Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

  • Conclusions changed
  • Review
  • Intervention

Authors

  • Vinícius Pedrazzi,

    Corresponding author
    1. Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Departamento de Materiais Dentários e Prótese, Ribeirão Preto, São Paulo, Brazil
    • Vinícius Pedrazzi, Departamento de Materiais Dentários e Prótese, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Av do Café s/nº, Ribeirão Preto, São Paulo, 14040-904, Brazil. pedrazzi@forp.usp.br.

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  • Jeronimo M Oliveira-Neto,

    1. Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Departamento de Materiais Dentários e Prótese, Ribeirão Preto, São Paulo, Brazil
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  • Patrick Sequeira,

    1. Endodontology SSE SFZ, Cham-Zug, Switzerland
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  • Zbys Fedorowicz,

    1. Ministry of Health, Bahrain, UKCC (Bahrain Branch), Awali, Bahrain
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  • Mona Nasser

    1. Institute for Quality and Efficiency in Health care, Department of Health Information, Köln, Germany
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Abstract

Background

Endodontic treatment of root canals or root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis (death) of the dental pulp (nerve). Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment.

Objectives

The objectives of this review were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth.

Search methods

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. We searched the reference lists of relevant articles in an attempt to locate additional published and unpublished trials. No language restriction was applied. The last electronic search was conducted in December 2007.

Selection criteria

Randomised controlled trials involving people over 18 years of age with single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption requiring root canal treatment were included. Patients undertaking re-treatment of a tooth were excluded.

Data collection and analysis

Screening of eligible studies was conducted in duplicate and independently. Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

Main results

No eligible randomised controlled trials were identified.

Authors' conclusions

This review illustrates the current lack of published or ongoing randomised controlled trials and the unavailability of high level evidence, based on clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment.
Future randomised controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant but also patient-centred outcomes.

摘要

背景

使用傳統根管治療方式以手動式和超音波器械治療恆牙

對不可逆牙髓炎造成牙髓壞死的牙齒進行根管治療,是臨床上非常常見的牙科工作;移除壞死組織與其殘留物以及清潔和擴大牙根根管是根管治療中非常重要的步驟;根管治療時,可選擇使用手動式和氣動式器械,及超音波和音波的方式進行。

目標

本篇文獻回顧的目的在了解,於傳統根管治療方式下,分別使用手動式及超音波器械,和同時使用兩者時的臨床效度差異。

搜尋策略

我們搜尋了Cochrane Oral Health Group Trials 、MEDLINE、EMBASE and LILACS等資料庫;同時為了能盡量囊括所有發表與未發表的資料,我們也搜尋相關文獻的參考資料,這些文獻的搜尋沒有使用語言上的限制,且在2007年12月做最新一次搜尋。

選擇標準

隨機對照試驗 (randomized controlled trials) 樣本包含超過18歲、有單顆或多顆牙根完全形成、沒有內吸收證據並要進行根管治療牙齒的成人;其中排除須進行根管再治療的病患。

資料收集與分析

以重複且獨立的方式來篩選合適的文獻;其結果以fixedeffect或randomeffect模型,在連續結果使用平均差異、雙叉結果使用95%CI風險比例來表示;並分別研究臨床和方法上各個不同因素所引起的差異性。

主要結論

並無發現合格的隨機對照試驗。

作者結論

本篇文獻回顧以臨床相關結果為基準,描述最新尚未被發表或正在進行的隨機對照試驗,以及難以取得的高可信度證據中,單獨使用超音波器械和結合手動式器械進行傳統根管治療的效度。未來的隨機對照試驗會著重在探討合併使用這些器械的效度,不只與臨床相關,更加入病患為主的結果。

翻譯人

本摘要由臺灣大學附設醫院王偉全翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

根管治療是治療神經壞死的牙齒常見的牙科工作;移除壞死組織的殘留物以及清潔和擴大牙根根管是關係根管治療成功的重要步驟;這些步驟中可使用手動式或氣動式,以及超音波器械;本篇文獻回顧中作者發現,在單獨使用超音波器械和合併手動器械進行傳統根管治療的效度差異上,缺少足夠的高可信度證據;因此他建議未來可針對使用超音波器械合併手動式器械的效度來做研究。

Plain language summary

Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

Root canal treatment is a frequently performed dental procedure which is carried out on teeth in which the nerve has died.
Removal of the tissue remnants and cleaning and shaping of the root canal are important steps for success. These may include the use of hand and rotary instruments and ultrasonically powered equipment.

The review authors found that there is currently insufficient high level evidence for the effectiveness of ultrasonic instrumentation used alone or in conjunction with hand instrumentation for orthograde root canal treatment and suggest that future studies might focus more closely on evaluating the effectiveness of the use of ultrasonic instrumentation in conjunction with hand instrumentation.