Materiales para la obturación retrógrada en el tratamiento del conducto radicular
Información
- DOI:
- https://doi.org/10.1002/14651858.CD005517.pub3Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 14 octubre 2021see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Citado por:
Autores
Contributions of authors
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Honglin Li and Zhiyong Guo were co‐first authors of this review.
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Xiangyu Ma, Honglin Li and Zhiyong Guo included the studies, obtained copies of trials, assessed the risk of bias, extracted data, and did the whole writing and revision of the systematic review.
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Honglin Li and Zhiyong Guo assessed the risk of bias, extracted data, carried out the analysis and revised the systematic review.
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Yan Wang included the studies, obtained copies of trials, and revised the whole writing.
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Chunjie Li helped to obtain copies of trials and revised the whole writing.
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Dingming Huang and Xuedong Zhou provided content expertise on the systematic review and revised the whole writing.
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Trevor M Johnson included the studies and provided content expertise on the systematic review and revised the whole writing.
Sources of support
Internal sources
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West China College of Stomatology, Sichuan University, China
External sources
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Cochrane Oral Health, UK
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Chinese Cochrane Center, China
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Cochrane Oral Health Global Alliance, Other
The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (oralhealth.cochrane.org/partnerships-alliances). Contributors in the last 2 years have been the American Association of Public Health Dentistry, USA; AS‐Akademie, Germany; the British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; and Swiss Society of Endodontology, Switzerland.
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National Institute for Health Research (NIHR), UK
This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Evidence Synthesis Programme, the NIHR, the NHS, or the Department of Health and Social Care.
Declarations of interest
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Honglin Li: none known.
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Zhiyong Guo: none known.
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Chunjie Li: none known.
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Xiangyu Ma: none known.
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Yan Wang: none known.
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Xuedong Zhou: none known.
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Trevor M Johnson: none known. Trevor M Johnson is an Editor with Cochrane Oral Health.
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Dingming Huang: none known.
Acknowledgements
Our thanks go to the Cochrane Oral Health editorial team and external peer reviewers for their help in conducting this systematic review. We would like to thank in particular Anne Littlewood, Information Specialist at Cochrane Oral Health, for developing the electronic search strategy and running the electronic searches. We would also like to thank Luisa Fernandez Mauleffinch (Managing Editor and Copy Editor, Cochrane Oral Health), Professor Ana Jeroncic (University of Split School of Medicine, Croatia), Professor Alison Qualtrough, and Philip Riley (Editor, Cochrane Oral Health), for their kind help and guidance in preparing and revising the review. We thank Dr Liuhe Jia and Wenwen Liu who participated in the preparing and writing of the previous version.
The review authors also send their thanks to Dr Raphael Freitas de Souza and Dr Anette Bluemle for their help in screening the titles and abstracts which were not in English or Chinese. Great thanks should also be sent to Dr Jerome AH Lindeboom, Dr Simon Storgård Jensen, Dr Minju Song, and Dr Dan‐Åke Wälivaara, who were the initial investigators of four randomised trials included in this systematic review, for their assistance in providing valuable information about the studies. And thanks to Dr Chenyang Xiang, Wenhang Dong, Qiushi Wang, Zhaoyang Ban, and Feng Li from West China College of Stomatology, Sichuan University, for their assistance with handsearching.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Oct 14 | Materials for retrograde filling in root canal therapy | Review | Honglin Li, Zhiyong Guo, Chunjie Li, Xiangyu Ma, Yan Wang, Xuedong Zhou, Trevor M Johnson, Dingming Huang | |
| 2016 Dec 17 | Materials for retrograde filling in root canal therapy | Review | Xiangyu Ma, Chunjie Li, Liuhe Jia, Yan Wang, Wenwen Liu, Xuedong Zhou, Trevor M Johnson, Dingming Huang | |
| 2005 Oct 19 | Materials for retrograde filling in root canal therapy | Protocol | Liuhe Jia, Wang Qi, Huang D Ming, Zhou X Dong | |
Differences between protocol and review
As the protocol was published more than ten years ago and many things changed during these years, a little modification was made on the protocol.
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The primary outcome was renamed as success rate; radiological outcome and clinical outcome were all considered criteria or subsets of success rate. The meaning of the outcome was not changed. Adverse events were added as a secondary outcome.
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More electronic databases (e.g. LILACS, VIP, China National Knowledge Infrastructure) were added to try to identify more non‐English studies. Ongoing/unpublished studies searching (via US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, Sciencepaper Online) was also added.
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We treated each tooth as units of analysis instead of individual participants. Based on a brief survey, Safi 2019; Wälivaara 2011; and Jesslen 1995 used tooth as a unit of analysis and have included patients with more than one treated tooth in the study which resulted in unit‐of‐analysis error. The rest of the studies used patient as a unit of analysis but as they included only one tooth per patient, unit of analysis can also be interpreted as per tooth as well as per patient.
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For the risk of bias assessment, seven domains were adopted instead of the previous four domains as it is suggested in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011); and the GRADE system was introduced.
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The random‐effects model was used when the number of studies for each outcome exceeded four instead of using it throughout.
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Intention‐to‐treat analysis was added as one of the sensitivity analysis.
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Following the introduction of Review Manager 5 (Review Manager 2020) and the conversion to a new review format, more subsections have been added to the methods section including: unit of analysis issues, dealing with missing data, assessment of reporting biases, subgroup analysis and investigation of heterogeneity, and summary of findings and assessment of the certainty of the evidence.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Humans;
PICO
A: an infected tooth. The inner space of the tooth is the root canal system, where the pulp is located. The pulp of this tooth is irreversibly inflamed from bacterial infection due to decay.
B and C: the process of root canal therapy. B: a hole has been drilled from the top of the crown of the tooth. The dentist could then remove the infected tissues and toxic irritants by a combination of mechanical cleaning and irrigation in the root canal system through the hole. C: after cleaning and irrigation, the dentist fills the space with an inert packing material and seals the opening.
D and E: the process of retrograde filling. D: when retrograde filling is indicated, the dentist needs to cut a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. E: after cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material.
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: MTA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 1: MTA versus IRM, Outcome 2: Success rate ‐ 2‐year outcome (tooth as unit of analysis)
Comparison 2: MTA versus Super‐EBA, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 2: MTA versus Super‐EBA, Outcome 2: Success rate ‐ 4‐year outcome (tooth as unit of analysis)
Comparison 3: Super‐EBA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1: Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2: Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3: Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis)
Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4: Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis)
Comparison 5: Glass ionomer cement versus amalgam, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Comparison 5: Glass ionomer cement versus amalgam, Outcome 2: Success rate ‐ 5‐year outcome (tooth as unit of analysis)
Comparison 6: MTA versus RRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)
| MTA versus IRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| IRM | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 806 per 1000 | 879 per 1000 | RR 1.09 | 222 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to IRM on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; IRM: intermediate restorative material; MTA: mineral trioxide aggregate; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; both studies had the personnel unblinded due to the nature of the study design, and Chong 2003 had incomplete outcome data reported) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| MTA versus Super‐EBA for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Super‐EBA | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 931 per 1000 | 959 per 1000 | RR 1.03 | 192 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to Super‐EBA on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; MTA: mineral trioxide aggregate; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Kim 2016) had high risk of bias regarding incomplete data reporting and personnel blinding) and imprecision (downgraded by 2 levels; small population might cause serious imprecision). | ||||||
| Super‐EBA versus IRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| IRM | Super‐EBA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 906 per 1000 | 815 per 1000 | RR 0.90 | 194 | ⊕⊝⊝⊝ | The evidence is very uncertain about the effect of Super‐EBA compared with IRM on success rate at 1 year, with results indicating Super‐EBA may reduce or have no effect on success rate |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; IRM: intermediate restorative material; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; high risk of bias existed in the only included study (Wälivaara 2011) on allocation concealment and personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| Dentine‐bonded resin composite versus glass ionomer cement for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth/roots | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Glass ionomer cement | Dentine‐bonded resin composite | |||||
| Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) | 306 per 1000 | 731 per 1000 | RR 2.39 | 122 teeth | ⊕⊝⊝⊝ | Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain |
| Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) | 519 per 1000 | 825 per 1000 | RR 1.59 | 127 roots | ⊕⊝⊝⊝ | Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PP: per‐protocol; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jensen 2002) did not have participants, personnel, or outcome assessors blinded) and imprecision (downgraded by 2 levels; small population might cause serious imprecision). | ||||||
| Glass ionomer cement versus amalgam for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Amalgam | Glass ionomer cement | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) | 904 per 1000 | 886 per 1000 | RR 0.98 | 105 | ⊕⊝⊝⊝ | The evidence is very uncertain about the effect of glass ionomer cement compared with amalgam on success rate at 1 year, with results indicating glass ionomer cement may reduce or have no effect on success rate |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jesslen 1995) had the personnel unblinded due to the nature of the study design) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| MTA versus RRM for retrograde filling in root canal therapy | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients needing retrograde filling in root canal therapy Settings: China Intervention: MTA versus RRM | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of teeth | Certainty of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| RRM | MTA | |||||
| Success rate ‐ 1‐year outcome (tooth as unit of analysis) Assessed by combination of clinical and radiological methods Follow‐up: 1 year | 933 per 1000 | 896 per 1000 | RR 1.00 | 278 | ⊕⊝⊝⊝ | There may be little to no effect of MTA compared to RRM on success rate at 1 year but the evidence is very uncertain |
| Adverse events | Outcome was not assessed by the included studies | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; MTA: mineral trioxide aggregate; RR: risk ratio; RRM: root repair material | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
| aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included studies (Safi 2019; Zhou 2017) had high risk of bias regarding personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 222 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.97, 1.22] |
| 1.2 Success rate ‐ 2‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 2.2 Success rate ‐ 4‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.2 Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.3 Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 4.4 Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| 5.2 Success rate ‐ 5‐year outcome (tooth as unit of analysis) Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot | 2 | 278 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.00 [0.94, 1.07] |
