牙周来源的牙周牙髓联合病变和牙周牙髓共存病变患牙牙周治疗时机的系统评价

doi:10.7518/hxkq.2018.02.010

摘要/Abstract

摘要：

目的评估牙周来源的牙周牙髓联合病变以及真正联合病变（牙周病变和牙髓病变共存）患牙的牙周治疗时机,从而指导临床治疗。方法在PubMed、EMbase、Cochrane、Web of Science、CNKI、CBM、万方数据库中搜索1980年至2017年3月间关于牙周牙髓联合病变治疗的相关文章,并对其进行分析。结果最终纳入2篇随机对照研究、2篇前瞻性病例系列研究和8篇病例报告。所有研究病例均采用根管治疗和牙周非手术治疗或牙周手术治疗,且根管治疗是综合治疗的第一步;观察指标包括牙周探诊深度及附着丧失等。结论对于牙周来源的牙周牙髓联合病变和真正的联合病变患牙,牙髓治疗和牙周非手术治疗间可能不需要观察期,但此结论还需大样本前瞻性随机对照临床研究来验证。

关键词: 牙周牙髓联合病变, 牙周治疗, 根管治疗, 治疗时机, 系统评价

Abstract:

Objective This study aims to evaluate the time lapse between the endodontic and periodontal treatments of the combined periodontal-endodontic lesion to guide the clinical treatment. Methods A systemic literature search was performed in articles published from 1980 to March 2017 using the electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, and Wanfang Databases. Results After screening, two randomized controlled trials, two prospective case series studies, and eight case reports were ultimately included. All clinical studies and case reports were treated with root canal therapy and periodontal nonsurgical or periodontal surgical treatment, with root canal therapy as the initial treatment step. Changes in the periodontal probing depth and attachment loss were reported in all clinical studies and case reports. Conclusion An observational period between the endodontic and periodontal nonsurgical treatments may not be required. However, given that the quality of several included studies was limited, and the number of randomized controlled trials was small, a large number of randomized controlled trials are needed to verify this result.

Key words: combined periodontal-endodontic lesion, periodontal treatment, root canal therapy, time lapse, syste-matic review

中图分类号:

R781.4

金玥, 陈斌, 泥艳红, 闫福华. 牙周来源的牙周牙髓联合病变和牙周牙髓共存病变患牙牙周治疗时机的系统评价[J]. 华西口腔医学杂志, 2018, 36(2): 167-173.

Yue Jin, Bin Chen, Yanhong Ni, Fuhua. Yan. Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review[J]. West China Journal of Stomatology, 2018, 36(2): 167-173.

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作者	年份	研究类型	性别		年龄/岁	最初牙数/		牙齿类型		基线时平均PD/mm			基线时平均AL/mm
作者	年份	研究类型	（男/女）		年龄/岁	最终牙数		牙齿类型		试验组		对照组	试验组	对照组
周伟等^[8]	2016	RCT	68/64		31~73	138/99		第一、第二磨牙		9.17±1.90		9.05±2.17	10.89±2.01	10.64±2.30
Gupta等^[11]*	2015	RCT	14/17		26~65,平	50/37		磨牙、前磨牙、		4.18±0.55		4.36±0.60	4.57±0.89	5.27±1.48
					均45.5			切牙
Vakalis等^[3]	2005	前瞻性病例系	3/6		平均49	9/8		磨牙、前磨牙、		4.79±1.16			7.31±1.41
		列研究						尖牙、切牙
孙江等^[12]	2009	前瞻性病例系	18/12		28~53	37		磨牙、前磨牙		6.59±0.203			8.65±0.188
		列研究
作者	治疗程序						随访时		失访例数		治疗后平均PD/mm		治疗后平均AL/mm
作者	试验组			对照组			间/月		失访例数		试验组	对照组	试验组	对照组
周伟等^[8]	RCT+S—4~6周—SRP			RCT+S—1周—SRP			3		10（拔除）;		6.20±2.80	7.59±2.63	8.60±2.76	9.91±2.86
									29（未计入）
							6				6.14±2.91	7.72±3.47	9.14±2.57	9.09±2.54
							12				7.00±2.16	6.50±2.12	9.75±2.40	9.60±1.89
Gupta等^[11]*	S—1周—RCT1+RCT2			S—1周—RCT1+RCT2+			3		实验组：7;		0.21±0.27	1.35±0.72	0.14±0.32	1.36±0.72
	—10 d—RCT3—3月			SRP—10 d—RCT3					对照组：6
	—SRP						6				1.48±0.58	1.39±1.24	1.47±0.56	1.32±1.17
							9				1.58±0.59		1.56±0.59
Vakalis等^[3]	RCT+S—1月—SRP						3		1（拔除）		3.87±1.64		6.33±1.58
孙江等^[12]	RCT—1周—S+SRP—						3		3		3.88±0.151		7.38±0.152
	4周—PS—AB（1周）
							6		8		2.83±0.149		6.79±0.182
							12		18		2.42±0.233		6.58±0.268

作者	年份/年	性别	年龄/岁	牙位	基线时PD/mm		基线时AL/mm
Zehnder^[13]	2001	男	28	15	颊侧近中、中部、远中：4、4、8;腭侧近中、
					中部、远中：>10、>10、>10
Fahmy等^[14]	2016	女	35	36	远中：12		平均：2.7
Oh等^[15]	2009	女	50	16	9
Zubery等^[16]	1993	女	25	36	>10
Azaripour等^[17]	2013	男	65	34	远中：>14
Karunakar等^[18]	2014	男	24	46	10
		女	32	44	8
Narang等^[19]	2011	男	22	46	VPD：4;HPD：6
Pico-Blanco等^[20]	2016			43	12		17
				21	13		16
				21	8		13
				11	6		15
				11	10		11
作者	治疗程序				随访时间/月	治疗后PD减少量/mm	治疗后AL减少量/mm
Zehnder^[13]	RCT1+SRP—1周—RCT2—1周—				6	颊侧近中、中部、远中：2、	颊侧近中、中部、远中：2、2、3;
	RCT3—4月—PS					2、3;腭侧近中、中部、远	腭侧近中、中部、远中：>6、>3、
						中：>8、>6、>5	>3
Fahmy等^[14]	RCT1+RCT2+SRP—1周—RCT3—				6		远颊9;远舌8
	4周—PS
					24	远中：8	平均1.2
Oh等^[15]	RCT+SRP—1月—GTR+SRP—AB				10	3
	（1周） —10月—GTR
					20	6
Zubery等^[16]	RCT—SRP—12月—PS				18	>8
Azaripour等^[17]	RCT—6月—PS				24	远中：10
Karunakar等^[18]	AD—SRP—AB（5 d）;RCT—				9	6
	3月—PS
	SRP—RCT—3月—PS				9	5
Narang等^[19]	RCT—3月—PS				9	3
Pico-Blanco等^[20]	RCT—S—至少3个月—PS—AB				14	9	5
	（1周）
					24	10	9
					36	5	4
					72	4	9
					204	7	6