Chinese Journal of Tissue Engineering Research ›› 2018, Vol. 22 ›› Issue (10): 1634-1640.doi: 10.3969/j.issn.2095-4344.0727
Influence of sodium hypochlorite irrigants on the bonding of fiber posts to root canals: a Meta-analysis
- Department of Pediatric Dentistry, Affiliated Hospital of Stomatology, Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Received:2017-11-26Online:2018-04-08Published:2018-04-08 -
Contact:Liu Xing-rong, Professor, Master’s supervisor, Department of Pediatric Dentistry, Affiliated Hospital of Stomatology, Southwest Medical University, Luzhou 646000, Sichuan Province, China -
About author:Wang Wang, Master candidate, Department of Pediatric Dentistry, Affiliated Hospital of Stomatology, Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Cite this article
Wang Wang, Wu You, Liu Xing-rong. Influence of sodium hypochlorite irrigants on the bonding of fiber posts to root canals: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(10): 1634-1640.
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2.1 检索结果 根据上述检索策略，在PubMed(n=29)、EMbase(n=21)、Web Of Science(n=33)、OVID(n=22)、ClinicalKey(n=170)、CBM(n=13)、CNKI(n=30)、维普数据库(n=3)、万方数据库(n=20)初检，共检索出相关文献341篇(包括英文文献275篇，中文文献66篇)，通过阅读文章标题和摘要，初筛出106篇文献，去除重复文献，再仔细阅读全文的材料方法，复筛得到68篇文献，根据纳入排除标准，排除文献57篇，最后纳入11篇文献。文献筛选流程图如图1。"
2.2 纳入文献基本情况 共纳入11篇文献，其中英文9篇，中文2篇，均为随机对照实验。实验组采用NaOCl溶液行根管冲洗，对照组采用纯水或生理盐水行根管冲洗，纸尖干 燥后，分别以全酸蚀系统、自酸蚀系统、自粘接系统进行纤维桩粘接。其中1篇文献分别进行了剪切强度、拉出强度和推出强度检测，其余10篇只进行推出强度检测；2篇使用全酸蚀系统，2篇使用自酸蚀系统，8篇使用自粘接系统(其中1篇同时使用自酸蚀、自粘接系统，1篇同时使用全酸蚀、自粘接系统)；1篇文献以6组独立实验纳入研究，1篇文献以4组独立实验纳入研究，2篇文献以3组独立实验纳入研究，2篇文献以2组独立实验纳入研究，11篇文献共形成25篇独立研究。纳入文献的基本特征见表1。"
2.3 风险评估结果 根据Cochrane协作网推荐的风险偏倚评估工具对纳入的11个研究进行评估，纳入文献均排除高风险偏移。11项研究中，无4个及以上项目评估为高度偏倚的研究。其中，随机序列产生(选择偏倚)低风险为72.7%，不确定为27.3%，高风险为0%；分配隐藏(选择偏倚)低风险为63.6%，不确定为36.4%，高风险为0；对研究者和受试者施盲(实施偏倚)低风险为0，不确定为100%，高风险为0；研究结果和盲法评价(测量偏倚)低风险为100%，不确定为0，高风险为0；结果数据完整性(随访偏倚)低风险为63.6%，不确定为0%，高风险为36.4%；选择性报告研究结果(报告偏倚)低风险为72.7%，不确定为9.1%，高风险为18.2%；其他偏倚低风险为0，不确定为100%，高风险为0。具体风险评估情况见图2。"
2.4 纤维桩根管粘接强度的Meta分析 2.4.1 Meta分析结果 纳入文献的统计学异质性较大，I2=90%，合并效应量WMD，采用随机效应模型进行分 析，结果显示：WMD的合并效应量为-0.90，其95%CI为(-1.50，-0.31)，Z=2.97，P=0.003，即差异有统计学意义，NaOCl冲洗液会降低纤维桩根管粘接强度。纳入的25篇独立研究中，8篇研究差异有统计学意义，认为NaOCl溶液的冲洗会降低纤维桩粘接强度[23，25-27]；5篇研究差异有统计学意义，认为NaOCl溶液的冲洗会增加纤维桩粘接强 度[20，22，24]；12篇研究差异无统计学意义，尚不能认为NaOCl溶液的冲洗会影响纤维桩粘接强度[18-19，21-23，25，27-28](图3)。"
2.4.2 亚组分析 分析异质性可能的来源。 NaOCl冲洗液对全酸蚀粘接系统粘接强度的影响：全酸蚀组中，共纳入2篇文献，包含4组研究，统计学异质性较明显，I2=83%>50%，其原因可能是由于样本切片厚度的不同造成。使用随机效应模型进行分析，结果显示：WMD的合并效应量为-2.38，其95%CI为(-4.86，0.10)，Z=1.88，P=0.06。即对于全酸蚀系统，实验组与对照组对纤维桩根管粘接强度的影响无统计学差异，尚不能认为NaOCl冲洗液会对全酸蚀系统的纤维桩根管粘接强度造成影响(图4)。"
NaOCl冲洗液对自酸蚀粘接系统粘接强度的影响：自酸蚀组中，共纳入2篇文献，包含5组研究，统计学异质性较明显，I2=58%>50%，其原因可能是由于标本贮藏时间的不同造成。使用随机效应模型进行分析，结果显示：WMD的合并效应量为-1.22，其95%CI为(-2.17，-0.28)，Z= 2.55，P=0.01。即对于自酸蚀系统，实验组与对照组对纤维桩根管粘接强度的影响存在明显统计学差异，NaOCl冲洗液会降低自酸蚀系统的纤维桩根管粘接强度(图5)。 NaOCl冲洗液对自粘接系统粘接强度的影响：自粘接组中，共纳8篇文献，其中3篇文献的研究与其他研究存在临床异质性：Ertas等[20]、夏勇等[24]的研究中，根管预备过 程中提前使用了2.5%浓度NaOCl冲洗液；Alkhudhairy等[22] 的研究中，根管预备过程使用了乙二胺四乙酸，故排除。余下的5篇文献，包含9组研究，同质性较好，I2=13%<50%。"
使用固定效应模型进行分析，结果显示：WMD的合并效应量为-1.97，其95%CI为(-2.30，-1.64)，Z=11.73，P < 0.000 01。即对于自粘接系统，实验组与对照组对纤维桩根管粘接强度的影响存在明显统计学差异，NaOCl冲洗液会降低自粘接系统的纤维桩根管粘接强度(图6)。"
2.4.3 敏感性分析 对NaOCl处理后纤维桩粘接强度进行敏感性分析，每次剔除1个研究后将剩余研究合并，发现单独剔除1个研究对结果影响不大，森林图结果未发生质的改变。 2.4.4 发表偏倚分析 采用 CMA v2软件绘制漏斗图，结合剪补法进行分析，漏斗图基本对称，不存在潜在的发表偏倚(图7)。"
| [1]Schwartz RS,Robbins JW.Post placement and restoration of endodontically treated teeth: a literature review.J Endod. 2004;30(5): 289-301.[2]Cecchin D,de Almeida JF,Gomes BP,et al.Effect of chlorhexidine and ethanol on the durability of the adhesion of the fiber post relined with resin composite to the root canal.J Endod.2011; 37(5):678-83.[3]Pashley DH.Smear layer: Physiological considerations.Oper Dent Suppl.1983;3:13-29.[4]Cecchin D,Giacomin M,Farina AP,et al.Effect of chlorhexidine and ethanol on push-out bond strength of fiber posts under cyclic loading.J Adhes Dent.2014;16(1):87-92.[5]Moreira DM,Almeida JF,Ferraz CC,et al.Structural analysis of bovine root dentin after use of different endodontics auxiliary chemical substances.J Endod.2009;35(7):1023-1027.[6]Moreira DM,de Andrade Feitosa JP,Line SR,et al.Effects of reducing agents on birefringence dentin collagen after use of different endodontic auxiliary chemical substances.J Endod. 2011;37(10):1406-1411.[7]Gu XH,Mao CY,Kern M.Effect of different irrigation on smear layer removal after post space preparation.J Endod. 2009; 35(4):583-586.[8]Lindblad RM,Lassila LV,Salo V,et al.Effect of chlorhexidine on initial adhesion of fiber-reinforced post to root canal.J Dent. 2010;38(10): 796-801.[9]Leitune VC,Collares FM,Werner Samuel SM.Influence of chlorhexidine application at longitudinal push-out bond strength of fiber posts.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2010;110(5):77-81.[10]Ermis RB,De Munck J,Cardoso MV,et al.Bond strength of self-etch adhesives to dentin prepared with three different diamond burs.Dent Mater.200;24(7):978-985.[11]Morris MD,Lee KW,Agee KA,et al.Effects of sodium hypochlorite and RC-prep on bond strengths of resin cement to endodontic surfaces.J Endod.2001;27(12):753-757.[12]Correr GM,Alonso RC,Grando MF,et al.Effect of sodium hypochlorite on primary dentin--a scanning electron microscopy(SEM)evaluation.J Dent.2006;34(7):454-459.[13]Carrilho MR,Carvalho RM,de Goes MF,et al.Chlorhexidine Preserves Dentin Bond in vitro.J Dent Res.2007;86(1):90-94.[14]Hassan AM,Goda AA,Baroudi K.The Effect of Different Disinfecting Agents on Bond Strength of Resin Composites. Int J Dent.2014;2014:231235.[15]Di Hipólito V,Rodrigues FP,Piveta FB,et al.Effectiveness of self-adhesive luting cements in bonding to chlorhexidine- treated dentin.Dent Mater.2011;28(5):495-501.[16]Gwinnett AJ.Effect of cavity disinfection on bond strength to dentin.J Esthet Dent.1992;4 Suppl:11-13.[17]Ari H,Yasar E,Belli S.Effects of NaOCl on bond strengths of resin cements to root canal dentin. J Endod. 2003;29(4): 248-251.[18]Haragushiku GA,Back ED,Tomazinho PH,et al.Influence of antimicrobial solutions in the decontamination and adhesion of glass-fiber posts to root canals.J Appl Oral Sci. 2015;23(4): 436-441.[19]Barreto MS,Rosa RA,Seballos VG,et al.Effect of Intracanal Irrigants on Bond Strength of Fiber Posts Cemented With a Self-adhesive Resin Cement.Oper Dent. 2016;41(6): e159-e167. [20]Ertas H,Ok E,Uysal B,et al.Effects of different irrigating solutions and disinfection methods on push-out bond strengths of fiber posts.Acta Odontol Scand. 2014;72(8): 783-787.[21]Tuncdemir AR,Yildirim C,Ozcan E,et al.The effect of a diode laser and traditional irrigants on the bond strength of self-adhesive cement.J Adv Prosthodont.2013;5(4):457-463.[22]Alkhudhairy FI,Bin-Shuwaish MS.The effect of sodium hypochlorite and resin cement systems on push-out bond strength of cemented fiber posts.Pak J Med Sci. 2016;32(4): 905-910.[23]Khoroushi M,Sheikhi M,Khaliliangourtani A,et al.Effect of root canal rinsing protocol on dentin bond strength of two resin cements using three different method of test.J Clin Exp Dent. 2016;8(3):e246-e254.[24]夏勇,程祥荣.不同桩腔预处理对两种根充系统充填后纤维桩粘接强度的影响[J].口腔医学研究,2014,30(10):945-948.[25]王霜剑,唐旭炎.根管内不同预处理对玻璃纤维桩粘接强度的影响[J].安徽医学,2015,36(8):920-923.[26]Elnaghy AM.Effect of QMix irrigant on bond strength of glass fibre posts to root dentine. Int Endod J.2013;47(3):280-289.[27]Arisu HD,Kivanç BH,Sa?lam BC,et al.Effect of post-space treatments on the push-out bond strength and failure modes of glass fibre posts.Aust Endod J.2013;39(39):19-24. [28]Arslan H,Akcay M,Saygili G,et al.Bond strength of self-adhesive resin cement to root dentin. Comparison of photon-initiated photoacoustic streaming technique with needle and ultrasonic irrigation.Acta Odontol Scand. 2015; 73(5):1-5.[29]Ferrari M,Vichi A,Mannocci F,et al.Retrospective study of the clinical performance of fiber posts.Am J Dent.2000;13(Spec No):9B.[30]Ferrari M,Vichi A,Garcíagodoy F.Clinical evaluation of fiber-reinforced epoxy resin posts and cast post and cores.Am J Dent.2000;13(Spec No):15B.[31]Naumann M,Blankenstein F,Dietrich T.Survival of glass fibre reinforced composite post restorations after 2 years-an observational clinical study.J Dent.2005;33(4):305-312.[32]Monticelli F,Grandini S,Goracci C,et al.Clinical behavior of translucent-fiber posts: a 2-year prospective study.Int J Prosthodont.2003;16(6):593-596.[33]Demiryürek EO,Külünk S,Saraç D,et al. Effect of different surface treatments on the push-out bond strength of fiber post to root canal dentin.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(2):74-80.[34]Hayashi M,Takahashi Y,Hirai M,et al.Effect of endodontic irrigation on bonding of resin cement to radicular dentin.Eur J Oral Sci.2005;113(1):70-76.[35]Vongphan N,Senawongse P,Somsiri W,et al.Effects of sodium ascorbate on microtensile bond strength of total-etching adhesive system to NaOCl treated dentine.J Dent. 2005;33(8): 689-695.[36]Perdigão J,Geraldeli S,Lee IK.Push-out bond strengths of tooth-colored posts bonded with different adhesive systems. Am J Dent.2005;17(6):422-426.[37]Glazer B.Restoration of endodontically treated teeth with carbon fibre posts--a prospective study.J Can Dent Assoc. 2000;66(11):613-618.[38]Vichi A,Grandini S,Davidson CL,et al.An SEM evaluation of several adhesive systems used for bonding fiber posts under clinical conditions.Dent Mater.2002;18(7):495-502.[39]Valandro LF,Filho OD,Valera MC,et al.The effect of adhesive systems on the pullout strength of a fiberglass-reinforced composite post system in bovine teeth.J Adh Dent. 2005; 7(4):331.[40]Watanabe I,Saimi Y,Nakabayashi N.Effect of smear layer on bonding to ground dentin-relationship between grinding conditions and tensile bond strength.Jpn Soc Dent Mater Dev. 1994;13:101-108.[41]Miyasaka K,Nakabayashi N.Combination of EDTA conditioner and phenyl-P/HEMA self-etching primer for bonding to dentin. Dent Mater.1999;15:153-157.[42]Lai SC,Mak YF,Cheung GS,et al.Reversal of compromised bonding to oxidized etched dentin.J Dent Res. 2001;80(10): 1919.[43]Ishizuka T,Kataoka H,Yoshioka T,et al.Effect of NaClO treatment on bonding to root canal dentin using a new evaluation method.Dent Mater J.2001;20(1):24. [1]Schwartz RS,Robbins JW.Post placement and restoration of endodontically treated teeth: a literature review.J Endod. 2004;30(5): 289-301.[2]Cecchin D,de Almeida JF,Gomes BP,et al.Effect of chlorhexidine and ethanol on the durability of the adhesion of the fiber post relined with resin composite to the root canal.J Endod.2011; 37(5):678-83.[3]Pashley DH.Smear layer: Physiological considerations.Oper Dent Suppl.1983;3:13-29.[4]Cecchin D,Giacomin M,Farina AP,et al.Effect of chlorhexidine and ethanol on push-out bond strength of fiber posts under cyclic loading.J Adhes Dent.2014;16(1):87-92.[5]Moreira DM,Almeida JF,Ferraz CC,et al.Structural analysis of bovine root dentin after use of different endodontics auxiliary chemical substances.J Endod.2009;35(7):1023-1027.[6]Moreira DM,de Andrade Feitosa JP,Line SR,et al.Effects of reducing agents on birefringence dentin collagen after use of different endodontic auxiliary chemical substances.J Endod. 2011;37(10):1406-1411.[7]Gu XH,Mao CY,Kern M.Effect of different irrigation on smear layer removal after post space preparation.J Endod. 2009; 35(4):583-586.[8]Lindblad RM,Lassila LV,Salo V,et al.Effect of chlorhexidine on initial adhesion of fiber-reinforced post to root canal.J Dent. 2010;38(10): 796-801.[9]Leitune VC,Collares FM,Werner Samuel SM.Influence of chlorhexidine application at longitudinal push-out bond strength of fiber posts.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2010;110(5):77-81.[10]Ermis RB,De Munck J,Cardoso MV,et al.Bond strength of self-etch adhesives to dentin prepared with three different diamond burs.Dent Mater.200;24(7):978-985.[11]Morris MD,Lee KW,Agee KA,et al.Effects of sodium hypochlorite and RC-prep on bond strengths of resin cement to endodontic surfaces.J Endod.2001;27(12):753-757.[12]Correr GM,Alonso RC,Grando MF,et al.Effect of sodium hypochlorite on primary dentin--a scanning electron microscopy(SEM)evaluation.J Dent.2006;34(7):454-459.[13]Carrilho MR,Carvalho RM,de Goes MF,et al.Chlorhexidine Preserves Dentin Bond in vitro.J Dent Res.2007;86(1):90-94.[14]Hassan AM,Goda AA,Baroudi K.The Effect of Different Disinfecting Agents on Bond Strength of Resin Composites. Int J Dent.2014;2014:231235.[15]Di Hipólito V,Rodrigues FP,Piveta FB,et al.Effectiveness of self-adhesive luting cements in bonding to chlorhexidine- treated dentin.Dent Mater.2011;28(5):495-501.[16]Gwinnett AJ.Effect of cavity disinfection on bond strength to dentin.J Esthet Dent.1992;4 Suppl:11-13.[17]Ari H,Yasar E,Belli S.Effects of NaOCl on bond strengths of resin cements to root canal dentin. J Endod. 2003;29(4): 248-251.[18]Haragushiku GA,Back ED,Tomazinho PH,et al.Influence of antimicrobial solutions in the decontamination and adhesion of glass-fiber posts to root canals.J Appl Oral Sci. 2015;23(4): 436-441.[19]Barreto MS,Rosa RA,Seballos VG,et al.Effect of Intracanal Irrigants on Bond Strength of Fiber Posts Cemented With a Self-adhesive Resin Cement.Oper Dent. 2016;41(6): e159-e167. [20]Ertas H,Ok E,Uysal B,et al.Effects of different irrigating solutions and disinfection methods on push-out bond strengths of fiber posts.Acta Odontol Scand. 2014;72(8): 783-787.[21]Tuncdemir AR,Yildirim C,Ozcan E,et al.The effect of a diode laser and traditional irrigants on the bond strength of self-adhesive cement.J Adv Prosthodont.2013;5(4):457-463.[22]Alkhudhairy FI,Bin-Shuwaish MS.The effect of sodium hypochlorite and resin cement systems on push-out bond strength of cemented fiber posts.Pak J Med Sci. 2016;32(4): 905-910.[23]Khoroushi M,Sheikhi M,Khaliliangourtani A,et al.Effect of root canal rinsing protocol on dentin bond strength of two resin cements using three different method of test.J Clin Exp Dent. 2016;8(3):e246-e254.[24]夏勇,程祥荣.不同桩腔预处理对两种根充系统充填后纤维桩粘接强度的影响[J].口腔医学研究,2014,30(10):945-948.[25]王霜剑,唐旭炎.根管内不同预处理对玻璃纤维桩粘接强度的影响[J].安徽医学,2015,36(8):920-923.[26]Elnaghy AM.Effect of QMix irrigant on bond strength of glass fibre posts to root dentine. Int Endod J.2013;47(3):280-289.[27]Arisu HD,Kivanç BH,Sa?lam BC,et al.Effect of post-space treatments on the push-out bond strength and failure modes of glass fibre posts.Aust Endod J.2013;39(39):19-24. [28]Arslan H,Akcay M,Saygili G,et al.Bond strength of self-adhesive resin cement to root dentin. Comparison of photon-initiated photoacoustic streaming technique with needle and ultrasonic irrigation.Acta Odontol Scand. 2015; 73(5):1-5.[29]Ferrari M,Vichi A,Mannocci F,et al.Retrospective study of the clinical performance of fiber posts.Am J Dent.2000;13(Spec No):9B.[30]Ferrari M,Vichi A,Garcíagodoy F.Clinical evaluation of fiber-reinforced epoxy resin posts and cast post and cores.Am J Dent.2000;13(Spec No):15B.[31]Naumann M,Blankenstein F,Dietrich T.Survival of glass fibre reinforced composite post restorations after 2 years-an observational clinical study.J Dent.2005;33(4):305-312.[32]Monticelli F,Grandini S,Goracci C,et al.Clinical behavior of translucent-fiber posts: a 2-year prospective study.Int J Prosthodont.2003;16(6):593-596.[33]Demiryürek EO,Külünk S,Saraç D,et al. Effect of different surface treatments on the push-out bond strength of fiber post to root canal dentin.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(2):74-80.[34]Hayashi M,Takahashi Y,Hirai M,et al.Effect of endodontic irrigation on bonding of resin cement to radicular dentin.Eur J Oral Sci.2005;113(1):70-76.[35]Vongphan N,Senawongse P,Somsiri W,et al.Effects of sodium ascorbate on microtensile bond strength of total-etching adhesive system to NaOCl treated dentine.J Dent. 2005;33(8): 689-695.[36]Perdigão J,Geraldeli S,Lee IK.Push-out bond strengths of tooth-colored posts bonded with different adhesive systems. Am J Dent.2005;17(6):422-426.[37]Glazer B.Restoration of endodontically treated teeth with carbon fibre posts--a prospective study.J Can Dent Assoc. 2000;66(11):613-618.[38]Vichi A,Grandini S,Davidson CL,et al.An SEM evaluation of several adhesive systems used for bonding fiber posts under clinical conditions.Dent Mater.2002;18(7):495-502.[39]Valandro LF,Filho OD,Valera MC,et al.The effect of adhesive systems on the pullout strength of a fiberglass-reinforced composite post system in bovine teeth.J Adh Dent. 2005; 7(4):331.[40]Watanabe I,Saimi Y,Nakabayashi N.Effect of smear layer on bonding to ground dentin-relationship between grinding conditions and tensile bond strength.Jpn Soc Dent Mater Dev. 1994;13:101-108.[41]Miyasaka K,Nakabayashi N.Combination of EDTA conditioner and phenyl-P/HEMA self-etching primer for bonding to dentin. Dent Mater.1999;15:153-157.[42]Lai SC,Mak YF,Cheung GS,et al.Reversal of compromised bonding to oxidized etched dentin.J Dent Res. 2001;80(10): 1919.[43]Ishizuka T,Kataoka H,Yoshioka T,et al.Effect of NaClO treatment on bonding to root canal dentin using a new evaluation method.Dent Mater J.2001;20(1):24. |
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