Chinese Journal of Tissue Engineering Research ›› 2016, Vol. 20 ›› Issue (47): 7119-7126.doi: 10.3969/j.issn.2095-4344.2016.47.018
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Received:
2016-09-08
Online:
2016-11-18
Published:
2016-11-18
Contact:
Guo Ling, Associate professor, Master’s supervisor, Department of Preventive Medicine, Southwest Medical University, Luzhou 646000, Sichuan Province, China
About author:
Li Wang-yang, Studying for master’s degree, Department of Prosthodonitics, Affiliated Hospital of Stomatology, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Supported by:
the Project of Sichuan Provincal Department of Education, China, No. 11ZB128
CLC Number:
Li Wang-yang, Zhang Ling, Zhang Hui, Li Ai-ling, Guo Ling. Influence of Gluma desensitizing agents on dentin bond strength: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(47): 7119-7126.
2.3 风险评估结果 通过Cochrane风险偏倚评估工具评估,纳入文献均排除高风险偏倚。17项评估项目中选择偏倚(随机序列产生)高风险为5%,不清楚40%,低风险为55%;选择偏倚(分配隐藏)高风险为5%,不清楚32.5%,低风险为62.5%;实施偏倚(受试者盲法)高风险为20%,不清楚50%,低风险为30%;测试偏倚(对结果评估的盲法)高风险为0%,不清楚10%,低风险为90%;失访偏倚(数据结果完全)高风险为5%,不清楚10%,低风险为85%;报告偏倚(选择性报告)高风险为0%,不清楚5%,低风险为95%;其他偏倚高风险为0%,不清楚50%,低风险为50%;纳入文献具体风险评估情况见图3。"
2.4 Meta分析结果 2.4.1 自酸蚀黏结剂对黏结效果的影响 自酸蚀组中,共有11篇文章,其中16个研究符合纳入标准,共有180个样本。结果表明有2个研究中使用Gluma脱敏剂对牙本质后自酸蚀黏接剂强度抗剪切强度大于对照组;有3个研究中表明使用Gluma脱敏剂对牙本质后自酸蚀黏接剂强度抗剪切强度小于对照组;另外,11个研究与无效线相交。Meta分析结果异质性高达86%,最后结果P=0.77,差异无显著性意义。异质性检验χ2=108.42, P < 0.000 01),合并效应量WMD采用随机效应模型,WMD的合并效应量(total)为-0.23,其95%CI为(-1.78, 1.32),合并效应量的检验Z=0.29,P=0.77。根据此结果分析异质性可能存在的原因。纳入的文献中Külünk等[10]、Huh等[11]、李娜[19]、Stawarczyk等[22]的4个研究产生了较大的异质性。若排除这4个研究,异质性则可以降到36%。自酸蚀组中,Sabatini等[21]和程梁[7]均对自酸蚀黏结剂Opti Bond和XenoIV进行分析,结果均是未使用Gluma脱敏剂的对照组比使用Gluma脱敏剂的黏结剂的实验组抗剪切强度大,但是差异无显著性意义。孙凯峥[6]和李娜[19]同时对AdperTMEasy自酸蚀剂进行研究,结果是使用Gluma脱敏剂可以增强牙本质黏结的抗剪切强度。其他研究因为品牌不同会有细微的差别[6,10,21-22],但是主体成分和原理是相近的(图4)。"
2.4.2 全酸蚀黏结剂对黏结效果的影响 全酸蚀组中,共9篇文章,其中11个研究符合纳入标准,共有134个样本。结果表明有3个研究中使用Gluma脱敏剂对牙本质后全酸蚀黏接剂强度抗剪切强度大于对照组;有3个研究中表明使用Gluma脱敏剂对牙本质后全酸蚀黏接剂强度抗剪切强度小于对照组;另外,5个与无效线相交。Meta分析结果异质性为90%,最后结果P=0.93,差异无显著性意义。异质性检验χ2=102.73,P < 0.000 01,合并效应量WMD采用随机效应模型,WMD的合并效应量(total)为-0.10,其95%CI为(-2.26,2.05),合并效应量的检验Z=0.09,P=0.93。根据此结果分析异质性可能存在的原因,主要是因为Cobb等[17]中Gluma脱敏剂对牙本质后全酸蚀黏接剂强度抗剪切强度明显大于对照组(图5)。"
2.4.3 自酸蚀与全酸蚀黏结剂对黏结效果的影响 Gluma脱敏剂对牙本质脱敏后应用自酸蚀和全酸蚀黏结剂的抗剪强度对比,符合纳入标准的文献有6篇,9个研究,63个样本。其中有2个研究表明Gluma脱敏剂对牙本质后自酸蚀黏接剂强度抗剪切强度大于全酸蚀; 有2个研究中表明使用Gluma脱敏剂对牙本质后自酸蚀黏接剂强度抗剪切强度小于全酸蚀组,另外,5个研究与无效线相交。 Meta分析结果异质性为98%,异质性检验χ2= 404.94,P < 0.000 01,合并效应量WMD采用随机效应模型,WMD的合并效应量(total)为1.81,其95%CI为(-3.07,6.68),合并效应量的检验Z=0.73,P=0.47。根据此结果分析异质性可能存在的原因,主要是因为Cobb等[17]中Gluma脱敏剂对牙本质后全酸蚀黏接剂强度抗剪切强度明显大于对照组。Sailer等[18]和程梁[7]的研究中,自酸蚀组明显大于全酸蚀组(图6)。"
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