Carisolv化学机械去龋技术治疗乳牙龋病效果的系统评价

Effectiveness of chemomechanical caries removal(Carisolv) in primary teeth:a systematic review

目的：评价Carisolv化学机械去龋技术治疗乳牙龋病的临床疗效。方法：计算机检索cochrane图书馆（2009年第2期）、PubMed（1966～2009）、MEDLINE（1966～2009）、Embase（1966～2009）、CBM（1978～2009）、CNKI（1989～2009）、VIP（1989～2009），同时采用手工检索相关资料，纳入Carisolv化学机械去龋技术与传统机械去龋比较治疗乳牙龋病的临床随机对照试验。按Cochrane系统评价方法评价纳入研究的质量，对同质研究采用RevMan5．0软件进行Meta分析。结果：共纳入5个随机对照试验，合计162例病人，272个乳牙。结果显示：与传统手用去龋器械比较，Carisolv化学机械去龋技术去龋时疼痛程度较轻，对龋损去除效果、去龋时间、病人接受程度及术后并发症发生率的影响，两种方法差异无统计学意义。与传统机用器械的比较，Carisolv与高速涡轮机联合去龋法对龋损去除效果的差异无统计学意义；但Carisolv的去龋时间较长[WDM=3．09，95％CI（2．38，3．80）]；而疼痛程度[RR=0．62，95％CI（0．42，0．90）]及病人接受度，Carisolv优于高速涡轮机联合去龋法。与慢速涡轮机联合去龋法的比较，Carisolv 15min内的龋损去净效率低[RR=0．61，95％CI（0．47，0．78）]；去龋时间较长[WDM=6．69，95％CI（5．77，7．61）]；但是，对于去龋的疼痛程度和病人的接受程度，两种方法差异无统计学意义。机用器械组中仅有1个研究进行了术后半年的随访，结果显示两种去龋方法术后并发症的发生率差异没有统计学意义。结论：Carisolv化学机械去龋技术治疗乳牙龋病能够有效去除龋损组织，但其去龋时间较长且去龋效率低于传统机用器械。Carisolv去龋引起的疼痛程度及病人的接受程度优于传统高速机用去龋器械，但无异于手用或慢速机用器械。由于本系统评价纳入研究的数量和质量有限，上述结论尚需开展更多大样本、设计良好、指标全面的临床随机对照试验来进一步验证。

AIM： To assess the clinical effectiveness of chemomechanical caries removal （Carisolv） in priary teeth. METHODS ： We searched the Cochrane Library, PubMed, MEDLINE, EMbase, CBM, CNKI and VIP database until 2009. Randomized controlled trials to compare Carisolv with traditional mechanical excavation in caries of primary teeth were included. We also manually searched some related information. The quality assessment and Meta-analyses were performed for the results of homogeneous studies using the Cochrane Collaboration＇s RevMan 5.0 software. RESULTS： We included 5 studies involving 162 patients and 272 primary teeth. The results indicated that less pain was felt in Carisolv than in traditional hand excavation method. There was no significant difference in caries removal effect, caries removal time, preference of patients and incidence of postoperative complications. Carisolv showed no significant difference with high-speed mechanical removal method in caries removal effects; but had a significantly longer caries removal time [ WDM = 3.09,95 % CI （2.38,3.80） ] and less pain [ RR = 0.62,95 % CI （0.42,0.90） ]. Carisolv showed significantly lower efficiency [ RR = 0.61,95% CI （ 0.47,0.78 ） ] and longer caries removal time [ WDM = 6.69,95 % CI（5. 77 ,7. 61 ）] than low-speed excavation but showed no significant difference in pain occurrence and preference of patients. The clinical follow-up was made by one trial of rotary instrument at half a year, the results indicated that there was no significant difference in incidence of postoperative complications. CONCLUSION： Chemomechanical caries removal （Carisolv） can effectively remove caries in primary teeth, but takes longer time and is with lower efficiency. In terms of pain and patient preference, Carisolv is better than high-speed mechanical caries removal, but no significant difference is found between Carislov and hand excavation or low-speed rotary instrument.