- 學位論文
使用Biodentine和MTA進行乳牙冠髓切除術療效之比較
Comparison of Pulpotomy with Biodentine and Mineral Trioxide Aggregate in Primary Teeth :a Meta-Analysis
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摘要
本研究旨在比較Biodentine和MTA在乳牙冠髓切除術中的療效，通過系統性回顧和統合分析評估其臨床和放射學成功率。乳牙的早期脫落可能導致兒童在功能和美觀方面的諸多問題，因此維持乳牙的健康至關重要。乳牙冠髓切除術是用於治療牙髓暴露的常見方法，而Biodentine和MTA是兩種常用的冠髓切除術的材料。納入2010年至2023年間發表的隨機對照試驗(Randomized controlled trials,RCTs），這些試驗比較了Biodentine和MTA在乳牙冠髓切除術中的有效性，且隨訪時間均為6個月或以上。通過臨床和放射學成功率以及牙根吸收和根管鈣化(pulp canal obliteration, PCO)共四項牙髓治療結果來評估其療效。本系統性回顧和統合分析共納入10項RCTs，包括584名患者和646顆乳牙。結果顯示，兩種材料在隨訪6個月、12個月、18個月和24個月時的臨床成功率相當（6個月：RR=1.00，95% CI, 0.98-1.03；12個月：RR=1.01，95% CI, 0.97-1.05；18個月：RR=0.99，95% CI, 0.94-1.05；24個月：RR=1.01，95% CI, 0.92-1.11），且在各時間點的異質性均不顯著（6個月：P=1.00，I²=0%；12個月：P=0.88，I²=0%；18個月：P=0.58，I²=0%；24個月：P=0.58，I²=0%）。放射學成功率的比較同樣顯示兩者之間無顯著差異（6個月：RR=0.99，95% CI, 0.97-1.02；12個月：RR=1.00，95% CI, 0.96-1.04；18個月：RR=1.02，95% CI, 0.94-1.11；24個月：RR=1.02，95% CI, 0.91-1.15），異質性也不顯著（6個月：P=0.94，I²=0%；12個月：P=0.77，I²=0%；18個月：P=0.37，I²=6%；24個月：P=0.58，I²=0%）。在牙根吸收的結果中，隨訪≥6個月、≥12個月和≥18個月的期間內，兩種材料的牙根吸收發生率無顯著差異（≥6個月：RR=1.31，95% CI, 0.65-2.64；≥12個月：RR=0.81，95% CI, 0.36-1.84；≥18個月：RR=1.06，95% CI, 0.33-3.37），異質性也未顯著（≥6個月：P=0.70，I²=0%；≥12個月：P=0.82，I²=0%；≥18個月：P=0.71，I²=0%）。此外，根管鈣化的發生率在隨訪6至18個月期間的Biodentine和MTA之間無顯著差異（RR=1.13，95% CI, 0.78-1.63），異質性同樣不顯著（P=0.47，I²=0%）。本研究結論是，在乳牙冠髓切除術中，Biodentine和MTA的臨床和放射學成功率相似。由於Biodentine具有較短的凝固時間、較低的變色風險和更易操作的特點，它可能比MTA更適合作為乳牙冠髓切除術的材料。然而，未來仍需更長隨訪時間以及更高品質的RCTs，以進一步驗證。本研究對於兒童牙科的臨床實踐具有重要意義，為臨床醫生在選擇乳牙冠髓切除術的材料時提供了依據。
並列摘要
This study aims to compare the efficacy of Biodentine and MTA in primary teeth pulpotomy by evaluating their clinical and radiographic success rates through a systematic review and meta-analysis. The early loss of primary teeth can lead to numerous functional and aesthetic problems in children, making the maintenance of healthy primary teeth crucial. Pulpotomy is a common method used to treat exposed pulp, and Biodentine and MTA are two frequently used pulpotomy agents. Randomized controlled trials (RCTs) published between 2010 and 2023 comparing the effectiveness of Biodentine and MTA in primary teeth pulpotomy with a follow-up period of 6 months or more were included. The efficacy was assessed based on clinical and radiographic success rates, as well as two endodontic outcomes: root resorption and pulp canal obliteration (PCO).This systematic review and meta-analysis included 10 RCTs involving 584 patients and 646 primary teeth. The results showed that the clinical success rates of the two materials were comparable at follow-up periods of 6, 12, 18, and 24 months (6 months: RR=1.00, 95% CI, 0.98-1.03; 12 months: RR=1.01, 95% CI, 0.97-1.05; 18 months: RR=0.99, 95% CI, 0.94-1.05; 24 months: RR=1.01, 95% CI, 0.92-1.11), with no significant heterogeneity observed at any time point (6 months: P=1.00, I²=0%; 12 months: P=0.88, I²=0%; 18 months: P=0.58, I²=0%; 24 months: P=0.58, I²=0%). Similarly, the comparison of radiographic success rates showed no significant differences between the two materials (6 months: RR=0.99, 95% CI, 0.97-1.02; 12 months: RR=1.00, 95% CI, 0.96-1.04; 18 months: RR=1.02, 95% CI, 0.94-1.11; 24 months: RR=1.02, 95% CI, 0.91-1.15), with no significant heterogeneity observed (6 months: P=0.94, I²=0%; 12 months: P=0.77, I²=0%; 18 months: P=0.37, I²=6%; 24 months: P=0.58, I²=0%). Regarding the outcome of root resorption, the rates of root resorption were comparable between the two materials during the follow-up periods of ≥6 months, ≥12 months, and ≥18 months (≥6 months: RR=1.31, 95% CI, 0.65-2.64; ≥12 months: RR=0.81, 95% CI, 0.36-1.84; ≥18 months: RR=1.06, 95% CI, 0.33-3.37), with no significant heterogeneity observed (≥6 months: P=0.70, I²=0%; ≥12 months: P=0.82, I²=0%; ≥18 months: P=0.71, I²=0%). Additionally, the incidence of pulp canal obliteration (PCO) between Biodentine and MTA during the 6 to 18 months follow-up period showed no significant difference (RR=1.13, 95% CI, 0.78-1.63), with no significant heterogeneity observed (P=0.47, I²=0%).Biodentine and MTA have comparable clinical and radiographic success rates in primary teeth pulpotomy over follow-up periods of up to 24 months. Given its shorter setting time, lower risk of discoloration, and easier handling, Biodentine may be preferred over MTA as a pulpotomy medicament for primary teeth. However, more high-quality RCTs with longer follow-up periods are needed to further validate these findings. This study is significant for clinical practice in pediatric dentistry, providing a basis for clinicians when choosing pulpotomy agents for primary teeth.
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