 随机对照试验 META分析 系统评价 

分 类 号：R783.3[医药卫生—口腔医学]