直接髓盖材料的临床成功比较：随机临床试验的网络meta回归。

IF 5.5 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of dentistry Pub Date : 2025-08-29 DOI:10.1016/j.jdent.2025.106073

Ömer Hatipoğlu , Elif Varlı Tekingür , Fatma Pertek Hatipoğlu

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引用次数: 0

摘要

目的：本系统综述和网络元回归（NMR）旨在评估和比较各种直接髓盖（DPC）材料用于恒牙的临床效果，并将随访时间作为一个变量。材料和方法：在多个数据库中进行了全面的文献检索，包括PubMed， Cochrane Library， Scopus和Web of Science，没有语言限制。只有比较至少两种DPC材料的随机临床试验，随访时间至少为3个月。进行贝叶斯核磁共振分析以整合直接和间接证据，在考虑随访时间的同时提供95%可信区间（CrIs）和预测区间（PI）的比值比（OR）。结果：系统评价共纳入21项随机对照试验，其中19项符合网络元回归（NMR），包括1733例患者和6种直接髓盖材料。与氢氧化钙相比，Biodentine （OR: 4.41; 95% CrI: 1.40-17.66）和MTA （OR: 3.02; 95% CrI: 1.19-8.30）的临床成功率明显更高。在SUCRA排名中，Biodentine （83.1%, 95% CrI: 40-100）和MTA （66.6%, 95% CrI: 20-100）位居前列，而氢氧化钙的成功率最低（18.2%,95% CrI: 0-60）。结论：生物牙定和MTA对成熟恒牙直接盖髓的临床成功率高于氢氧化钙。然而，由于大量的异质性、广泛的可信区间和证据的低确定性，对于任何材料的优越性都不能得出明确的结论。临床意义：与氢氧化钙相比，硅酸钙材料如Biodentine和MTA在直接盖髓治疗中具有更高的临床成功率，这表明它们在重要髓治疗中可能提供更可预测的结果。然而，由于现有证据的局限性，包括不精确和研究的异质性，临床医生在选择牙髓盖盖材料时还应考虑处理性能、固定时间和修复质量等因素。长期的成功可能既取决于封堵剂的生物学特性，也取决于修复的完整性。

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Comparative clinical success of direct pulp capping materials: A network meta-regression of randomized clinical trials

Objectives

This systematic review and network meta-regression (NMR) aimed to evaluate and compare the clinical effectiveness of various direct pulp capping (DPC) materials used in permanent teeth, incorporating follow-up duration as a covariate.

Materials and methods

A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Scopus, and Web of Science, without language restrictions. Only randomized clinical trials comparing at least two DPC materials with a minimum follow-up of three months were included. Bayesian NMR analyses were performed to integrate direct and indirect evidence, providing odds ratios (OR) with 95 % credible intervals (CrIs) and prediction intervals (PI) while accounting for the follow-up duration.

Results

A total of 21 randomized controlled trials were included in the systematic review, of which 19 were eligible for the network meta-regression (NMR), comprising 1733 patients and six direct pulp capping materials. Biodentine (OR: 4.41; 95 % CrI: 1.40–17.66) and MTA (OR: 3.02; 95 % CrI: 1.19–8.30) demonstrated significantly higher clinical success compared to calcium hydroxide. SUCRA rankings placed Biodentine (83.1 %, 95 % CrI: 40–100) and MTA (66.6 %, 95 % CrI: 20–100) at the top, while calcium hydroxide had the lowest probability of success (18.2 %, 95 % CrI: 0–60).

Conclusions

Biodentine and MTA showed higher clinical success rates than calcium hydroxide in direct pulp capping of mature permanent teeth. However, due to substantial heterogeneity, wide credible intervals, and low certainty of evidence, no definitive conclusions can be drawn regarding the superiority of any material.

Clinical significance

Calcium silicate-based materials such as Biodentine and MTA are associated with higher clinical success in direct pulp capping compared to calcium hydroxide, suggesting they may offer more predictable outcomes in vital pulp therapy. However, due to limitations in the current evidence, including imprecision and study heterogeneity, clinicians should also consider factors such as handling properties, setting time, and restoration quality when selecting a pulp capping material. Long-term success may depend as much on restorative integrity as on the biological properties of the capping agent.

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来源期刊

Journal of dentistry 医学-牙科与口腔外科

CiteScore

7.30

自引率

11.40%

发文量

349

审稿时长

35 days

期刊介绍： The Journal of Dentistry has an open access mirror journal The Journal of Dentistry: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The Journal of Dentistry is the leading international dental journal within the field of Restorative Dentistry. Placing an emphasis on publishing novel and high-quality research papers, the Journal aims to influence the practice of dentistry at clinician, research, industry and policy-maker level on an international basis. Topics covered include the management of dental disease, periodontology, endodontology, operative dentistry, fixed and removable prosthodontics, dental biomaterials science, long-term clinical trials including epidemiology and oral health, technology transfer of new scientific instrumentation or procedures, as well as clinically relevant oral biology and translational research. The Journal of Dentistry will publish original scientific research papers including short communications. It is also interested in publishing review articles and leaders in themed areas which will be linked to new scientific research. Conference proceedings are also welcome and expressions of interest should be communicated to the Editor.