中国局部用氟预防正畸治疗中牙釉质脱矿的系统评价
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摘要
目的系统评价我国局部用氟预防正畸治疗中牙釉质脱矿的效果。方法计算机检索The CochraneLibrary(2012年第9期)、MEDLINE(1996～2012.10)、EMbase(1974～2012.10)、CNKI(1994～2012.10)、VIP(1994～2012.10)、WanFang Data(1998～2012.10)和CBM(1978～2012.10),纳入关于我国局部用氟预防正畸治疗中牙釉质脱矿的随机和半随机对照试验,同时追溯纳入文献的参考文献。由2位研究者独立对纳入研究的质量进行严格评价和资料提取,而后采用RevMan 5.2软件进行Meta分析。结果共纳入19篇文献(20个研究),包括26 323颗牙齿。Meta分析结果显示:氟保护漆组的牙釉质脱矿率(8.4%)低于对照组(16.0%)[OR=0.44,95%CI(0.33,0.59),P<0.000 01];局部涂氟组的牙釉质脱矿率(8.3%)低于对照组(17.7%)[OR=0.46,95%CI(0.35,0.60),P<0.000 01];含氟牙膏组的牙釉质脱矿率(9.0%)低于对照组(14.5%)[OR=0.59,95%CI(0.49,0.71),P<0.000 01];含氟泡沫组的牙釉质脱矿率(11.6%)低于对照组(18.2%)[OR=0.48,95%CI(0.24,0.96),P=0.04];其他方式组的牙釉质脱矿率(12.0%)低于对照组(21.8%)[OR=0.43,95%CI(0.30,0.60),P<0.000 01]。2个结局的GRADE系统推荐分级为低等级,3个为极低等级。结论国内现有研究显示,局部用氟可以达到预防正畸治疗中牙釉质脱矿的效果,但由于纳入研究的方法学质量较低,本研究结果的可靠性尚需开展更多设计严谨的高质量、大样本的研究予以证实。
Objective To evaluate the effectiveness of topical fluoride on prevention of enamel demineralization during the orthodontic treatment in China.Methods The Cochrane Library(Issue 9,2012),MEDLINE(1996 to 2012.10),EMbase(1974 to 2012.10),CNKI(1994 to 2012.10),VIP(1994 to 2012.10),WanFang data(1998 to 2012.10) and CBM(1978 to 2012.10) are searched for the randomized controlled trials(RCTs) and quasi-Randomized controlled trials(qRCTs) about topical fluoride preventing enamel demineralization during the orthodontic treatment.The bibliographies of the included studies were searched,too.Two reviewers evaluated the quality of the included studies and extracted data critically and independently,and then the extracted data were analyzed using RevMan 5.2 software.Results A total of 20 studies within 19 articles were included,which involved 26 323 teeth.The results of meta-analysis results show that,the rate of enamel demineralization of the fluoride varnish group(8.4%) was lower than that of the control group(16.0%)(OR=0.44,95%CI 0.33 to 0.59,P<0.000 01);the rate of enamel demineralization of the fluoride coating group(8.3%) was lower than that of the control group(17.7%)(OR=0.46,95%CI 0.35 to 0.60,P<0.000 01);the rate of enamel demineralization of the fluoride toothpaste group(9.0%) was lower than that of the control group(14.5%)(OR=0.59,95%CI 0.49 to 0.71,P<0.000 01);the rate of enamel demineralization of the fluoride foam group(11.6%) was lower than that of the control group(18.2%)(OR=0.48,95%CI 0.24 to 0.96,P=0.04);the rate of enamel demineralization of other groups(12.0%) was lower than that of the control group(21.8%)(OR=0.43,95%CI 0.30 to 0.60,P<0.000 01).Two outcomes were low quality in the GRADE system and the other three are very low quality.Conclusion Current domestic evidence shows that topical fluoride is effective to prevent enamel demineralization during the orthodontic treatment.However,given the low methodological quality of most included studies,this conclusion still needs to be further proved by conducting more strictly-designed,high-quality and large-scale studies.
Objective To evaluate the effectiveness of topical fluoride on prevention of enamel demineralization during the orthodontic treatment in China.Methods The Cochrane Library(Issue 9,2012),MEDLINE(1996 to 2012.10),EMbase(1974 to 2012.10),CNKI(1994 to 2012.10),VIP(1994 to 2012.10),WanFang data(1998 to 2012.10) and CBM(1978 to 2012.10) are searched for the randomized controlled trials(RCTs) and quasi-Randomized controlled trials(qRCTs) about topical fluoride preventing enamel demineralization during the orthodontic treatment.The bibliographies of the included studies were searched,too.Two reviewers evaluated the quality of the included studies and extracted data critically and independently,and then the extracted data were analyzed using RevMan 5.2 software.Results A total of 20 studies within 19 articles were included,which involved 26 323 teeth.The results of meta-analysis results show that,the rate of enamel demineralization of the fluoride varnish group(8.4%) was lower than that of the control group(16.0%)(OR=0.44,95%CI 0.33 to 0.59,P<0.000 01);the rate of enamel demineralization of the fluoride coating group(8.3%) was lower than that of the control group(17.7%)(OR=0.46,95%CI 0.35 to 0.60,P<0.000 01);the rate of enamel demineralization of the fluoride toothpaste group(9.0%) was lower than that of the control group(14.5%)(OR=0.59,95%CI 0.49 to 0.71,P<0.000 01);the rate of enamel demineralization of the fluoride foam group(11.6%) was lower than that of the control group(18.2%)(OR=0.48,95%CI 0.24 to 0.96,P=0.04);the rate of enamel demineralization of other groups(12.0%) was lower than that of the control group(21.8%)(OR=0.43,95%CI 0.30 to 0.60,P<0.000 01).Two outcomes were low quality in the GRADE system and the other three are very low quality.Conclusion Current domestic evidence shows that topical fluoride is effective to prevent enamel demineralization during the orthodontic treatment.However,given the low methodological quality of most included studies,this conclusion still needs to be further proved by conducting more strictly-designed,high-quality and large-scale studies.
引文
1吴永生.方丝弓矫治技术应用常见误点分析.口腔正畸学,2001,8(4):183-184.
2潘一春,张丁,傅民魁.固定矫治器粘结前后牙齿颊面菌斑PH值的改变和变形链球菌附着的改变.口腔正畸学,2003,10(1):23-26.
3 Lovror S,Hertrich K,Hirschfelder U.Enamel demineralization dur-ing fixed orthodontic treatment-incidence and correlation to various oral-hygiene parameters.J Orofac Orthop,2007,68(5):353-363.
4胡炜,王勤,傅民魁,等.口腔正畸固定矫治器应用中牙釉质脱矿的临床调查.口腔正畸学,2001,8(2):51-53.
5吴娜,周学东,郝玉庆.氟对脱矿和再矿化牙釉质表面的影响.华西口腔医学杂志,2012,30(5):493-497.
6黄璟,李智,郭毅.局部用氟预防儿童龋齿的系统评价.中国循证医学杂志,2012,12(7):1-7.
7董宁,刘东旭.氟化物在预防正畸釉质脱矿中的应用.国际口腔医学杂志,2007,34(4):306-308.
8阮建平,台保军.氟化物的防龋机制.见:胡德渝,主编.口腔预防医学.第6版.北京:人民卫生出版社,2012:96-97.
9 Atkins D,Best D,Briss PA,et al.Grading quality of evidence and strength of recommendations.BMJ,2004,328(7454):1490.
10张晔,王培军,邵平.氟保护漆防治正畸牙釉质脱矿的临床观察.哈尔滨医科大学学报,2002,36(4):327-328.
11张超,伍军.氟保护漆预防正畸治疗中釉质脱矿的临床研究.中国美容医学,2009,18(3):374-375.
12王佳宁,莎日娜,张晓静,等.氟保护漆防治正畸牙釉质脱矿的临床研究.内蒙古医学院学报,2011,33(4):327-328.
13王愿林,祝深山.应用氟防护漆预防固定矫治中釉质脱矿的效果观察.成宁学院学报(医学版),2010,24(6):515.
14白雪芹,邵菊萍,郝艳红.口腔健康教育及局部用氟对正畸治疗后牙釉质脱矿的影响.中国妇幼保健,2008,23(17):2390-2392.
15董雅妮,陈敏,任晓敏.氟保护漆预防牙釉质脱矿的效果评价.中国组织工程研究与临床康复,2008,12(25):4997-4999.
16钟巧芬.氟保护漆在固定矫治中预防牙面脱矿的效果观察.中国社区医师.医学专业,2011,13(20):98.
17陈玉梅,王传涛,李大建,等.固定矫治中牙釉质脱矿的防治观察.广西预防医学,2004,10(1):37-38.
18李业荣,王大为.两种局部用氟对预防正畸牙脱矿的临床研究.广东牙病防治,2006,14(3):181-183.
19林铭,邱冬梅,陈巨峰.固定正畸酸蚀后用氟法的临床应用.南方医科大学学报,2008,28(5):794-795.
20胡振梅,高振涛,王丽娟,等.含氟酸蚀液防治正畸牙釉质脱矿的临床观察.实用口腔医学杂志,2006,22(1):2911.
21张定铭,刘朝霞,戴红卫,等.应用含氟牙膏预防固定正畸患者牙釉质脱矿的临床研究.重庆医科大学学报,2003,28(6):781-783.
22李沙.正畸治疗中牙釉质脱矿的临床观察及预防措施.中国学校卫生,2004,25(2):230.
23张浛宇,卢书源.氟化泡沫在正畸治疗中的应用.黑龙江医学,2003,27(5):371.
24钱成明,秦明群,毛峻武.氟化处理对正畸酸蚀牙防龋的临床探讨.口腔医学纵横杂志,2000,16(4):305-306.
25王朝辉.两种含氟粘接系统在正畸治疗中的应用.实用医学杂志,2008,24(6):959-960.
26赵利芳.含氟漱口液预防固定矫治中釉质脱矿疗效观察.基层医学论坛,2012,16(11):1393-1394.
27邵坪,张苗苗,张晔.固定矫治后牙釉质脱矿及再矿化的临床研究.哈尔滇医科大学学报,2003,37(6):519-521.
28陈少武,吴敏.含氟复合体预防正畸治疗中釉质脱矿的临床研究.北京口腔医学,2003,11(3):144-145.
29 Benson PE,Parkin N,Millett DT,et al.Fluorides for the preven-tion of white spots on teeth during fixed brace treatment.Cochrane Database of Systematic Reviews 2004,Issue 3.Art.No.:CD003809.DOI:10.1002/14651858.CD003809.pub2.
30 Chadwick BL,Roy J,Knox J,et al.The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances:a sys-tematic review.Am J Orthod Dentofacial Orthop,2005,128(5):601-606.
31徐强,朱鹏武,曲雯雯,等.正畸学的Cochrane系统评价证据.中国循证医学杂志,2006,6(5):390-392.
32 Mattick CR,Mitchell L,Chadwick SM,et al.Fluoride-releasing elas-tomeric modules reduce decalcification:a randomized controlled trial.J Orthod,200l,28(3):217-219.
33 Banks PA,Chadwick SM,Asher McDade C,et al.Fluoride releasing elastomerics:a prospective controlled clinical trial.Eur J Orthod,2000,22(4):401-407.
34庞光明,白丁,陈扬熙,等.正畸不同用氟方法预防釉质粘接面早期龋的超微结构观察.华西口腔医学杂志,1999,17(3):267-268.
35华永梅,陈捷,Jean Gong.不同浓度含氟牙膏对正畸牙龋病与脱矿的预防效果.华西口腔医学杂志,2006,24(6):146-147.
36 Benson PE,Shah AA,Millett DT,et al.Fluorides,orthodontics and demineralization:a systematic review.J Orthod,2005,32(2):102-114.
37 Tavss EA,Mellberg JR,Joziak M,et al.Relationship between denti-frice fluoride concentration and clinical caries reduction.Am J Dent,2003,l6(6):369-374.
38马长柏,刘新强,李金华.氟对镍钛弓丝的腐蚀性研究.现代口腔医学杂志,2009,23(6):587-590.
39 Storie DJ,Regennitter F,von Fraunhofer JA.Characteristics of a fluoride-releasing elastomeric chain.Angle Orthod,1994,64(3):199-209.
40王晓燕,高学军,王嘉德.含氟复合树脂释氟量及其对吸水值和溶解值的影响.中华口腔医学杂志,2000,35(6):437-438.
41李刚,王志良,杭大磊.使用氟化泡沫前后晨尿含氟量临床对比观察.牙体牙髓牙周病学杂志,1999,2(9):1-3.
42张光明,田恒丹,张达生.武汉地区126例使用含氟牙膏者发氟含量测定.口腔医学纵横,1994,10(2):118-119.
2潘一春,张丁,傅民魁.固定矫治器粘结前后牙齿颊面菌斑PH值的改变和变形链球菌附着的改变.口腔正畸学,2003,10(1):23-26.
3 Lovror S,Hertrich K,Hirschfelder U.Enamel demineralization dur-ing fixed orthodontic treatment-incidence and correlation to various oral-hygiene parameters.J Orofac Orthop,2007,68(5):353-363.
4胡炜,王勤,傅民魁,等.口腔正畸固定矫治器应用中牙釉质脱矿的临床调查.口腔正畸学,2001,8(2):51-53.
5吴娜,周学东,郝玉庆.氟对脱矿和再矿化牙釉质表面的影响.华西口腔医学杂志,2012,30(5):493-497.
6黄璟,李智,郭毅.局部用氟预防儿童龋齿的系统评价.中国循证医学杂志,2012,12(7):1-7.
7董宁,刘东旭.氟化物在预防正畸釉质脱矿中的应用.国际口腔医学杂志,2007,34(4):306-308.
8阮建平,台保军.氟化物的防龋机制.见:胡德渝,主编.口腔预防医学.第6版.北京:人民卫生出版社,2012:96-97.
9 Atkins D,Best D,Briss PA,et al.Grading quality of evidence and strength of recommendations.BMJ,2004,328(7454):1490.
10张晔,王培军,邵平.氟保护漆防治正畸牙釉质脱矿的临床观察.哈尔滨医科大学学报,2002,36(4):327-328.
11张超,伍军.氟保护漆预防正畸治疗中釉质脱矿的临床研究.中国美容医学,2009,18(3):374-375.
12王佳宁,莎日娜,张晓静,等.氟保护漆防治正畸牙釉质脱矿的临床研究.内蒙古医学院学报,2011,33(4):327-328.
13王愿林,祝深山.应用氟防护漆预防固定矫治中釉质脱矿的效果观察.成宁学院学报(医学版),2010,24(6):515.
14白雪芹,邵菊萍,郝艳红.口腔健康教育及局部用氟对正畸治疗后牙釉质脱矿的影响.中国妇幼保健,2008,23(17):2390-2392.
15董雅妮,陈敏,任晓敏.氟保护漆预防牙釉质脱矿的效果评价.中国组织工程研究与临床康复,2008,12(25):4997-4999.
16钟巧芬.氟保护漆在固定矫治中预防牙面脱矿的效果观察.中国社区医师.医学专业,2011,13(20):98.
17陈玉梅,王传涛,李大建,等.固定矫治中牙釉质脱矿的防治观察.广西预防医学,2004,10(1):37-38.
18李业荣,王大为.两种局部用氟对预防正畸牙脱矿的临床研究.广东牙病防治,2006,14(3):181-183.
19林铭,邱冬梅,陈巨峰.固定正畸酸蚀后用氟法的临床应用.南方医科大学学报,2008,28(5):794-795.
20胡振梅,高振涛,王丽娟,等.含氟酸蚀液防治正畸牙釉质脱矿的临床观察.实用口腔医学杂志,2006,22(1):2911.
21张定铭,刘朝霞,戴红卫,等.应用含氟牙膏预防固定正畸患者牙釉质脱矿的临床研究.重庆医科大学学报,2003,28(6):781-783.
22李沙.正畸治疗中牙釉质脱矿的临床观察及预防措施.中国学校卫生,2004,25(2):230.
23张浛宇,卢书源.氟化泡沫在正畸治疗中的应用.黑龙江医学,2003,27(5):371.
24钱成明,秦明群,毛峻武.氟化处理对正畸酸蚀牙防龋的临床探讨.口腔医学纵横杂志,2000,16(4):305-306.
25王朝辉.两种含氟粘接系统在正畸治疗中的应用.实用医学杂志,2008,24(6):959-960.
26赵利芳.含氟漱口液预防固定矫治中釉质脱矿疗效观察.基层医学论坛,2012,16(11):1393-1394.
27邵坪,张苗苗,张晔.固定矫治后牙釉质脱矿及再矿化的临床研究.哈尔滇医科大学学报,2003,37(6):519-521.
28陈少武,吴敏.含氟复合体预防正畸治疗中釉质脱矿的临床研究.北京口腔医学,2003,11(3):144-145.
29 Benson PE,Parkin N,Millett DT,et al.Fluorides for the preven-tion of white spots on teeth during fixed brace treatment.Cochrane Database of Systematic Reviews 2004,Issue 3.Art.No.:CD003809.DOI:10.1002/14651858.CD003809.pub2.
30 Chadwick BL,Roy J,Knox J,et al.The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances:a sys-tematic review.Am J Orthod Dentofacial Orthop,2005,128(5):601-606.
31徐强,朱鹏武,曲雯雯,等.正畸学的Cochrane系统评价证据.中国循证医学杂志,2006,6(5):390-392.
32 Mattick CR,Mitchell L,Chadwick SM,et al.Fluoride-releasing elas-tomeric modules reduce decalcification:a randomized controlled trial.J Orthod,200l,28(3):217-219.
33 Banks PA,Chadwick SM,Asher McDade C,et al.Fluoride releasing elastomerics:a prospective controlled clinical trial.Eur J Orthod,2000,22(4):401-407.
34庞光明,白丁,陈扬熙,等.正畸不同用氟方法预防釉质粘接面早期龋的超微结构观察.华西口腔医学杂志,1999,17(3):267-268.
35华永梅,陈捷,Jean Gong.不同浓度含氟牙膏对正畸牙龋病与脱矿的预防效果.华西口腔医学杂志,2006,24(6):146-147.
36 Benson PE,Shah AA,Millett DT,et al.Fluorides,orthodontics and demineralization:a systematic review.J Orthod,2005,32(2):102-114.
37 Tavss EA,Mellberg JR,Joziak M,et al.Relationship between denti-frice fluoride concentration and clinical caries reduction.Am J Dent,2003,l6(6):369-374.
38马长柏,刘新强,李金华.氟对镍钛弓丝的腐蚀性研究.现代口腔医学杂志,2009,23(6):587-590.
39 Storie DJ,Regennitter F,von Fraunhofer JA.Characteristics of a fluoride-releasing elastomeric chain.Angle Orthod,1994,64(3):199-209.
40王晓燕,高学军,王嘉德.含氟复合树脂释氟量及其对吸水值和溶解值的影响.中华口腔医学杂志,2000,35(6):437-438.
41李刚,王志良,杭大磊.使用氟化泡沫前后晨尿含氟量临床对比观察.牙体牙髓牙周病学杂志,1999,2(9):1-3.
42张光明,田恒丹,张达生.武汉地区126例使用含氟牙膏者发氟含量测定.口腔医学纵横,1994,10(2):118-119.