钙钠磷硅酸和硝酸钾牙膏抗牙本质敏感效果的系统评价和Meta分析

Effect of calcium sodium phosphosilicate and potassium nitrate on dentin hypersensitivity: a systematic review and Meta-analysis

目的系统评价钙钠磷硅酸(CSPS)与硝酸钾牙膏抗牙本质敏感效果的临床疗效。方法计算机检索The Cochrane Library(2017年6期)、Pub Med、Embase、Wan Fang Data、CBM和CNKI数据库,查找CSPS与硝酸钾牙膏对牙本质敏感症状疗效的随机对照试验(RCT),检索时限均为从建库至2017年6月。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入8个RCT,包括411例患者,其中试验组203例,对照组208例。Meta分析结果显示:试验组2、4、6、8周吹气敏感值优于对照组[SMD=-1.85,95%CI(-2.89,-0.81),P=0.000 5,I2=93%],[SMD=-1.61,95%CI(-1.96,-1.26),P<0.000 01,I2=49%],[SMD=-3.79,95%CI(-7.18,-0.40),P=0.03,I2=98%],[SMD=-2.13,95%CI(-2.69,-1.58),P<0.000 01]。试验组12周吹气敏感值与对照组差异无统计学意义[SMD=-0.63,95%CI(-1.47,0.20),P=0.14,I2=71%]。试验组2、4、6、8、12周冷水刺激敏感值优于对照组[SMD=-1.07,95%CI(-1.48,-0.66),P<0.000 01,I2=69%],[SMD=-1.29,95%CI(-1.81,-0.76),P<0.000 01,I2=64%],[SMD=-1.20,95%CI(-1.57,-0.83),P<0.000 01,I2=86%],[SMD=-1.30,95%CI(-2.51,-0.08),P=0.04,I2=82%],[SMD=-0.79,95%CI(-1.27,-0.31),P=0.001]。试验组1周冷水刺激敏感值与对照组差异无统计学意义[SMD=0.00,95%CI(-0.62,0.62),P=1]。试验组2、4、8周探诊敏感值优于对照组[SMD=-1.31,95%CI(-2.00,-0.62),P=0.000 2,I2=67%],[SMD=-1.37,95%CI(-1.74,-0.99),P<0.000 01,I2=23%],[SMD=-1.33,95%CI(-1.82,-0.84),P<0.000 01]。试验组1周探诊敏感值与对照组差异无统计学意义[SMD=-0.32,95%CI(-0.94,0.31),P=0.32]。结论 CSPS比硝酸钾牙膏更有效地降低牙本质敏感。受纳入研究的数量和质量限制,上述结论尚需更多高质量、大样本RCT予以验证。

Objective This systematic review and Meta-analysis aimed to compare the efficacy of calcium sodium phosphosilicate （CSPS） and potassium nitrate as desensitizing agents for the treatment of dentin hypersensitivity （DH）. Methods A thorough search in The Cochrane Library, PubMed, Embase, Chinese WanFang Data, CBM, and CNKI were conducted for studies published up to June 2017. Randomized controlled trials （RCTs） of the treatment of DH with CSPS and potassium nitrate toothpaste were included. Quality assessment and data extraction were performed by two reviewers independently,and Meta-analysis was performed by using RevMan 5.3 software. Results Eight RCTs involving 411 patients were included. Experimental group comprised 203 and control group had 208 patients. The Meta-analysis indicated the superior effect of CSPS dentifrice on air blast sensitivity at 2, 4, 6, and 8 weeks of follow-up [SMD=-1.85, 95%CI （-2.89,-0.81）, P=-0.000 5,I^2=93%], [SMD=-1.61, 95%CI （-1.96,-1.26）, P〈0.000 01,I^2=49%], [SMD=-3.79, 95%CI （-7.18,-0.40）, P=0.03, I^2=98%], and [SMD=-2.13, 95%CI （-2.69,-1.58）, P〈0.000 01] , respectively. No significant effects were seen at 12 weeks [SMD=-0.63, 95%CI （-1.47, 0.20）, P=-0.14, I^2=71%]. CSPS dentifrice showed a better desensitizing effect at 2, 4, 6, 8, and 12 weeks of follow-up on cold water sensitivity [SMD=-1.07, 95%CI （-1.48,-0.66）, P〈0.000 01,I^2=69%], [SMD=-1.29, 95%CI （-1.81,-0.76）, P〈0.000 01,I^2=64%], [SMD=-1.20, 95%CI （-1.57,-0.83）, P〈0.000 01,I^2=86%], [SMD=-1.30, 95%CI （-2.51,-0.08）, P=0.04, I^2=82%], and [SMD=-0.79, 95%CI （-1.27,-0.31）, P=0.001], respectively. No significant effects at 1 week of follow-up [SMD=0.00, 95%CI （-0.62, 0.62）, P=1]. The favorable effect of CSPS dentifrice on tactile sensitivity was more obvious than the control group at 2, 4, and 8 weeks of follow-up [SMD=-1.31, 95%CI （-2.00,-0.62）, P=0.000 2,I^2=67%], [SMD=-1.37, 95%CI （-1.74,-0.99）, P〈0.000 01,I^2=23%]; and [SMD=-1.33, 95%CI （-1.82,-0.84）, P〈0.000 01], respectively. No significant effects at 1 week of follow-up [SMD=-0.32, 95%CI （-0.94, 0.31）, P=0.32] were observed. Conclusion Current evidence indicated that CSPS was more effective than potassium nitrate at reducing DH. The evidence generated by this review was based on a small number of individuals. High-quality and large sample size as well as ideally-designed clinical trials are required in the future before definitive recommendations can be made.