Evidence-based dentistry最新文献_第4页

Systemic antimicrobials as an adjunct in the management of periodontitis – which drug is best? 全身用抗菌药作为牙周炎治疗的辅助手段--哪种药物最好？

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-13 DOI: 10.1038/s41432-024-01084-6

Ellis Hayes, Ryan McSorley

This study is a systematic review and meta-analysis that assesses systemic antimicrobials: azithromycin (AZT) and amoxicillin/metronidazole (AMX/MTZ), as adjuvants to subgingival instrumentation in the treatment of periodontitis. The aim is to establish if one antimicrobial is superior as an adjuvant therapy in the management of periodontal disease. This systematic review and meta-analysis included randomised controlled trials (RCTs), controlled clinical trials, and prospective and retrospective human studies. Participants had to be adults (≥18 years of age) with a diagnosis of periodontitis in the categories: chronic/aggressive, stages II/III, grades B/C. All participants completed full mouth subgingival instrumentation (SI) with the use of adjunct systemic antimicrobial therapy: the intervention group: AZT and the control group: AMX/MTZ. A total of 779 studies were retrieved from the data search; following the application of selection criteria and independent review duplicated by two authors, seven studies were eligible for review. Two studies were subsequently excluded due to insufficient information. Therefore five studies were included in the review, all were self-funded and four were conducted in recognised universities. The primary outcome measure was probing pocket depth changes at 1–12 months. Secondary outcome measures were: the number of residual sites with pocket depths ≥5 mm, clinical attachment levels, bleeding on probing, plaque indices (at 1–12 months), and occurrence of adverse events. Review Manager Software (The Cochrane Collaboration, Copenhagen, Denmark) was used to conduct meta-analysis. Heterogeneity between studies was expected, therefore the random-effects model was utilised to pool results from multiple studies. Statistical heterogeneity was assessed by I2 and Cochrane’s test for heterogeneity. The certainty of evidence was assessed and a summary of GRADE criteria: risk of bias, inconsistency, imprecision, indirectness and publication bias. Bias was graded for the five studies included in this meta-analysis and systematic review. Two studies were low risk, two were moderate risk and one was high risk. The study rated high for risk of bias was due to an incomplete description of blinding. Three of the studies were rated low bias for outcome measurement as they reported blinding of data assessors. No studies had deviations from the intended interventions and all outcomes were detected; therefore, all studies were rated as low bias for these domains. All five of the studies demonstrated changing in probing pocket depths at 1–3 months, however, the intervention and control cohorts showed no significant difference. One study showed a statistically significant difference in probing pocket depths at 12 months, in favour of AZT. This systematic review and meta-analysis demonstrates no statistically significant difference between the two cohorts: AZT and AMX/MTZ for mean changes in clinical attachment level, probing pocket depths

设计：本研究是一项系统性综述和荟萃分析，评估了阿奇霉素（AZT）和阿莫西林/甲硝唑（AMX/MTZ）这两种系统性抗菌药作为龈下器械治疗牙周炎的辅助药物。研究的目的是确定在牙周病的治疗中，是否有一种抗菌药作为辅助疗法更具优势：本系统综述和荟萃分析包括随机对照试验（RCT）、临床对照试验以及前瞻性和回顾性人类研究。参与者必须是成年人（≥18 岁），且诊断为慢性/侵袭性、II/III 期、B/C 级牙周炎。所有参与者都完成了全口龈下器械治疗（SI），并使用辅助系统抗菌疗法：干预组：AZT；对照组：AZT：干预组：AZT；对照组：AMX/MTZ：AMX/MTZ。数据搜索共检索到 779 项研究；在应用筛选标准并由两位作者重复进行独立审查后，有 7 项研究符合审查条件。随后，有两项研究因信息不足而被排除。因此，有五项研究被纳入审查范围，所有研究都是自筹资金进行的，其中四项研究是在公认的大学进行的：主要结果指标是1-12个月时探诊袋深度的变化。次要结果指标包括：袋深≥5 毫米的残留部位数量、临床附着水平、探诊出血量、斑块指数（1-12 个月时）和不良事件发生率。使用Review Manager软件（The Cochrane Collaboration，丹麦哥本哈根）进行荟萃分析。预计研究之间存在异质性，因此采用随机效应模型来汇总多项研究的结果。统计异质性通过 I2 和 Cochrane 的异质性检验进行评估。对证据的确定性进行了评估，并总结了 GRADE 标准：偏倚风险、不一致性、不精确性、间接性和发表偏倚。对纳入本次荟萃分析和系统综述的五项研究进行了偏倚分级。两项研究为低风险，两项为中度风险，一项为高度风险。被评为高偏倚风险的研究是由于盲法描述不完整。其中三项研究的结果测量偏倚风险被评为低，因为它们报告了数据评估者的盲法。没有研究偏离了预期的干预措施，而且所有结果都被检测到；因此，所有研究在这些方面都被评为低偏倚：所有五项研究都表明，探查袋深度在 1-3 个月时发生了变化，但干预组和对照组没有明显差异。一项研究显示，12 个月时探查袋深度的差异具有统计学意义，AZT 更胜一筹。这项系统回顾和荟萃分析表明，两个队列之间没有统计学意义上的显著差异：AZT和AMX/MTZ在1-3个月的临床附着水平、探诊袋深度或探诊出血的平均变化方面，在作为机械干预治疗牙周炎的辅助手段时，没有统计学意义上的差异。根据低度至中度确定性证据的记录，AZT队列的不良反应较少，1-3个月时探诊袋残留深度≥5毫米的部位也较少：根据这项系统综述和荟萃分析，在牙周病患者的辅助治疗中，使用 AZT 与 AMX/MTZ 相比，在统计学上没有明显的药物治疗优势。不过，中低度确定性证据显示，与 AMX/MTZ 相比，AZT 组群的不良反应较少，1-3 个月时残留牙周袋深度≥5 毫米的部位也较少。未来将有更多的临床试验和更强大的证据基础来验证目前的研究结果。

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引用次数: 0

Does adjunctive phototherapy have better outcomes than adjunctive antibiotic therapy for the management of peri-implantitis? 在治疗种植体周围炎时，辅助光疗是否比辅助抗生素治疗效果更好？

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-13 DOI: 10.1038/s41432-024-01082-8

Jacqueline Fraser, Vithurran Vijayenthiran

Elsevier’s Scopus, Web of Science and Pubmed through Medline identified 431 articles, which were reduced to 206 when duplicates were removed. 8 articles were screened, and 1 excluded after reading the full-text, leaving 7 studies. 6 of these were randomised controlled trials, and 1 a non-randomised controlled clinical trial. Studies selected were either blinded, double-blinded, split-mouth clinical studies, comparative or controlled clinical studies, or randomised controlled trials in humans. There were no limitations on year of publication or language of studies. Most studies had a control of mechanical debridement (MD) with adjuvant antibiotics; 1 was surgical therapy. The test group was MD with adjuvant phototherapy. Exclusions were in vitro reports, animal studies, treatment with sole laser therapy, treatment with no additional antimicrobial therapy alongside MD. Pre-prints, reviews, abstracts, opinion articles, editorials, case reports and case series were also excluded. Data were extracted electronically by a single author and a senior librarian from the 3 databases. Titles and abstracts of articles were screened by the author if they contained Medical Subject Headings either in free terms or with Boolean operators. Full text studies that met the inclusion criteria were included. Data were also searched manually in 6 journals. For missing or conflicting information, the author of the article was contacted for clarification. Data extracted were country of origin of article, study design, sample size, research groups, diagnostic criteria, frequency of intervention, follow-up visits, and outcome of parameters which included clinically: plaque index (PI), probing depth (PD), bleeding on probing (BOP) and radiographically: crestal bone loss (CBL). Additional data on lasers were also collected, although not all studies had complete data on this. RevMan was used for statistical analysis. Inconsistencies were evaluated using I2 value > 50% and Cochrane’s Q test, with a P value < 0.05 considered. Standard Mean Differences (SMD) were calculated and Confidence Interval was set at 95%. A random effects model was used for each meta-analysis. PI had no statistical difference, with high heterogeneity. PD had no statistical difference, with no heterogeneity. BOP had a statistically significant difference and a high level of heterogeneity, favouring adjunctive phototherapy. MBL had statistically non-significant differences between control and test groups, and no heterogeneity. The findings from the systematic review differed from the meta-analysis, suggesting that application of adjuvant phototherapy was equally as effective as adjunctive antibiotic therapy in outcomes such as PI, PD, BOP and MBL. The meta-analysis found that implants treated with adjuvant phototherapy had superior outcomes in relation to BOP only.

数据来源Elsevier的Scopus、Web of Science和Pubmed通过Medline检索到431篇文章，去除重复文章后减至206篇。对 8 篇文章进行了筛选，1 篇在阅读全文后被排除，剩下 7 项研究。其中 6 篇为随机对照试验，1 篇为非随机对照临床试验：所选研究均为盲法、双盲法、分口临床研究、对比或对照临床研究，或人体随机对照试验。对研究的发表年份或语言没有限制。大多数研究的对照组是机械清创（MD）和辅助抗生素；其中一项是手术疗法。试验组为机械清创加辅助光疗。不包括体外报告、动物研究、仅使用激光疗法的治疗、在使用 MD 的同时未使用额外抗菌疗法的治疗。还排除了预印本、综述、摘要、观点文章、社论、病例报告和病例系列：数据由一位作者和一位资深图书管理员从 3 个数据库中以电子方式提取。如果文章的标题和摘要中包含医学主题词，则由作者用自由词或布尔运算符对其进行筛选。符合纳入标准的研究报告全文被纳入其中。此外，还人工搜索了 6 种期刊的数据。对于缺失或相互矛盾的信息，会联系文章作者进行澄清。提取的数据包括文章来源国、研究设计、样本大小、研究小组、诊断标准、干预频率、随访和参数结果，其中临床参数包括：牙菌斑指数（PI）、探诊深度（PD）、探诊出血量（BOP）；影像学参数包括：骨嵴骨质流失（CBL）。此外，还收集了有关激光的其他数据，但并非所有研究都有这方面的完整数据。RevMan用于统计分析。使用 I2 值>50%和 Cochrane's Q 检验来评估不一致性，并得出 P 值结果：PI 没有统计学差异，异质性较高。PD无统计学差异，无异质性。BOP 在统计学上有显著差异，异质性较高，倾向于辅助光疗。MBL 在对照组和试验组之间的差异无统计学意义，且无异质性：系统综述的结果与荟萃分析的结果不同，它表明在 PI、PD、BOP 和 MBL 等结果方面，辅助光疗与辅助抗生素治疗同样有效。荟萃分析发现，使用辅助光疗治疗的植入物仅在 BOP 方面具有更好的疗效。

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引用次数: 0

Pondering the problem of peri-implant pathology 思考种植体周围病变的问题。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-12 DOI: 10.1038/s41432-024-01083-7

Ajay S. Kotecha, Amelia Nadia Karim

Randomised control trials were identified via searches of PubMed, Embase, Web of Science and The Cochrane Library. Only randomised control trials involving adults with at least a single dental implant which had experienced peri-implant mucositis or peri-implantitis were considered. Within studies, one cohort must have been treated with a combination of mechanical debridement (MD) and non-surgical strategies, and the other solely by mechanical debridement. Outcomes were measured using periodontal indices such as bleeding on probing, and each group needed to comprise minimum five patients. Extracted information included the name of the lead author, size of patient groups, length of follow-up and the main results from the studies. The results indicated that in peri-implantitis the most effective treatment in reducing periodontal pocketing depths (PPDs) was photo biomodulation therapy and MD, while systemic antibiotics and MD were the most effective in improving clinical attachment loss and marginal bone loss. With regards to peri-implant mucositis; probiotics and MD yielded the best improvement in PPDs and plaque index, whereas systemic antibiotics with MD improved bleeding on probing the most. This analysis gives potentially useful data regarding specific treatment combinations for peri-implant disease. In light of this, it may help in guiding clinical decisions, but should be used in conjunction with recognised guidelines, and further high quality primary research is still required in the field.

数据来源：随机对照试验通过搜索 PubMed、Embase、Web of Science 和 Cochrane 图书馆来确定：只考虑至少有一个种植体的成人，且曾经历过种植体周围粘膜炎或种植体周围炎的随机对照试验。在这些研究中，必须有一组人同时接受了机械清创（MD）和非手术疗法的治疗，另一组人则只接受了机械清创治疗。研究结果采用牙周指数（如探诊出血）进行测量，每组至少包括五名患者：提取的信息包括主要作者姓名、患者组别、随访时间和研究的主要结果：结果表明，对于种植体周围炎，减少牙周袋深度（PPDs）最有效的治疗方法是光生物调节疗法和MD，而全身性抗生素和MD对改善临床附着丧失和边缘骨丧失最有效。在种植体周围粘膜炎方面，益生菌和MD对PPDs和牙菌斑指数的改善效果最好，而全身性抗生素和MD对探诊出血的改善效果最好：这项分析提供了有关种植体周围疾病特定治疗组合的潜在有用数据。有鉴于此，它可能有助于指导临床决策，但应与公认的指南结合使用，该领域仍需进一步开展高质量的基础研究。

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引用次数: 0

Routine antibiotic prophylaxis and early implant failure: is there a link? 常规抗生素预防与早期植入失败：两者之间有联系吗？

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-11 DOI: 10.1038/s41432-024-01086-4

Mojtaba Mehrabanian, Hassan Mivehchi, Mojtaba Dorri

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30–1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.

数据来源：截至 2023 年 10 月 1 日，在多个数据库（PubMed 通过 MEDLINE、Cochrane 图书馆和 Web of Science）中进行了系统检索。同时还对参考文献列表进行了人工筛选，并在临床试验登记处进行了搜索，以确保研究的全面覆盖：仅纳入对接受牙科种植手术的全身健康者进行抗生素预防与不使用抗生素或安慰剂比较的随机对照试验（RCT）。不包括偏倚风险高的研究、非随机研究以及没有安慰剂或对照组的研究。此外，还排除了针对病情严重的患者或其他种植技术（如微型种植体或在根尖病变部位即刻种植）的研究：数据提取由两位作者独立完成，存在分歧时由所有综述作者讨论解决。采用科克伦偏倚风险工具（RoB-2）评估了每项纳入的随机对照试验（RCT）的偏倚风险。证据质量采用建议、评估、发展和评价分级（GRADE）框架进行评估。采用随机效应模型进行 Meta 分析，并通过 I² 统计量和 Q 检验检查异质性：最初共确定了 1267 项研究，最终有 7 项随机对照试验 (RCT) 符合纳入标准，包括来自 1859 名参与者和 3014 个植入物的数据。其中四项研究质量较高，三项研究质量中等。对这些研究进行的元分析表明，使用抗生素预防与减少早期牙科植入失败之间并无统计学意义（RR：0.66，95% CI：0.30-1.47）。预防一次种植失败所需的治疗次数（NNT）为143次，这表明抗生素在预防早期种植失败方面的效果有限：研究得出结论：常规抗生素预防并不能显著降低体格健壮的患者早期种植失败的风险。鉴于抗生素的作用非常有限，而且抗生素耐药性的增加令人担忧，因此应避免在牙科种植手术中常规使用抗生素。

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引用次数: 0

Bone graft substitutes and dental implant stability in immediate implant surgery: a systematic review and meta-analysis. 骨移植替代物与即刻种植手术中牙科种植体的稳定性：系统回顾与荟萃分析。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-11 DOI: 10.1038/s41432-024-01077-5

Shanthi Vanka, Fatima Abul Kasem, Tasnem Kailani, Othman Wali, Amit Vanka

Introduction: Implant dentistry is currently being revolutionized by breakthroughs in techniques, technology, and material, there are few systematic reviews and meta-analyses that examine the effects of utilizing different bone graft substitutes in immediate implant placement surgeries.

Aim: The purpose of this research is to systematically review and meta-analyze the effect that different bone graft substitutes have on implant stability when concurrently utilized in patients undergoing immediate implant surgeries.

Methodology: The PICO criteria were used to construct the focused question, and the systematic review has been outlined as per the PRISMA guidelines. The revised Cochrane risk-of-bias method for randomized trials was used to assess the risk of bias for the selected articles. To derive estimates for the results, random effects meta-analysis was conducted on the selected articles.

Results: The electronic databases were searched and a total of 1583 articles were identified. After title and abstract screening and due to problems in retrieval a further 1358 articles were eliminated. Fifteen articles were finally chosen to be qualified for review. Of which full text evaluation of 5 articles were found to meet the eligibility criteria and were therefore included in the systematic review.

Conclusion: This systematic review and meta-analysis on the stability of dental implants and bone graft substitutes in immediate implant surgery, was unable to draw any conclusions and established no statistically significant correlation between the different types of grafts used and implant stability.

导言：目的：本研究的目的是系统回顾和荟萃分析在即刻种植手术中同时使用不同骨移植替代物对种植体稳定性的影响：采用 PICO 标准构建重点问题，并根据 PRISMA 指南概述系统综述。修订后的 Cochrane 随机试验偏倚风险法用于评估所选文章的偏倚风险。为了得出结果的估计值，对所选文章进行了随机效应荟萃分析：对电子数据库进行了检索，共找到 1583 篇文章。经过标题和摘要筛选后，由于检索问题，又有 1358 篇文章被排除。最后有 15 篇文章被选中进行审查。其中 5 篇文章的全文评估符合资格标准，因此被纳入系统综述：这项关于即刻种植手术中牙科种植体和骨移植替代物稳定性的系统性综述和荟萃分析无法得出任何结论，也无法确定所使用的不同移植类型与种植体稳定性之间存在统计学意义上的显著相关性。

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引用次数: 0

A systematic review of the implications of lipocalin-2 expression in periodontal disease. 脂钙蛋白-2表达对牙周病影响的系统性综述。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-08 DOI: 10.1038/s41432-024-01070-y

Diana L Solís-Suárez, Saúl E Cifuentes-Mendiola, Ana L García-Hernández

Objective: Evidence suggests that lipocalin-2 (LCN-2), a bone-derived protein, is upregulated in periodontal diseases. This systematic review aimed to evaluate LCN-2 concentrations in individuals with periodontal diseases, identifying the most suitable body fluids for its detection, the type of periodontal disease with the highest LCN-2 expression, its association with other inflammatory markers and systemic diseases, and whether its expression can be modified by periodontal treatment.

Methods: A systematic search of Google Scholar, PubMed, and ProQuest up to August 2024 was conducted. The studies were screened and selected by the authors according to specific eligibility criteria. Quality assessment of the included studies was performed according to the study type using STROBE statement for observational studies or the modified Jadad scale for experimental studies. The review was registered in PROSPERO (CRD42023458565).

Results: In total, three thousand six hundred and thirty-eight reports were identified, of which twenty-seven were full-text assessed for eligibility, including eleven articles. Seven articles were observational, and four were experimental. Significantly elevated LCN-2 levels were reported in patients with periodontal disease across 9 studies, being higher in periodontitis rather than gingivitis. LCN-2 was mainly detected in gingival crevicular fluid (GCF) and saliva. LCN-2 expression is related to the increment of inflammatory markers, and periodontal therapy decreases LCN-2 concentrations. LCN-2 levels were aggravated when periodontitis was accompanied by obesity and type 2 diabetes.

Conclusion: LCN-2 is implicated in periodontal diseases, probably through the inflammation process.

目的：有证据表明，脂钙蛋白-2（LCN-2）是一种骨源性蛋白，在牙周疾病中上调。本系统综述旨在评估牙周病患者体内的 LCN-2 浓度，确定最适合检测 LCN-2 的体液、LCN-2 表达量最高的牙周病类型、LCN-2 与其他炎症标志物和全身性疾病的关系，以及牙周治疗是否能改变 LCN-2 的表达：方法：对截至 2024 年 8 月的 Google Scholar、PubMed 和 ProQuest 进行了系统检索。作者根据特定的资格标准对研究进行了筛选。根据研究类型对纳入的研究进行质量评估，对观察性研究采用 STROBE 声明，对实验性研究采用修改后的 Jadad 量表。综述已在 PROSPERO（CRD42023458565）上注册：结果：总共发现了三千六百三十八篇报告，其中二十七篇经过全文资格评估，包括十一篇文章。七篇为观察性文章，四篇为实验性文章。9项研究均报告牙周病患者的LCN-2水平显著升高，牙周炎患者的LCN-2水平高于牙龈炎患者。LCN-2 主要在牙龈缝隙液（GCF）和唾液中检测到。LCN-2 的表达与炎症标志物的增加有关，牙周治疗会降低 LCN-2 的浓度。当牙周炎伴有肥胖和 2 型糖尿病时，LCN-2 水平会升高：结论：LCN-2 可能通过炎症过程与牙周疾病有关。

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引用次数: 0

Effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients attending dental clinics - a systematic review and meta-analysis. 行为疗法和吸入镇静剂对减轻牙科门诊患者牙科焦虑症的效果--系统回顾和荟萃分析。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-06 DOI: 10.1038/s41432-024-01081-9

Greeshma Unnikrishnan, Abhinav Singh, Bharathi M Purohit

Objective: The study aims to compare the effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients visiting dental clinics.

Methods: A search was conducted in PubMed, Cochrane databases, Scopus, and Google scholar through August 2024. All the randomized control trials, cohort studies, case control, cross-sectional studies that evaluated the effectiveness of behavioural therapy with inhalational/conscious sedation among children and adults to reduce dental anxiety were included. Outcome assessed was change in the dental anxiety scores as measured by the validated tools. PRISMA guidelines were followed for the meta-analysis. Meta-analysis was conducted using Cochrane Review Manager (Revman) version 5.3. Random effects model was used to compare the two groups in reducing dental anxiety. Quality of the studies included was evaluated using the Risk of Bias Assessment tool and Newcastle-Ottawa tool. Heterogeneity was assessed using I² values. Certainty of evidence was assessed using GRADE pro software. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024581013.

Results: A total of 940 participants were included in the analysis. Behavioural therapy was significantly more effective than inhalational sedation in reducing dental anxiety among patients prior to the dental treatment (SMD: -0.87; 95% CI: -1.29 to -0.45; P < 0.0001; I²:78%). Additionally, behavioural therapy demonstrated more effectiveness than inhalational sedation in reducing the dental anxiety among children (SMD: -0.64; 95% CI: -1.16 to -0.11, P = 0.02%; I²:88%). Certainty of evidence was high among the randomized controlled trials and moderate among the observational studies.

Conclusion: The findings of this review and meta-analysis suggests that behavioural therapy is more effective than inhalational sedation in reducing dental anxiety specifically among children.

研究目的本研究旨在比较行为疗法和吸入镇静剂在减轻牙科诊所就诊患者牙科焦虑症方面的效果：在 PubMed、Cochrane 数据库、Scopus 和 Google scholar 中进行了搜索，搜索时间截至 2024 年 8 月。所有评估行为疗法与吸入/意识镇静对儿童和成人减轻牙科焦虑有效性的随机对照试验、队列研究、病例对照和横断面研究均被纳入其中。评估的结果是通过有效工具测量的牙科焦虑评分的变化。荟萃分析遵循 PRISMA 指南。荟萃分析使用 Cochrane Review Manager (Revman) 5.3 版进行。随机效应模型用于比较两组研究在减轻牙科焦虑方面的效果。使用偏倚风险评估工具和纽卡斯尔-渥太华工具评估了纳入研究的质量。异质性采用 I2 值进行评估。证据的确定性使用 GRADE pro 软件进行评估。研究方案已在 PROSPERO（CRD-NIHR）数据库注册，参考编号为 CRD42024581013：结果：共有 940 名参与者参与了分析。在减轻牙科治疗前患者的牙科焦虑方面，行为疗法明显比吸入镇静剂更有效（SMD：-0.87；95% CI：-1.29 至 -0.45；P 2：78%）。此外，在减少儿童牙科焦虑方面，行为疗法比吸入镇静剂更有效（SMD：-0.64；95% CI：-1.16 至 -0.11，P = 0.02%；I2：88%）。随机对照试验的证据确定性较高，观察性研究的证据确定性中等：本综述和荟萃分析的结果表明，在减少儿童牙科焦虑方面，行为疗法比吸入镇静剂更有效。

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引用次数: 0

Effectiveness of hand and rotary instrumentations during biomechanical preparation in primary teeth: an umbrella review with evidence stratification. 乳牙生物力学预备过程中手动器械和旋转器械的有效性：带证据分层的总体综述。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-04 DOI: 10.1038/s41432-024-01080-w

Arun Kumar Patnana, Krupal Joshi, Satya Narain, Shantanu Choudhari, Ashwini Agarwal, Pravin Kumar

Aims/objectives: Biomechanical preparation (BMP) of primary teeth often involves using hand and rotary instruments. This study aimed to assess the effectiveness of hand and rotary instruments during BMP in primary teeth.

Methods: A thorough search for relevant systematic reviews and meta-analyses (SRMAs) was conducted in four databases, including MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. The primary outcome assessed was the instrumentation time (IT) for BMP, and the identified SRMAs were qualitatively analysed using the ROBIS tool. Furthermore, quantitative analysis, evidence stratification, and GRADE analysis of eligible SRMAs were performed using the browser-based R package metaumbrella software.

Results: Six SRMAs addressing the research question were included, with five being evaluated as having a high risk of bias (ROB). The findings indicated that the IT required for BMP in primary teeth was 3.2 min less (95% CI = 1.52 to 4.93; I² = 96%; P = < 0.001) using rotary instruments compared to hand instruments, with a 'class IV' evidence stratification and 'very low' class of evidence.

Conclusions: Based on the existing evidence, it can be inferred that there is insufficient quality data to recommend the use of rotary instruments over hand instruments in primary teeth.

目的/目标：乳牙的生物力学预备（BMP）通常需要使用手动和旋转器械。本研究旨在评估手用器械和旋转器械在基牙生物力学预备过程中的有效性：方法：在 MEDLINE、EMBASE、Google Scholar 和 Cochrane Library 等四个数据库中对相关的系统综述和荟萃分析 (SRMA) 进行了全面搜索。评估的主要结果是 BMP 的器械植入时间（IT），并使用 ROBIS 工具对确定的 SRMA 进行了定性分析。此外，还使用基于浏览器的 R 软件包 metaumbrella 对符合条件的 SRMA 进行了定量分析、证据分层和 GRADE 分析：结果：针对研究问题纳入了六项SRMA，其中五项被评估为高偏倚风险（ROB）。研究结果表明，基牙BMP所需的IT时间减少了3.2分钟（95% CI = 1.52至4.93；I2 = 96%；P = 结论：根据现有证据可以推断，没有足够的高质量数据建议在乳牙治疗中使用旋转器械而非手工器械。

{"title":"Effectiveness of hand and rotary instrumentations during biomechanical preparation in primary teeth: an umbrella review with evidence stratification.","authors":"Arun Kumar Patnana, Krupal Joshi, Satya Narain, Shantanu Choudhari, Ashwini Agarwal, Pravin Kumar","doi":"10.1038/s41432-024-01080-w","DOIUrl":"10.1038/s41432-024-01080-w","url":null,"abstract":"Aims/objectives: Biomechanical preparation (BMP) of primary teeth often involves using hand and rotary instruments. This study aimed to assess the effectiveness of hand and rotary instruments during BMP in primary teeth.Methods: A thorough search for relevant systematic reviews and meta-analyses (SRMAs) was conducted in four databases, including MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. The primary outcome assessed was the instrumentation time (IT) for BMP, and the identified SRMAs were qualitatively analysed using the ROBIS tool. Furthermore, quantitative analysis, evidence stratification, and GRADE analysis of eligible SRMAs were performed using the browser-based R package metaumbrella software.Results: Six SRMAs addressing the research question were included, with five being evaluated as having a high risk of bias (ROB). The findings indicated that the IT required for BMP in primary teeth was 3.2 min less (95% CI = 1.52 to 4.93; I2 = 96%; P = < 0.001) using rotary instruments compared to hand instruments, with a 'class IV' evidence stratification and 'very low' class of evidence.Conclusions: Based on the existing evidence, it can be inferred that there is insufficient quality data to recommend the use of rotary instruments over hand instruments in primary teeth.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575645","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}

引用次数: 0

What role does antibiotic resistance play in secondary endodontic infections? 抗生素耐药性在牙髓继发感染中扮演什么角色？

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-11-04 DOI: 10.1038/s41432-024-01079-3

Arunika Nehra, Melissa Sin

The systematic review utilised multiple electronic databases to gather relevant literature, including PubMed, Scopus, EMBASE, Web of Science, and Medline. The search was conducted focusing on clinical studies where Enterococcus strains were isolated to assess their antimicrobial resistance. The search strategy was designed based on the PICO model, targeting patients with secondary/persistent endodontic infections (SPEI) and evaluating the resistance profiles of Enterococci to systemic antibiotics. A total of 584 studies were initially identified through database searches. After removing duplicates, 517 studies were excluded based on title and abstract screening, leading to the final inclusion of 11 clinical trials that met the eligibility criteria. The studies were conducted in various countries, including Brazil, Lithuania, Poland, Germany, Sweden, the United States, and Japan. The focus was on permanent teeth with post-treatment apical periodontitis undergoing endodontic retreatment. Data extraction was performed independently by two reviewers, who compiled details such as authorship, year of publication, country of study, sample groups, bacterial strains tested, antibiotics used, and resistance outcomes. The risk of bias was assessed using the ROB-2 platform, and all studies were considered to have a low risk of bias, with occasional minor deficiencies noted. The analysis revealed fluctuating resistance profiles of Enterococcus faecalis (E. faecalis) and Enterococcus faecium (E. faecium) to various antibiotics over time. E. faecalis isolated from teeth with SPEI showed intermediate resistance to 16 antibiotics. The most effective antibiotics identified were the combination of amoxicillin and clavulanate, followed by amoxicillin and benzylpenicillin. In patients with penicillin allergies, moxifloxacin and azithromycin were suggested as alternatives, albeit with caution due to their varying resistance levels. The antibiotics demonstrating the highest resistance patterns against E. faecalis included clindamycin, gentamicin, metronidazole, and rifampicin, which are contraindicated in SPEI cases. Ongoing monitoring of antibiotic resistance patterns is crucial for effective endodontic treatment protocols. The emergence of resistance among Enterococci, particularly E. faecalis, necessitates regular susceptibility testing to inform clinical decisions and improve treatment outcomes. The findings underscore the need for health professionals to stay informed about the evolving resistance landscape to ensure safe and effective therapeutic regimens in endodontics.

数据来源：系统性综述利用多个电子数据库收集相关文献，包括 PubMed、Scopus、EMBASE、Web of Science 和 Medline。检索的重点是分离肠球菌菌株以评估其抗菌药耐药性的临床研究。搜索策略是根据 PICO 模型设计的，目标是继发性/顽固性牙髓感染（SPEI）患者，并评估肠球菌对全身抗生素的耐药性情况：通过数据库搜索，初步确定了 584 项研究。在去除重复研究后，根据标题和摘要筛选排除了 517 项研究，最终纳入了 11 项符合资格标准的临床试验。这些研究在不同国家进行，包括巴西、立陶宛、波兰、德国、瑞典、美国和日本。研究重点是接受牙髓再治疗的根尖牙周炎治疗后的恒牙：数据提取由两名审稿人独立完成，他们汇总了作者、发表年份、研究国家、样本组、检测的细菌菌株、使用的抗生素和耐药结果等详细信息。使用 ROB-2 平台对偏倚风险进行了评估，认为所有研究的偏倚风险较低，偶尔会发现一些小的不足。分析结果表明，随着时间的推移，粪肠球菌和粪肠球菌对各种抗生素的耐药性会发生波动：结果：从患有 SPEI 的牙齿中分离出的粪肠球菌对 16 种抗生素表现出中等耐药性。最有效的抗生素是阿莫西林和克拉维酸的复方制剂，其次是阿莫西林和苄青霉素。对于青霉素过敏的患者，建议使用莫西沙星和阿奇霉素作为替代品，但由于这两种抗生素的耐药性水平不同，使用时需谨慎。对粪肠球菌耐药性最高的抗生素包括克林霉素、庆大霉素、甲硝唑和利福平，这些药物在 SPEI 病例中是禁用的：结论：持续监测抗生素耐药性模式对于有效的牙髓治疗方案至关重要。肠球菌，尤其是粪肠球菌耐药性的出现要求定期进行药敏试验，以便为临床决策提供依据并改善治疗效果。研究结果强调，医疗专业人员需要随时了解不断变化的耐药性情况，以确保牙髓病学治疗方案的安全和有效。

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引用次数: 0

Contemporary Dental Pharmacology: Evidence-Based Considerations 当代牙科药理学：基于证据的考虑。

Q3 Dentistry

Evidence-based dentistry

Pub Date : 2024-10-31 DOI: 10.1038/s41432-024-01074-8

Nafeesa Hussain

引用次数: 0