To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders’ perceptions in implementing and sustaining tooth brushing programs. This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability. The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines. This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.
目的：评估监督式刷牙计划在改善3至18岁儿童和青少年口腔健康结果方面的有效性，并探讨利益相关者对实施和维持刷牙计划的看法。方法：采用JBI方法学和PRISMA指南进行综合综述。系统检索了MEDLINE、Cochrane、Scopus、Web of Science、CINAHL、Epistemonikos、ProQuest和谷歌Scholar等数据库。共纳入159篇文献，经筛选，有3篇系统评价符合纳入标准。定量和定性的发现是综合使用收敛隔离的方法。理论领域框架（TDF）被用于绘制影响项目采用和可持续性的障碍和促进因素。结果：定量综合包括一项系统综述和四项纳入试验，其中两项发现在监督下刷牙可以显著减少龋齿。定性综合（两个混合方法的系统评价）揭示了关键的促进因素和障碍。在这些综述中发现的最突出的促进因素和障碍是关于口腔健康/刷牙的知识、社会影响、环境背景和资源。具体而言，知识领域收到了32个促进性回答和25个障碍性回答，强调了了解口腔健康实践对改善刷牙行为的重要性。社会支持获得了35个促成反应和26个障碍反应，突出了支持性环境在增强坚持刷牙习惯方面的作用。结论：本综述强调了监督刷牙计划在减少龋齿方面的有效性。在理论领域框架（TDF）的指导下，定性综合确定了主要障碍和促进因素，包括知识差距、环境约束、社会影响和行为调节因素。
{"title":"Supervised toothbrushing programs: evaluating impact, barriers, and facilitators – a mixed-method umbrella review","authors":"Chandrashekar Janakiram, Anju James, Sujay Vivek Vattiprolu, Nitika Monga, Monika Arora","doi":"10.1038/s41432-025-01178-9","DOIUrl":"10.1038/s41432-025-01178-9","url":null,"abstract":"To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders’ perceptions in implementing and sustaining tooth brushing programs. This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability. The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines. This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"176-177"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-26DOI: 10.1038/s41432-025-01181-0
Lucy Bennett, Lucy Tiplady, Greig Taylor
Rokhshad R, Banakar M, Shobeiri, P, Zhang P. Artificial intelligence in early childhood caries detection and prediction: a systematic review and meta-analysis. Pediatr Dent. 2024;46:385–394. A literature search was performed in May 2024 via PubMed, Scopus, Embase, Web of Science, Institute of Electrical and Electronics Engineer database sources, and across the grey literature. Further studies were identified after analysis of reference lists. The research question was defined using the population-intervention-comparison-outcome (PICO) framework. Studies published between 2010 and 2024 were included, that used artificial intelligence (AI) algorithms including machine learning (ML), deep learning (DL) and neutral networks (NN) for detecting and predicting early childhood caries (ECC). Exclusion occurred where the full text was inaccessible and non-English papers. Two independent reviewers screened titles and abstracts, with the use of a third reviewer in the case of any disagreement. The process was then repeated with the full texts to assess eligibility, again with a third reviewer where necessary. A total of 21 studies were used in the final analysis following assessment, 7 of which described ECC detection, and 14 for ECC prediction. The extracted data included author, publication year, study objectives, data modalities, datasets, annotation procedures, follow ups, ML test, AI model architecture, outcome measures and evaluation metrics. The findings were summarised descriptively. Quantitative synthesis was performed on six studies that reported sensitivity and specificity. Summary receiver operator characteristic curves were used to assess discriminatory ability. Statistical analysis was completed. A total of 21 studies were included in the final analysis. It revealed that AI based methods, especially DL algorithms showed promising results in detecting ECC, with accuracy range of 78–86%, sensitivity of 67–96%, and specificity from 81–99%. ECC prediction had accuracy range of 60-100%, sensitivity of 20–100%, and specificity of 54–94%. The pooled sensitivity and specificity of these studies was 80% and 81% respectively, with confidence intervals of 95%, indicating statistically significant effects. AI has demonstrated substantial potential in the detection and prediction of ECC. Further research is required to refine the technology and establish its application in paediatric dentistry.
Rokhshad R, Banakar M, Shobeiri， P, Zhang P.人工智能在儿童早期龋齿检测和预测中的应用综述。儿科杂志。2024;46:385-394。数据来源：文献检索于2024年5月通过PubMed， Scopus, Embase, Web of Science， Institute of Electrical and Electronics Engineer数据库资源和灰色文献进行。在对参考文献进行分析后，确定了进一步的研究。研究问题采用人口-干预-比较-结果（PICO）框架定义。研究选择：纳入了2010年至2024年间发表的研究，这些研究使用人工智能（AI）算法，包括机器学习（ML）、深度学习（DL）和神经网络（NN）来检测和预测儿童早期龋齿（ECC）。排除发生在全文无法访问和非英文论文。两名独立审稿人筛选标题和摘要，如果有任何分歧，则使用第三名审稿人。然后对全文重复该过程以评估合格性，必要时再次由第三方审稿人进行审查。评估后的最终分析共有21项研究，其中7项研究描述了ECC检测，14项研究描述了ECC预测。数据提取和综合：提取的数据包括作者、出版年份、研究目标、数据模式、数据集、注释过程、随访、ML测试、AI模型架构、结果测量和评估指标。对调查结果进行了描述性总结。对六项报告敏感性和特异性的研究进行了定量综合。摘要接收者操作者特征曲线用于评估鉴别能力。完成统计分析。结果：最终分析共纳入21项研究。结果表明，基于AI的方法，特别是DL算法在检测ECC方面显示出良好的效果，准确率范围为78-86%，灵敏度为67-96%，特异性为81-99%。ECC预测准确率为60-100%，灵敏度为20-100%，特异性为54-94%。这些研究的合并敏感性和特异性分别为80%和81%，置信区间为95%，表明有统计学意义。结论：人工智能在ECC的检测和预测方面显示出巨大的潜力。需要进一步的研究来完善该技术并确定其在儿科牙科中的应用。
{"title":"Can AI find the cavities in caries prediction and diagnosis?","authors":"Lucy Bennett, Lucy Tiplady, Greig Taylor","doi":"10.1038/s41432-025-01181-0","DOIUrl":"10.1038/s41432-025-01181-0","url":null,"abstract":"Rokhshad R, Banakar M, Shobeiri, P, Zhang P. Artificial intelligence in early childhood caries detection and prediction: a systematic review and meta-analysis. Pediatr Dent. 2024;46:385–394. A literature search was performed in May 2024 via PubMed, Scopus, Embase, Web of Science, Institute of Electrical and Electronics Engineer database sources, and across the grey literature. Further studies were identified after analysis of reference lists. The research question was defined using the population-intervention-comparison-outcome (PICO) framework. Studies published between 2010 and 2024 were included, that used artificial intelligence (AI) algorithms including machine learning (ML), deep learning (DL) and neutral networks (NN) for detecting and predicting early childhood caries (ECC). Exclusion occurred where the full text was inaccessible and non-English papers. Two independent reviewers screened titles and abstracts, with the use of a third reviewer in the case of any disagreement. The process was then repeated with the full texts to assess eligibility, again with a third reviewer where necessary. A total of 21 studies were used in the final analysis following assessment, 7 of which described ECC detection, and 14 for ECC prediction. The extracted data included author, publication year, study objectives, data modalities, datasets, annotation procedures, follow ups, ML test, AI model architecture, outcome measures and evaluation metrics. The findings were summarised descriptively. Quantitative synthesis was performed on six studies that reported sensitivity and specificity. Summary receiver operator characteristic curves were used to assess discriminatory ability. Statistical analysis was completed. A total of 21 studies were included in the final analysis. It revealed that AI based methods, especially DL algorithms showed promising results in detecting ECC, with accuracy range of 78–86%, sensitivity of 67–96%, and specificity from 81–99%. ECC prediction had accuracy range of 60-100%, sensitivity of 20–100%, and specificity of 54–94%. The pooled sensitivity and specificity of these studies was 80% and 81% respectively, with confidence intervals of 95%, indicating statistically significant effects. AI has demonstrated substantial potential in the detection and prediction of ECC. Further research is required to refine the technology and establish its application in paediatric dentistry.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"139-140"},"PeriodicalIF":2.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01181-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-23DOI: 10.1038/s41432-025-01180-1
Quang Tuan Lam, Minh Huu Nhat Le, I-Ta Lee, Nguyen Quoc Khanh Le
Recent advancements in the You Only Look Once (YOLO) algorithm show promise for dental caries diagnosis. We aimed to evaluate the diagnostic performance of different YOLO versions using photographic and radiographic images for caries detection. We searched PubMed (MEDLINE), EMBASE, Web of Science, and Scopus for studies up to December 12, 2024. Studies using any YOLO version for caries detection were included. Binary diagnostic accuracy data were extracted to calculate pooled sensitivity, specificity, and area under the curve (AUC) using a bivariate random-effects model. Quality was assessed with QUADAS-2 and the Radiomics Quality Score (RQS). This review is registered in PROSPERO (CRD42024615440). We included 15 studies in the systematic review and 14 in the meta-analysis. Overall, YOLO-based models achieved a pooled sensitivity of 79.3% and specificity of 84.9%, with an AUC of 0.832. YOLO using radiographic images demonstrated higher specificity (92.5% vs 72.0%) and AUC (0.847 vs 0.735) than using photographic images, while sensitivity was similar (78.6% vs 80.0%). Differences between YOLO versions (v5 and earlier vs v6 and later) and the use of external validation did not significantly affect diagnostic accuracy. Radiograph-based YOLO models showed superior specificity to photograph-based models, reflecting the higher diagnostic detail of radiographs. However, photographic approaches are completely radiation-free and more accessible, which could benefit screening in low-resource settings. Newer YOLO versions did not significantly outperform older versions, likely due to the limited complexity of the task and dataset constraints in current studies. YOLO algorithms provide a reliable tool for dental caries detection. Radiograph imaging combined with YOLO offers enhanced diagnostic specificity, while even older YOLO versions remain effective for caries detection in practice.
目的：你只看一次（YOLO）算法的最新进展显示了龋齿诊断的希望。我们的目的是评估不同的YOLO版本的诊断性能，使用摄影和放射图像检测龋。方法：检索截至2024年12月12日的PubMed （MEDLINE）、EMBASE、Web of Science和Scopus。使用任何YOLO版本进行龋齿检测的研究都包括在内。提取二元诊断准确性数据，使用二元随机效应模型计算合并敏感性、特异性和曲线下面积（AUC）。采用QUADAS-2和放射组学质量评分（RQS）评估质量。本综述已在PROSPERO注册（CRD42024615440）。结果：我们在系统评价中纳入了15项研究，在meta分析中纳入了14项研究。总体而言，基于yolo的模型的总灵敏度为79.3%，特异性为84.9%，AUC为0.832。x线影像的YOLO特异性（92.5% vs 72.0%）和AUC （0.847 vs 0.735）高于摄影影像，而灵敏度相似（78.6% vs 80.0%）。YOLO版本之间的差异（v5和更早的版本与v6和更高的版本）和外部验证的使用并没有显著影响诊断的准确性。讨论：基于x线片的YOLO模型比基于照片的模型具有更好的特异性，反映了x线片更高的诊断细节。然而，照相方法是完全无辐射和更容易获得的，这可能有利于在资源匮乏的情况下进行筛查。较新的YOLO版本并没有明显优于旧版本，这可能是由于当前研究中任务和数据集约束的复杂性有限。结论：YOLO算法为龋病检测提供了可靠的工具。x线影像结合YOLO提供了增强的诊断特异性，而即使是较老的YOLO版本在龋齿检测中仍然有效。
{"title":"Evaluating YOLO for dental caries diagnosis: a systematic review and meta-analysis","authors":"Quang Tuan Lam, Minh Huu Nhat Le, I-Ta Lee, Nguyen Quoc Khanh Le","doi":"10.1038/s41432-025-01180-1","DOIUrl":"10.1038/s41432-025-01180-1","url":null,"abstract":"Recent advancements in the You Only Look Once (YOLO) algorithm show promise for dental caries diagnosis. We aimed to evaluate the diagnostic performance of different YOLO versions using photographic and radiographic images for caries detection. We searched PubMed (MEDLINE), EMBASE, Web of Science, and Scopus for studies up to December 12, 2024. Studies using any YOLO version for caries detection were included. Binary diagnostic accuracy data were extracted to calculate pooled sensitivity, specificity, and area under the curve (AUC) using a bivariate random-effects model. Quality was assessed with QUADAS-2 and the Radiomics Quality Score (RQS). This review is registered in PROSPERO (CRD42024615440). We included 15 studies in the systematic review and 14 in the meta-analysis. Overall, YOLO-based models achieved a pooled sensitivity of 79.3% and specificity of 84.9%, with an AUC of 0.832. YOLO using radiographic images demonstrated higher specificity (92.5% vs 72.0%) and AUC (0.847 vs 0.735) than using photographic images, while sensitivity was similar (78.6% vs 80.0%). Differences between YOLO versions (v5 and earlier vs v6 and later) and the use of external validation did not significantly affect diagnostic accuracy. Radiograph-based YOLO models showed superior specificity to photograph-based models, reflecting the higher diagnostic detail of radiographs. However, photographic approaches are completely radiation-free and more accessible, which could benefit screening in low-resource settings. Newer YOLO versions did not significantly outperform older versions, likely due to the limited complexity of the task and dataset constraints in current studies. YOLO algorithms provide a reliable tool for dental caries detection. Radiograph imaging combined with YOLO offers enhanced diagnostic specificity, while even older YOLO versions remain effective for caries detection in practice.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"176-176"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1038/s41432-025-01179-8
Liana Rita Nicole Umbrio, Hieu Michael Pham, Abdul B. Barmak, Nasser Assery, Elli Anna Kotsailidi
To evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) on periodontal status through a systematic review and meta-analysis. Nine databases were searched for clinical studies up to September 2024 to identify clinical studies comparing periodontal parameters such as probing depth (PD), clinical attachment level (CAL), marginal bone level (MBL), and gingival and plaque indices (GI and PI) between SSRI-users and non-users. Study selection, data extraction, and risk of bias assessment were performed independently by two authors. Random-effects meta-analyses of mean differences (MD) were performed. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of available evidence. Five cross-sectional studies, including a total of 1254 patients (54.15% females) and 13170 teeth, were included. The use of SSRIs was significantly associated with inferior MBL (MD, 0.10; 95% confidence interval, 0.01 to 0.20) compared to non-users. No significant differences were observed in PD, CAL, and GI between SSRI-users and non-users. The overall quality of evidence was low, and all studies presented a moderate risk of bias. Based on a low level of available scientific evidence, the use of SSRIs has a marginal yet significant effect on MBL. However, there is no direct association between SSRIs usage and periodontal parameters such as PD, CAL, and GI. Nonetheless, further research is warranted.
{"title":"Association between selective serotonin reuptake inhibitors and the periodontal status: a systematic review and meta-analysis of observational clinical studies","authors":"Liana Rita Nicole Umbrio, Hieu Michael Pham, Abdul B. Barmak, Nasser Assery, Elli Anna Kotsailidi","doi":"10.1038/s41432-025-01179-8","DOIUrl":"10.1038/s41432-025-01179-8","url":null,"abstract":"To evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) on periodontal status through a systematic review and meta-analysis. Nine databases were searched for clinical studies up to September 2024 to identify clinical studies comparing periodontal parameters such as probing depth (PD), clinical attachment level (CAL), marginal bone level (MBL), and gingival and plaque indices (GI and PI) between SSRI-users and non-users. Study selection, data extraction, and risk of bias assessment were performed independently by two authors. Random-effects meta-analyses of mean differences (MD) were performed. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of available evidence. Five cross-sectional studies, including a total of 1254 patients (54.15% females) and 13170 teeth, were included. The use of SSRIs was significantly associated with inferior MBL (MD, 0.10; 95% confidence interval, 0.01 to 0.20) compared to non-users. No significant differences were observed in PD, CAL, and GI between SSRI-users and non-users. The overall quality of evidence was low, and all studies presented a moderate risk of bias. Based on a low level of available scientific evidence, the use of SSRIs has a marginal yet significant effect on MBL. However, there is no direct association between SSRIs usage and periodontal parameters such as PD, CAL, and GI. Nonetheless, further research is warranted.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 4","pages":"177-177"},"PeriodicalIF":2.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-15DOI: 10.1038/s41432-025-01174-z
StJohn Crean
{"title":"Dental science for the medical professional: an evidence-based approach.","authors":"StJohn Crean","doi":"10.1038/s41432-025-01174-z","DOIUrl":"https://doi.org/10.1038/s41432-025-01174-z","url":null,"abstract":"","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-19DOI: 10.1038/s41432-025-01175-y
Patrick Quinn, Mairead Harding
Leghrouz L, Khole M R, Splieth C H, Schmoekel J. Tooth Brushing Learning Methods: Differential or Conventional? – A Randomized Controlled Clinical Trial. Caries Res 2024; 58: 399–406. A two-arm single-blinded randomised controlled clinical trial to investigate the effects of the differential learning method versus conventional tooth brushing instruction by assessing changes in plaque levels and gingivitis in children aged three to eight years. Children aged three to eight years with poor oral hygiene at baseline, needing parental assistance with tooth brushing, and available to attend follow-up appointments were included in the study. Exclusion criteria included children with acute dental pain, those with serious systemic diseases requiring special attention during dental care, and those who refused to participate in the study. Participants were randomly assigned to the test and control groups by self-drawing an unlabelled envelope from a box. The sealed envelopes contained oral hygiene instructions with exercises to use the differential learning method for the test group and children in the control group received the usual tooth brushing instructions. Participants were asked to follow the instructions at home for 28 days. The sample size was calculated according to previous similar oral hygiene studies, with a final sample size of 29 participants in each group to allow for dropouts of approximately 30%. Data was analysed using Microsoft Excel, with the significance threshold set at p < 0.05. Descriptive analysis included the calculation of means, standard deviation, absolute numbers, and percentages. Comparisons between the two groups were made using the independent samples t-test for quantitative variables and the chi-squared test for categorical variables. Two calibrated and blinded examiners recorded the papillary bleeding index (PBI) and the Quigley-Hein Index for dental plaque (QHI) at baseline and at the first and second recall visits at four and twelve weeks respectively. Of the 58 children recruited for the study, 46 were included in the final analysis with 22 in the control group and 24 in the test group. At baseline, there were no significant differences between the groups with respect to plaque and gingival indices. At the first recall, a statistically significant difference in the PBI index was found in favour of the test group (test: 0.1 ± 0.2 v. control: 0.3 ± 0.2; p < 0.001) but the difference in relation to the QHI index was not statistically significant (test: 2.1 ± 0.9 v. control 2.6 ± 0.9; p = 0.07). At the second recall, statistically significant differences in both indices were found in favour of the test group (PBI test: 0.1 ± 0.2 v. PBI control: 0.5 ± 0.2; p < 0.001; QHI test: 2.1 ± 0.9 v. QHI control: 3.2 ± 1; p < 0.001). The authors of the study concluded that simple instructions with the differential learning method for home tooth brushing can lead to significantly greater improvements in oral hygiene in chi
Leghrouz L, Khole M R, splth C H, Schmoekel J.刷牙学习方法的差异与传统？一项随机对照临床试验。龋齿研究2024；58: 399 - 406。设计：一项双臂单盲随机对照临床试验，通过评估3至8岁儿童牙菌斑水平和牙龈炎的变化，研究差异学习方法与传统刷牙指导的影响。病例选择：研究对象为年龄在3至8岁之间、口腔卫生基线较差、需要父母帮助刷牙、可参加随访预约的儿童。排除标准包括患有急性牙痛的儿童、患有严重全身性疾病需要在牙科护理中特别注意的儿童以及拒绝参加研究的儿童。通过从一个盒子里自己画一个没有标签的信封，参与者被随机分配到试验组和对照组。密封的信封里有口腔卫生说明和练习，实验组的孩子使用不同的学习方法，对照组的孩子则接受常规的刷牙说明。参与者被要求在家中按照指示进行28天。数据分析：样本量是根据之前类似的口腔卫生研究计算的，每组最终样本量为29名参与者，允许大约30%的辍学率。结果：两名校准和盲法检查人员分别在基线和第4周和第12周的第一次和第二次召回访问时记录了牙菌斑的乳头状出血指数（PBI）和Quigley-Hein指数（QHI）。在参与研究的58名儿童中，有46名被纳入最终分析，其中22名在对照组，24名在试验组。在基线时，两组之间在菌斑和牙龈指数方面没有显著差异。在第一次召回时，发现实验组的PBI指数有统计学显著差异（测试：0.1±0.2 v）。对照：0.3±0.2；p结论：该研究的作者得出结论，与传统的口腔卫生指导相比，家庭刷牙的简单指导与差异学习方法可以显著改善口腔卫生，特别是在中期保持阶段。
{"title":"Tooth brushing learning methods: time to change practice?","authors":"Patrick Quinn, Mairead Harding","doi":"10.1038/s41432-025-01175-y","DOIUrl":"10.1038/s41432-025-01175-y","url":null,"abstract":"Leghrouz L, Khole M R, Splieth C H, Schmoekel J. Tooth Brushing Learning Methods: Differential or Conventional? – A Randomized Controlled Clinical Trial. Caries Res 2024; 58: 399–406. A two-arm single-blinded randomised controlled clinical trial to investigate the effects of the differential learning method versus conventional tooth brushing instruction by assessing changes in plaque levels and gingivitis in children aged three to eight years. Children aged three to eight years with poor oral hygiene at baseline, needing parental assistance with tooth brushing, and available to attend follow-up appointments were included in the study. Exclusion criteria included children with acute dental pain, those with serious systemic diseases requiring special attention during dental care, and those who refused to participate in the study. Participants were randomly assigned to the test and control groups by self-drawing an unlabelled envelope from a box. The sealed envelopes contained oral hygiene instructions with exercises to use the differential learning method for the test group and children in the control group received the usual tooth brushing instructions. Participants were asked to follow the instructions at home for 28 days. The sample size was calculated according to previous similar oral hygiene studies, with a final sample size of 29 participants in each group to allow for dropouts of approximately 30%. Data was analysed using Microsoft Excel, with the significance threshold set at p < 0.05. Descriptive analysis included the calculation of means, standard deviation, absolute numbers, and percentages. Comparisons between the two groups were made using the independent samples t-test for quantitative variables and the chi-squared test for categorical variables. Two calibrated and blinded examiners recorded the papillary bleeding index (PBI) and the Quigley-Hein Index for dental plaque (QHI) at baseline and at the first and second recall visits at four and twelve weeks respectively. Of the 58 children recruited for the study, 46 were included in the final analysis with 22 in the control group and 24 in the test group. At baseline, there were no significant differences between the groups with respect to plaque and gingival indices. At the first recall, a statistically significant difference in the PBI index was found in favour of the test group (test: 0.1 ± 0.2 v. control: 0.3 ± 0.2; p < 0.001) but the difference in relation to the QHI index was not statistically significant (test: 2.1 ± 0.9 v. control 2.6 ± 0.9; p = 0.07). At the second recall, statistically significant differences in both indices were found in favour of the test group (PBI test: 0.1 ± 0.2 v. PBI control: 0.5 ± 0.2; p < 0.001; QHI test: 2.1 ± 0.9 v. QHI control: 3.2 ± 1; p < 0.001). The authors of the study concluded that simple instructions with the differential learning method for home tooth brushing can lead to significantly greater improvements in oral hygiene in chi","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"135-136"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41432-025-01175-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-19DOI: 10.1038/s41432-025-01177-w
Reanna Craig, Gerry McKenna
{"title":"Correction: What role do luting cements play in zirconia crown survival?","authors":"Reanna Craig, Gerry McKenna","doi":"10.1038/s41432-025-01177-w","DOIUrl":"10.1038/s41432-025-01177-w","url":null,"abstract":"","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-19DOI: 10.1038/s41432-025-01176-x
Lydia Cross
Taylor KW, Eftim SE, Sibrizzi CA, Blain RB, Magnuson K, Hartman PA, Rooney AA, Bucher JR. Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatr 2025; 179: 282–292. A literature search without language restrictions was undertaken in October 2023 using the following databases: BIOSIS, Embase, PsycINFO, PubMed, Scopus, Web of Science, CNKI, and Wanfang. Two independent reviewers screened studies based on the title and abstract. Studies were included if the exposure was fluoride and the outcome was a quantitative measure of children’s intelligence. In studies with multiple fluoride exposure levels, the highest was considered the exposure and the lowest the reference. Exclusion criteria included case reports, articles without original data, and conference abstracts. Full text articles were then screened. Translation assistance was obtained for non-English studies. Data was extracted by one extractor and verified by a second. Risk-of-bias was evaluated by two independent trained assessors using the National Toxicology Programme’s OHAT approach. Three meta-analyses were conducted: mean-effects, dose-response mean-effects, and regression slopes. Subgroup and sensitivity analyses were undertaken, including subgroup analyses without high risk-of-bias studies. 74 studies were included, of which 59 reported mean IQ scores for group-level exposures and 19 reported regression slopes for individual-level exposures. Children exposed to higher levels of fluoride had statistically significantly lower IQs than those exposed to lower levels (standardised mean difference (SMD), −0.45; 95%CI, −0.57 to −0.33; P < 0.001). A dose-response association was also reported, with lower IQ scores reported with increasing fluoride exposure with a SMD of −0.15 (95%CI, −0.20 to −0.11; P < 0.001) for water fluoride levels and −0.15 (95%CI, −0.23 to −0.07; P < 0.001) for urinary fluoride levels. Fluoride exposure concentrations of <4 mg/L, <2 mg/L, and <1.5 mg/L were analysed. For water fluoride <1.5 mg/L, the association was not statistically significant. In the regression slopes meta-analysis, a 1 mg/L increase in urinary fluoride was associated with a decrease in IQ score of 1.63 points (95%CI, −2.33 to −0.93; P < 0.001); the effect size was smaller when analysis was limited to low risk-of-bias studies (decrease of 1.14 points (95%CI, −1.68 to −0.61; P < 0.001)). An inverse association was found between fluoride exposure and children’s IQ scores, including an inverse dose-response association. This association was less certain at water fluoride concentrations <1.5 mg/L.
Taylor KW, Eftim SE, Sibrizzi CA, Blain RB, Magnuson K, Hartman PA, Rooney AA, Bucher JR。氟化物暴露与儿童智商：系统评价和荟萃分析。JAMA pediatrics 2025；179: 282 - 292。数据来源：于2023年10月进行无语言限制的文献检索，检索数据库为：BIOSIS、Embase、PsycINFO、PubMed、Scopus、Web of Science、CNKI、万方。研究选择：两位独立审稿人根据标题和摘要筛选研究。如果接触的是氟化物，研究结果是对儿童智力的定量测量，研究也包括在内。在有多种氟化物接触水平的研究中，最高的被认为是接触，最低的被认为是参考。排除标准包括病例报告、没有原始数据的文章和会议摘要。然后对全文文章进行筛选。非英语研究获得了翻译协助。数据提取和合成：数据由一个提取器提取，由另一个提取器验证。偏倚风险由两名经过独立培训的评估人员使用国家毒理学规划的OHAT方法进行评估。进行了三项荟萃分析：平均效应、剂量-反应平均效应和回归斜率。进行了亚组和敏感性分析，包括无高偏倚风险研究的亚组分析。结果：纳入了74项研究，其中59项报告了群体水平暴露的平均智商分数，19项报告了个人水平暴露的回归斜率。接触较高水平氟化物的儿童的智商在统计学上显著低于接触较低水平氟化物的儿童(标准化平均差（SMD）， -0.45；95%CI, -0.57 ~ -0.33；结论：氟化物暴露与儿童智商得分呈负相关，包括剂量反应负相关。这种联系在水的氟化物浓度上不太确定
{"title":"Fluoride: friend or foe? Exploring the effect of fluoride exposure on children’s IQ scores","authors":"Lydia Cross","doi":"10.1038/s41432-025-01176-x","DOIUrl":"10.1038/s41432-025-01176-x","url":null,"abstract":"Taylor KW, Eftim SE, Sibrizzi CA, Blain RB, Magnuson K, Hartman PA, Rooney AA, Bucher JR. Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatr 2025; 179: 282–292. A literature search without language restrictions was undertaken in October 2023 using the following databases: BIOSIS, Embase, PsycINFO, PubMed, Scopus, Web of Science, CNKI, and Wanfang. Two independent reviewers screened studies based on the title and abstract. Studies were included if the exposure was fluoride and the outcome was a quantitative measure of children’s intelligence. In studies with multiple fluoride exposure levels, the highest was considered the exposure and the lowest the reference. Exclusion criteria included case reports, articles without original data, and conference abstracts. Full text articles were then screened. Translation assistance was obtained for non-English studies. Data was extracted by one extractor and verified by a second. Risk-of-bias was evaluated by two independent trained assessors using the National Toxicology Programme’s OHAT approach. Three meta-analyses were conducted: mean-effects, dose-response mean-effects, and regression slopes. Subgroup and sensitivity analyses were undertaken, including subgroup analyses without high risk-of-bias studies. 74 studies were included, of which 59 reported mean IQ scores for group-level exposures and 19 reported regression slopes for individual-level exposures. Children exposed to higher levels of fluoride had statistically significantly lower IQs than those exposed to lower levels (standardised mean difference (SMD), −0.45; 95%CI, −0.57 to −0.33; P < 0.001). A dose-response association was also reported, with lower IQ scores reported with increasing fluoride exposure with a SMD of −0.15 (95%CI, −0.20 to −0.11; P < 0.001) for water fluoride levels and −0.15 (95%CI, −0.23 to −0.07; P < 0.001) for urinary fluoride levels. Fluoride exposure concentrations of <4 mg/L, <2 mg/L, and <1.5 mg/L were analysed. For water fluoride <1.5 mg/L, the association was not statistically significant. In the regression slopes meta-analysis, a 1 mg/L increase in urinary fluoride was associated with a decrease in IQ score of 1.63 points (95%CI, −2.33 to −0.93; P < 0.001); the effect size was smaller when analysis was limited to low risk-of-bias studies (decrease of 1.14 points (95%CI, −1.68 to −0.61; P < 0.001)). An inverse association was found between fluoride exposure and children’s IQ scores, including an inverse dose-response association. This association was less certain at water fluoride concentrations <1.5 mg/L.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"137-138"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucchese A, Marcolina M, Mancini N et al. A comparison of the alterations of oral microbiome with fixed orthodontic therapy and clear aligners: a systematic review. J Oral Microbiol 2025; 17: 2372751. The review searched multiple electronic databases (PubMed, Cochrane Library, Embase, Web of Science, Scopus, Ovid, Dentistry and Oral Sciences Source) and gray literature (OpenGray) up to May 30, 2023. The selection of the studies was processed according to PRISMA guidelines. Two reviewers independently screened titles and abstracts, with disagreements resolved by a third reviewer. Full-text articles were then assessed for eligibility based on pre-defined inclusion/exclusion criteria (RCTs, nRCTs, cohort studies; at least two time points for analysis; minimum 10 patients; clear aligners vs. fixed appliances or comparison between them; patients with good systemic health not taking medications). Data extraction from the included studies was carried out by two reviewers in consultation with a third reviewer to define the variables for extraction and resolve any disagreements. Extracted data included study characteristics (author, year, design, sample size, patient age), intervention details, sample collection methods (saliva, plaque), microbial analysis methods (16S rRNA sequencing, PCR, BANA test), and microbiological outcomes. A qualitative synthesis was performed due to the heterogeneity of the included studies, precluding meta-analysis. A total of 484 articles were identified, with 9 studies that met the inclusion and exclusion criteria: eight non-randomized controlled trials and one randomized controlled trial. Sample sizes ranged from 10 to 77 participants. Various microbial analysis methods were employed, including 16S rRNA gene sequencing (5 studies), PCR (3 studies), and the BANA test (1 study). Following the application of rating scales, 1 article was classified as having a low risk of bias, 6 as having a moderate risk, and 2 as having a serious risk of bias. The review suggests that clear aligners may be associated with a less detrimental impact on the oral microbiome compared to fixed appliances, possibly due to improved oral hygiene. Both therapies alter the oral microbiome; however, the changes caused by aligners are more conducive to better oral health compared to fixed appliances.
评述：Lucchese A， Marcolina M， Mancini N等。固定正畸治疗和透明矫正器口腔微生物组变化的比较：一项系统综述。口腔微生物学杂志；17: 2372751。数据来源：本综述检索了截至2023年5月30日的多个电子数据库（PubMed, Cochrane Library, Embase, Web of Science, Scopus, Ovid, Dentistry and Oral Sciences Source）和灰色文献（OpenGray）。研究选择：根据PRISMA指南对研究进行选择。两位审稿人独立筛选标题和摘要，分歧由第三位审稿人解决。然后根据预先定义的纳入/排除标准评估全文文章的合格性(rct、nrct、队列研究；至少两个时间点进行分析；最少10名患者；明确对准器与固定器具或两者之间的比较；全身健康，不服用药物的患者)。数据提取和综合：从纳入的研究中提取数据由两名审稿人在与第三名审稿人协商后进行，以确定提取的变量并解决任何分歧。提取的数据包括研究特征（作者、年份、设计、样本量、患者年龄）、干预细节、样本收集方法（唾液、菌斑）、微生物分析方法（16S rRNA测序、PCR、BANA检测）和微生物学结果。由于纳入研究的异质性，排除了meta分析，进行了定性综合。结果：共纳入484篇文献，9项研究符合纳入和排除标准：8项非随机对照试验和1项随机对照试验。样本量从10到77人不等。采用多种微生物分析方法，包括16S rRNA基因测序（5项研究）、PCR（3项研究）和BANA检测（1项研究）。应用评定量表后，1篇文章被分类为低偏倚风险，6篇文章被分类为中等偏倚风险，2篇文章被分类为严重偏倚风险。结论：该综述表明，与固定矫治器相比，透明矫正器可能对口腔微生物群的有害影响较小，这可能是由于改善了口腔卫生。这两种疗法都能改变口腔微生物群；然而，与固定矫治器相比，矫正器带来的改变更有利于口腔健康。
{"title":"A comparative review of the oral microbiome in clear aligners and fixed orthodontic appliances","authors":"Anand Marya, Thantrira Porntaveetus, Katsushi Okazaki, Abdolreza Jamilian","doi":"10.1038/s41432-025-01173-0","DOIUrl":"10.1038/s41432-025-01173-0","url":null,"abstract":"Lucchese A, Marcolina M, Mancini N et al. A comparison of the alterations of oral microbiome with fixed orthodontic therapy and clear aligners: a systematic review. J Oral Microbiol 2025; 17: 2372751. The review searched multiple electronic databases (PubMed, Cochrane Library, Embase, Web of Science, Scopus, Ovid, Dentistry and Oral Sciences Source) and gray literature (OpenGray) up to May 30, 2023. The selection of the studies was processed according to PRISMA guidelines. Two reviewers independently screened titles and abstracts, with disagreements resolved by a third reviewer. Full-text articles were then assessed for eligibility based on pre-defined inclusion/exclusion criteria (RCTs, nRCTs, cohort studies; at least two time points for analysis; minimum 10 patients; clear aligners vs. fixed appliances or comparison between them; patients with good systemic health not taking medications). Data extraction from the included studies was carried out by two reviewers in consultation with a third reviewer to define the variables for extraction and resolve any disagreements. Extracted data included study characteristics (author, year, design, sample size, patient age), intervention details, sample collection methods (saliva, plaque), microbial analysis methods (16S rRNA sequencing, PCR, BANA test), and microbiological outcomes. A qualitative synthesis was performed due to the heterogeneity of the included studies, precluding meta-analysis. A total of 484 articles were identified, with 9 studies that met the inclusion and exclusion criteria: eight non-randomized controlled trials and one randomized controlled trial. Sample sizes ranged from 10 to 77 participants. Various microbial analysis methods were employed, including 16S rRNA gene sequencing (5 studies), PCR (3 studies), and the BANA test (1 study). Following the application of rating scales, 1 article was classified as having a low risk of bias, 6 as having a moderate risk, and 2 as having a serious risk of bias. The review suggests that clear aligners may be associated with a less detrimental impact on the oral microbiome compared to fixed appliances, possibly due to improved oral hygiene. Both therapies alter the oral microbiome; however, the changes caused by aligners are more conducive to better oral health compared to fixed appliances.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"26 3","pages":"132-134"},"PeriodicalIF":2.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1038/s41432-025-01170-3
Meenakshi Lall
Silva E J N L D, Pinto K P, Riche F N S J et al. Success of primary teeth pulpotomy using calcium silicate cements: a systematic review and meta-analysis of randomised clinical trials. Pediatr Dent 2024; 46: 373–395. This systematic review and meta-analysis of randomised clinical trials aimed to evaluate and compare the outcomes of pulpotomy procedures using Mineral Trioxide Aggregate (MTA) and other Calcium-Silicate Cements (CSCs). The review protocol was registered with PROSPERO (CRD42023479322) and adhered to PRISMA 2020 guidelines. Two independent reviewers conducted a comprehensive systematic search across PubMed®, Cochrane Library, Scopus, Web of Science™, Embase®, and ScienceDirect®, supplemented by manual searches and OpenGrey. Eligible studies were selected according to the PICOS criteria, including only randomised clinical trials that reported clinical and radiographic evaluations of pulpotomies with a minimum follow-up period of six months. The certainty of evidence was appraised using the GRADE framework, evaluating domains such as risk of bias, inconsistency, indirectness, imprecision, and publication bias. Two reviewers independently assessed the severity of each domain. Meta-analyses were performed using RevMan 5.3, comparing clinical and radiographic success rates of MTA pulpotomies with those of alternative materials, based on dichotomous outcomes and patient recall. Risk of bias was assessed using the Cochrane RoB-2 tool, and the overall certainty of evidence was determined according to the GRADE methodology. A total of 662 articles were initially identified, with 26 studies included after screening and full-text review. Quality appraisal showed seven studies at low risk of bias, two with some concerns, and 17 at high risk, mainly due to poor randomisation, missing intention-to-treat analyses, and high attrition. Despite challenges in radiographic blinding, outcome and reporting biases remained consistently low. Meta-analyses compared pulpotomy outcomes in primary teeth treated with MTA versus other CSCs. No significant differences were observed between MTA and Biodentine™ in clinical success (P > 0.05), though MTA showed higher radiographic success at 12 months (P < 0.05). No significant differences were found between MTA and TheraCal® or Portland cement (P > 0.05). Data were insufficient for analyses by pulpotomy type, tooth type, or irrigant used. The overall quality of evidence was low, due to a serious risk of bias and imprecision. Publication bias appeared minimal, and studies were free from private sector funding. This systematic review and meta-analysis demonstrated that mineral trioxide aggregate (MTA) and other calcium silicate-based cements (CSCs) are effective materials for managing pulpotomies in primary teeth. Although MTA exhibited superior treatment outcomes at 12 months compared to Biodentine™, no significant difference in overall efficacy was observed between the two materials at 24 months. However, th
评论：Silva E J N L D， Pinto K P， Riche F N S J等。硅酸钙骨水泥成功的乳牙切髓：随机临床试验的系统回顾和荟萃分析。儿科Dent 2024；46: 373 - 395。本研究对随机临床试验进行了系统回顾和荟萃分析，旨在评估和比较使用三氧化矿物骨料（MTA）和其他硅酸钙水泥（CSCs）进行髓切开术的结果。方法：审查方案在PROSPERO注册（CRD42023479322），并遵守PRISMA 2020指南。两位独立审稿人对PubMed®、Cochrane Library、Scopus、Web of Science™、Embase®和ScienceDirect®进行了全面的系统检索，并辅以人工检索和OpenGrey。根据PICOS标准选择符合条件的研究，仅包括随机临床试验，这些试验报告了髓质切开术的临床和放射学评估，随访时间至少为6个月。使用GRADE框架评估证据的确定性，评估偏倚风险、不一致性、间隔性、不精确性和发表偏倚等领域。两名评审人员独立评估每个领域的严重性。使用RevMan 5.3进行meta分析，比较MTA髓切术与替代材料髓切术的临床和影像学成功率，基于二分类结果和患者回忆。使用Cochrane rob2工具评估偏倚风险，并根据GRADE方法确定证据的总体确定性。结果：最初共纳入662篇文献，筛选和全文综述后纳入26篇研究。质量评估显示，7项研究存在低偏倚风险，2项存在一些问题，17项存在高风险，主要原因是随机化较差、缺少意向治疗分析和高损耗率。尽管放射学盲法存在挑战，但结果和报告偏差始终保持在较低水平。荟萃分析比较了MTA与其他CSCs治疗的乳牙切牙结果。MTA和Biodentine™在临床成功率方面没有显著差异（P < 0.05），尽管MTA在12个月时的放射学成功率更高（P < 0.05）。数据不充分，无法分析牙髓切开术类型、牙齿类型或使用的冲洗剂。由于严重的偏倚和不精确风险，证据的总体质量较低。发表偏倚似乎很小，而且研究没有得到私营部门的资助。结论：本系统综述和荟萃分析表明，矿物三氧化物聚集体（MTA）和其他硅酸钙基水泥（CSCs）是处理乳牙切髓术的有效材料。尽管MTA在12个月时的治疗效果优于Biodentine™，但在24个月时，两种材料的总疗效没有显著差异。然而，支持这些发现的证据的确定性被评估为较低，强调需要进一步的研究，采用可靠的研究设计和延长随访时间，以更全面地了解不同材料的椎髓切开术的结果。
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