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  • 學位論文

牙齒顏色修復體於恆牙第二級窩洞缺損的臨床表現統合分析

Meta-analysis of clinical performance of tooth-colored restoration for permanent teeth with class II cavity

指導教授 : 林立德
共同指導教授 : 杜裕康(Yu-Kang Tu)

摘要


目的: 臨床上我們很常會面對到窩洞大小為第二級以上的缺損,可使用的牙齒顏色填補材料為樹脂及陶瓷,製作方式又可分為直接、間接(嵌體、冠蓋體、局部牙冠、完整牙冠)。大部分在不同修復體設計的比較都是實驗室的研究,且沒有一個一致的結論。大部分的臨床研究也沒有足夠的資訊告訴我們間接修復體中,嵌體、冠蓋體、局部牙冠,有沒有牙阜的覆蓋及修磨量的多少,與直接修復體在使用不同的材料時,抗斷裂性(fracture resistance)及其他臨床表現上是否有差別。所以我們希望能夠集結許多臨床試驗,利用統合分析(meta-analysis),在這個部分做出一個統整。 材料與方法: 我們搜尋範圍包括電子資料庫(PubMed、Medline、CENTRAL、全國期刊聯合資料庫,中國知識資源總庫—CNKI 系列數據、全國博碩士論文資訊加值網、華藝線上圖書館),相關期刊進行人工手搜尋,及使用Google學術搜尋,從西元1997到2012年做全面系統性的搜尋。由失敗個數及「牙齒-年」計算事件發生率,使用統合分析方式比較使用不同材料及不同設計的修復體間臨床表現。 結果: 最後篩選出36篇文章,將研究中使用的修復體依材料及設計的不同分為7組,只有5組可以納入統計分析,分別是1.「複合樹脂直接填補」比「複合樹脂加上玻璃離子的三明治法」,2.「複合樹脂直接填補」比「複合樹脂嵌體/冠蓋體」,3.「複合樹脂嵌體/冠蓋體」比「陶瓷樹脂嵌體/冠蓋體」,4.「複合樹脂直接填補」間比較,5.「陶瓷嵌體或冠蓋體」間的比較。統計的結果各組間事件發生率的差異沒有達到統計上顯著的差異,但其中陶瓷嵌體的表現有比樹脂嵌體要好的趨勢。在各組中造成失敗的原因主要是修復體或牙齒的斷裂、蛀牙、牙髓問題。 結論:每組中進行統計分析的文章篇數皆不多,有可能因此使得彼此的差異不顯著,希望未來有更多的臨床試驗,可以做更詳盡的結果分析。此外或許可以使用更高階的Network meta-analysis,來將彼此間的結果串聯再一起。

並列摘要


Purpose: We often faced with the cavity size above standard class II cavity in daily practice. We can use the tooth-color restoration like composite and ceramics material and direct and indirect restoration (in/ onlays, partial crown, full coverage crown) to treat them. Most of the comparison of different prosthesis design are in vitro studies and there is no consistent finding. In addition, we don't have a clinical guideline for us to use the different materials and different designs of restoration. Therefore we want to use the meta-analysis method and search many clinical trials to compare the clinical performance between the tooth-colored restoration in class II defects and larger ones. Materials and methods: We did a comprehensive systematic search that includes many electronic databases (Pubmed, Medline, Google scholar, CENTRAL, STICNET in Taiwan, NDLTD in Taiwan, Airiti library in Taiwan, CNKI in China) and hand-searched the relevant journals from 1997 to 2012. By the number of failure and "Tooth - Year", we calculated the incidence rate and compared the clinical performance of different materials (composite and ceramics) and different designs of prosthesis by means of Meta-analysis. Results: We sieved out all articles and finally selected 36 articles. According to different materials and restoration designs, these articles are divided into 7 groups. At last, only 5 groups can be included in the Meta-analysis, 1.direct composite restoration v.s. composite direct restoration + GIC sandwich technique, 2.direct composite restoration v.s. composite in/onlays, 3."composite in/onlays v.s. ceramic in/onlays", 4.comparison between different types of composite resin direct restoration, 5.comparison between different types of ceramic in/onlays". There is no statistically significant difference of incidence rate in each groups. But the ceramic inlays tend to better than the composite inlays. The main failure mode in all groups are fracture of restoration or tooth, caries, endodontic problem. Conclusions: Because the quantity of articles in each groups are small, that may results in no significant difference between these groups. We need the more and better prospective clinical trials for Meta-analysis in the future. Moreover, we also can use the advanced statistical method just like Network meta-analysis that can combine the data from more different group .

參考文獻


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