Er:YAG激光在儿童窝洞预备中应用的Meta分析

发布时间：2018-06-08 22:15

本文选题：Er:YAG激光 + 机械窝洞预备　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:随着口腔生物材料和微创技术的发展,Er:YAG激光逐渐替代传统机械方法在儿童窝洞预备中已得到越来越广泛的应用。国内外学者对其临床疗效进行了大量的研究,但至今仍缺乏全面的系统性评价。本研究采用循证医学的方法对国内外公开发表的关于Er:YAG激光在儿童窝洞预备中应用的临床研究文献进行Meta分析,全面而系统地评价Er:YAG激光在儿童窝洞预备中应用的临床效果,为其临床应用提供科学依据和指导。方法:1检索文献途径和方法计算机与手工检索相结合,检索数据库包括:CNKI(中国期刊网全文数据库),CBM(中国生物医学文献数据库),VIP(中文科技期刊数据库),万方数据库,Pubmed,Cochrane图书馆,OVID外文全文数据库,Science Direct全文数据库,检索国内外关于Er:YAG激光在儿童窝洞预备中应用的临床疗效研究的文献,并对纳入研究的文献进行筛选,剔除不符合纳入标准及灰色的文献,检索各数据库从1997年(1997年FDA批准Er:YAG激光作为牙体硬组织激光应用于临床)到2016年12月的相关文献。2文献纳入标准2.1研究设计本次研究纳入文献均为同期比较Er:YAG激光和传统机械方法在儿童窝洞预备中应用的临床随机对照试验研究。2.2研究对象:本次研究纳入文献的研究对象均为儿童龋病患者,年龄3-15岁。2.3干预措施:所有纳入文献的实验组均采用Er:YAG激光进行窝洞预备。2.4对照措施:所有纳入文献的对照组均采用传统机械方法进行窝洞预备。修复体边缘着色率,修复体边缘密合度和继发龋率。2.6失访率20%,能提供有效的数据用于计算SMD值、RR值和95%CI。由2位研究者独立进行筛选,包括阅读文献题目、摘要及全文。如果遇到不同意见,则两者讨论解决或由权威专家协助判断,最终确定纳入的文献。3对纳入研究的文献进行质量评价和提取资料由2位研究者独立对文献进行质量评价和提取资料。采用2002年Banares提出的改良后的Jadad量表对本研究的纳入文献进行质量评价。计分标准为1~7分,其中1~3分视为低质量文献,4~7分视为高质量文献,同期按照本研究方案提取纳入文献的基本特征和有效数据。4统计分析采用stata11.0软件对纳入文献进行统计分析。因本研究纳入文献中操作时间和疼痛评价属于计量资料,故选择标准化均数差(standardized mean difference,SMD)和95%可信区间(confidence interval,CI)表示效应量;其修复体完全保留率,修复体边缘着色率,修复体边缘密合度和继发龋率为分类资料,故计算相对危险度(relative risk,RR)和95%可信区间(confidence interval,CI)作为其效应量。首先对纳入研究的文献进行Q检验,根据异质性检验结果:若多个研究间具有同质性即P0.1,选择固定效应模型进行分析;若多个研究间不具有同质性即P0.1,选择随机效应模型进行分析,通过Begg秩相关方法检验纳入文献是否存在发表偏倚。结果:1检索结果:从所选数据库中检索出相关文献共计768篇,最后符合纳入标准的文献有7篇(中文4篇,英文3篇)。2纳入文献质量评价结果:依据修正后的Jadad量表对纳入文献进行质量评价,其结果显示:3篇为低质量文献,4篇为高质量文献。3 Meta分析结果3.1 Er:YAG激光与传统机械方法比较:Er:YAG激光在窝洞预备时操作时间更长(SMD=1.945,95%CI=0.942-2.948,P0.001,合并效应量的检验Z=3.80,P0.001);2.5疗效判断标准主要包括:操作时间,疼痛评价,修复体完全保留率,程中产生的疼痛更轻微,两者差异具有统计学意义(SMD=-1.013,95%CI=-1.829--0.196,P0.001,合并效应量的检验Z=2.43,P=0.015);3.3 Er:YAG激光和传统机械方法窝洞预备完成,同种材料充填治疗后比较:两者在修复体完全保留率方面差异无统计学意义(三个月复查:RR=1.015,95%CI=0.925-1.113,P=0.773,合并效应两检验Z=0.31,P=0.754;六个月复查:RR=1.011,95%CI=0.937-1.091,P=0.495,合并效应量的检验Z=0.28,P=0.783;一年复查:RR=1.021,95%CI=0.936-1.114,P=0.190,合并效应量的检验Z=0.47,P=0.636);3.4 Er:YAG激光和传统机械方法窝洞预备完成,同种材料充填治疗后比较:两者在修复体边缘着色方面差异无统计学意义(三个月复查:RR=0.337,95%CI=0.036-3.169,P=0.992,合并效应量的检验:Z=0.95,P=0.342;六个月复查:RR=1.298,95%CI=0.300-5.615,P=0.892,合并效应量的检验:Z=0.35,P=0.727;一年复查:RR=1.638,95%CI=0.224-11.986,P=0.594,合并效应量的检验:Z=0.49,P=0.627);3.5 Er:YAG激光和传统机械方法窝洞预备完成,同种材料充填治疗后比较:两者在修复体边缘密合度方面差异无统计学意义(六个月复查:RR=0.969,95%CI=0.063-14.799,P0.001,合并效应量的检验:Z=0.02,P=0.981;一年复查:RR=1.480,95%CI=0.257-8.515,P=0.692,合并效应量的检验:Z=0.44,P=0.661)。3.6继发龋率:stata11.0软件提示:数据不充分,无法继续完成该Meta分析,对该指标进行定量分析,其中Rodrigo A V的研究中修复后观察一年Er:YAG激光组继发龋率为0%,传统机械组继发龋率也为0%,SPSS统计结果显示两者差异无统计学意义;Galia G的研究中,修复后观察一年得出的结论与Rodrigo A V的结果具有一致性。结论:1关于Er:YAG激光在儿童窝洞预备中应用的临床随机对照试验研究总体质量偏低,尤其关于样本量,随机化隐藏和盲法等方面需要更加完善,且符合纳入标准的文献数量较少。这一结论提示在未来的应用与研究中需要增加高质量的临床随机对照试验。2敏感性分析结果表明:Meta分析的结果稳定,可靠,能真实准确反映Er:YAG激光在儿童窝洞预备中应用的临床疗效。3.2 Er:YAG激光与传统机械方法比较:Er:YAG激光在窝洞预备时操作过3本次研究的Meta分析结果显示:1)与传统机械方法相比,Er:YAG激光用于儿童窝洞预备时,两者在修复体完全保留率,修复体边缘着色和修复体边缘密合度方面差异无统计学意义。2)在操作过程中产生疼痛感方面Er:YAG激光明显优于传统机械方法。3)与传统机械方法相比,Er:YAG激光操作时间更长。4 Er:YAG激光应用于儿童窝洞预备的临床效果良好,安全、可靠,患儿产生痛觉少,值得临床推广。
[Abstract]:Objective: with the development of oral biomaterials and minimally invasive techniques, the Er:YAG laser has been gradually replaced by the traditional mechanical method in the preparation of children's nest. The domestic and foreign scholars have done a lot of research on its clinical efficacy, but still lack comprehensive systematic evaluation. This study adopts the method of evidence-based medicine to the country. A Meta analysis of the clinical literature on the application of Er:YAG laser in the preparation of pit holes in children was published in and out of China. The clinical effects of Er:YAG laser in the preparation of pit holes in children were evaluated comprehensively and systematically, and the scientific basis and guidance for its clinical application were provided. Method: 1 retrieval of documents and methods by computer and manual retrieval The retrieval database includes: CNKI (Chinese Journal Network full text database), CBM (Chinese biomedical literature database), VIP (Chinese sci-tech journal database), Wanfang database, Pubmed, Cochrane library, OVID full text database and Science Direct full text database, to retrieve the application of Er:YAG laser in the children's nest preparation. The literature of the clinical efficacy study was selected and the literature included in the study was screened to eliminate the documents that did not conform to the inclusion criteria and gray, and to retrieve each database from 1997 (1997 FDA approved Er:YAG laser as the dental hard tissue laser applied to the clinic) to December 2016 related documents into the standard 2.1 research design. A randomized controlled trial of Er:YAG laser and traditional mechanical methods used in the preparation of pit holes for children in the same period was studied in the.2.2 study. The subjects included in this study were children's caries and age 3-15 years old.2.3 intervention measures: all the experimental groups included Er:YAG laser for cavities. .2.4 control measures: all the control groups that were included in the literature were prepared by traditional mechanical methods. The edge coloring rate of the prosthesis, the edge density of the prosthesis and the secondary caries rate of.2.6 were 20%, and the effective data could be used to calculate the SMD value. The RR value and 95%CI. were screened by 2 researchers independently, including reading literature titles, Abstract and full text. If different opinions are met, the two discussions are solved or by authoritative experts, and finally the quality evaluation and extraction of the included literature.3 on the documents included in the study are evaluated and extracted by the 2 researchers independently of the literature. The modified Jadad scale proposed by Banares in 2002 is used. The study included the quality evaluation of the literature. The score standard was 1~7. The 1~3 scores were considered as low quality literature, 4~7 was considered as the high quality literature. The basic features and effective data of the literature were extracted according to this research scheme in the same period, and the statistical analysis of the effective data was analyzed by stata11.0 software. The research was included in the literature. The operation time and pain evaluation belonged to the measurement data, so the standardized mean difference (SMD) and the 95% confidence interval (confidence interval, CI) were selected to express the effect. The total retention rate of the prosthesis, the edge coloring rate of the prosthesis, the edge density of the prosthesis and the secondary caries rate were classified, so the relative risk degree (R) was calculated. Elative risk, RR) and the 95% confidence interval (confidence interval, CI) as their effects. First, we conduct Q tests on the literature included in the study, according to the heterogeneity test results: if multiple studies have homogeneity, namely P0.1, select the fixed effect model; if multiple studies do not have homogeneity, i.e. P0.1, choose random effect model into the model. The Begg rank correlation method was used to test whether there was a publication bias in the literature. Results: 1 retrieval results: 768 articles were retrieved from the selected database, and 7 articles (4 in Chinese and 3 in English) were included in the literature of the selected database, and the results were included in the quality evaluation of the literature: the revised Jadad scale was used for the inclusion of the literature. The results showed that 3 articles were low quality literature, 4 were high quality literature.3 Meta analysis, 3.1 Er:YAG laser was compared with traditional mechanical method: Er:YAG laser had longer operation time in pit preparation (SMD=1.945,95%CI=0.942-2.948, P0.001, Z=3.80, P0.001), and 2.5 evaluation criteria included: Operation time, pain evaluation, complete retention rate of the prosthesis, the pain produced in the process was more mild, and the difference was statistically significant (SMD=-1.013,95%CI=-1.829--0.196, P0.001, Z=2.43, P=0.015); 3.3 Er:YAG laser and traditional mechanical method of cavity preparation were completed, and the same material filling treatment was compared: both were repaired. There was no significant difference in total body retention rate (three months reexamination: RR=1.015,95%CI=0.925-1.113, P=0.773, combined effect two test Z=0.31, P=0.754; six months reexamination: RR=1.011,95%CI=0.937-1.091, P=0.495, Z=0.28, P=0.783; one year review: RR=1.021,95%CI=0.936-1.114, P=0.190, combined effect test Z. =0.47, P=0.636); 3.4 Er:YAG laser and traditional mechanical method of cavity preparation completed, the same material filling treatment compared: the two in the restoration of marginal color difference is not statistically significant (three months reexamination: RR=0.337,95%CI=0.036-3.169, P=0.992, combined effect test: Z=0.95, P=0.342; six months reexamination: RR=1.298,95%CI=0.300-5.615: RR=1.298,95%CI=0.300-5.615 P=0.892, test of combined effect: Z=0.35, P=0.727; one year review: RR=1.638,95%CI=0.224-11.986, P=0.594, test of combined effect: Z=0.49, P=0.627); 3.5 Er:YAG laser and traditional mechanical method of cavity preparation completed, and the same material filling treatment compared: there was no statistical difference between the two on the edge density of the restorations (six Monthly review: RR=0.969,95%CI=0.063-14.799, P0.001, combined effect test: Z=0.02, P=0.981; one year review: RR=1.480,95%CI=0.257-8.515, P=0.692, combined effect test: Z=0.44, P=0.661).3.6 secondary caries rate: stata11.0 software: data is not sufficient to continue the Meta analysis, quantitative analysis of the index, including Ro In the study of drigo A V, the secondary caries rate of the one year Er:YAG laser group was 0%, and the secondary caries in the traditional mechanical group was 0%, and the SPSS statistical results showed that there was no statistical difference between them. In the study of Galia G, the conclusion was consistent with the result of Rodrigo A V. Conclusion: 1 about Er:YAG laser in children's nest. The total quality of the clinical randomized controlled trial used in the preparation of the cavities is low, especially on the sample size, randomization and blindness, and the number of documents which conform to the standard is less. This conclusion suggests that high quality clinical randomized controlled trial.2 sensitivity scores need to be increased in future applications and studies. The results show that the results of Meta analysis are stable, reliable, and can truly reflect the clinical effect of Er:YAG laser in the preparation of children's pit and cave..3.2 Er:YAG laser is compared with traditional mechanical method. The results of Meta analysis operating 3 times when Er:YAG laser has been prepared in the hole preparation show: 1) compared with the traditional mechanical method, the Er:YAG laser is used. There is no significant difference in the total retention rate of the prosthesis, the edge coloration of the prosthesis and the edge cohesion of the prosthesis,.2). In the operation process, the Er:YAG laser is obviously superior to the traditional mechanical method.3) compared with the traditional mechanical method, and the Er:YAG laser operation time is longer than the.4 Er:YAG laser. It has good clinical effect, safe and reliable for children's cavity preparation. It has less pain and is worthy of clinical promotion.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R788.1

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