比较注射冲洗与辅助超声荡洗对根管清洁效果的系统评价

Cleaning effect of ultrasonic activation as an adjunct to syringe irrigation of root canals: a systematic review

目的系统比较单独使用注射冲洗与辅助超声荡洗在根管预备过程中的根管清洁效果。方法电子检索PubMed、Embase、Web of Science、Cochrane Library、ProQuest Dissertation and Theses,以及中文科技期刊数据库、中国期刊全文数据库、万方数据库和中国生物医学文献数据库,检索时间为1985年1月1日—2014年3月1日,同时对中文口腔医学杂志进行手工检索,对全部纳入文献的参考文献进行追索,收集辅助超声荡洗能否提高注射冲洗质量的临床随机对照试验(RCT)和临床对照试验(CCT)。使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据,采用RevMan 5.2软件进行统计分析。结果最终纳入9篇文献,7篇为低度风险,2篇为中度风险。Meta分析结果:组织学方法显示辅助超声荡洗能显著提高根管根尖区主侧支根管碎屑和玷污层的清洁程度,与仅使用注射冲洗相比,其差异有统计学意义(P<0.01),但细菌培养法(P=0.26)及聚合酶链反应(PCR)检测法(0.99)均显示辅助超声荡洗的根管抗菌效果与仅使用注射冲洗无明显差异。结论辅助超声荡洗对根管根尖区碎屑和玷污层的清洁效果明显优于单独使用注射冲洗,但两者的根管抗菌效果没有明显差异。

Objective To investigate evidence supporting whether ultrasonic irrigation as a supplement is more effective than syringe irrigation in root canal cleaning. Methods An electronic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, ProQuest Dissertation and Theses, Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature Database. Studies were retrieved from January 1, 1985 to March l, 2014. The Chinese journals on stomatology and the bibliography of all relevant articles were manually searched. Relevant clinical randomized controlled trial （RCT） and clinical controlled trial （CCT） were selected. Two investigators evaluated the risk of bias of the included trials in accordance with Cochrane risk of bias assessment tools and collected data of included studies. Meta-analysis was then performed in RevMan 5.2. Results Nine articles that satis- fied the eligibility criteria were included in this Meta-analysis. Seven studies showed low bias risk, and the remaining studies exhibited moderate bias risk. Histological results showed that ultrasonic irrigation supplement could significantly improve canal and isthmus debridement at the apical area （P〈0.01）. Antibacterial efficacy was evaluated by bacterial culture （P=0.26） and polymerase chain reaction （P=0.99） methods, no sig- nificant differences in antibacterial efficacy were observed. Conclusion Ultrasonic irrigation supplement is more effec- tive than syringe irrigation in root canal debridement at the apical area. However, antibacterial efficacy is not statisti-cally significant.