- 學位論文
自體齒移植的存活率、牙根吸收及牙根黏連率的系統性回顧與統合分析
Systematic Review and Meta-analysis for Survival Rate and Risks of Resorption and Ankylosis for Autotransplanted Mature Teeth
摘要
研究目的：本篇研究要利用系統性回顧及統合分析方式評估發育成熟的移植自體齒的存活率、牙根吸收率、及牙根黏連率；並且評估全身性口服抗生素、根管治療的時間點、移植牙的牙根型態以及術後將移植齒與鄰接牙固定對於術後結果的影響。 研究方法：利用電子資料庫搜尋直至民國一百零二年二月的相關文獻，最後納入的文章資料利卜瓦松迴歸模型統合分析自體齒失敗率、一年及五年存活率、一年的牙根吸收率和牙根黏連率、以及全身性口服抗生素、根管治療時間、術後牙齒固定方式與時間和牙根型態對於以上三種結果的影響。 結果：總共二十六篇文章收錄至本篇研究。經過統合分析之後，發育成熟的移植自體齒失敗率為2.0% (95% confidence interval (CI) 1.2%~3.2%)；一年存活率為98.0% (95% CI 96.8%~98.8%)；五年存活率為90.5% (95% CI 84.9%~94.1%); 牙根吸收率為2.1% (95% CI 1.1%~4.0%); 牙根黏連率為1.2% (95% CI 0.5%~3.2%)。比起有服用全身性抗生素的研究，沒有服用抗生素的研究顯示有較高的自體移植齒失敗率；單純只有用縫線做為術後固定的研究顯示比有使用金屬固定線的研究有較高的失敗率；使用金屬固定線固定少於14天的研究比多於14天以上的研究有較高的失敗率；當移植齒為後牙的情況也會有較高的失敗率。在沒有使用口服抗生素、在術後14天後才開始根管治療、以及前牙移植齒的研究均顯示有較高的牙根吸收率。在使用金屬固定線做術後固定和使用前牙做為移植齒的研究也顯示有較高的牙根黏連率。 結論：本篇研究顯示發育成熟的牙齒做為自體移植齒的預後及結果都是相當良好並且高度可預期性；但是有許多的因素可能會影響自體移植齒的結果。
並列摘要
Aim: The aim of this review was to assess clinical outcomes of autotransplanted teeth with complete root formation and the effects of various influencing factors. Materials and Methods: A systematic literature search was performed for publications to February 2013. Treatment outcomes were estimated by multilevel Poisson regression analysis. Results: Twenty-six studies were included. The estimated failure rate was 2.0% (95% confidence interval (CI) 1.2%~3.2%); estimated 1-year survival rate was 98.0% (95% CI 96.8%~98.8%); estimated 5-year survival rate was 90.5% (95% CI 84.9%~94.1%); estimated infection-related root resorption rate was 2.1% (95% CI 1.1%~4.0%); and estimated ankylosis rate was 1.2% (95% CI 0.5%~3.2%). The estimated failure rate was higher in studies without a systemic antibiotic regimen, with only suture splinting, with wire splinting for ≤ 14 days, and with posterior donor teeth. The estimated infection-related root resorption rate was higher in studies without a systemic antibiotic regimen, with endodontic treatment initiated after 14 days postoperatively, and with anterior donor teeth. The estimated ankylosis rate was higher in studies with wire splinting and anterior donor teeth. Conclusions: Results showed that outcomes and prognoses of autotransplanted teeth with complete root formation were highly predictable. Several factors seemed to influence the outcome of tooth autotransplantation.