| Objective In this paper,through a comprehensive search of the randomized controlled trial studies that have been published in China and abroad,we selected the research on the treatment of irreversible pulp damage in young permanent teeth with two options of pulp revascularization and apexification,and compared the clinical efficacy of the two treatment options in the treatment of irreversible pulp damage in young permanent teeth by using the method of evidence-based medicine,in order to provide certain reference value for future clinical work.Methods From the foreign language database(Pub Med,Embase,Cochrane library)and Chinese database(China journal full-text database(CNKI),China biomedical literature service system(CBM),Wanfang data knowledge service platform(Wang Fang)library and VIP Chinese science and technology journal full-text database)From January 2001 to December 2022,a randomized controlled trial of two methods of pulp revascularization and apexification for the treatment of irreversible damage to the pulp of young permanent teeth was conducted.Management analysis of the retrieved studies was performed using Endnote X9 software.Study screening and data extraction were conducted independently by two members in strict accordance with the inclusion and exclusion criteria.The quality of included studies was evaluated using the Cochrane system evaluation manual.A meta-analysis of the combined effects was performed using a combination of Rev Man 5.3 and STATA 12.0 software,and sensitivity analysis and publication bias assessment were performed.Results Finally,24 RCTs were included,including 2029 subjects.Twenty-four of them compared the thickness of the tube wall before and after treatment,23 compared the success rates of the two treatments,5 studied the length of the tooth before and after treatment,and 11 compared the complications of the two treatments.The results of the meta-analysis showed that the total success rate of pulp revascularization in the treatment of young permanent teeth with irreversible pulp damage was significantly higher than that of apexification [RR = 1.19,95 % CI(1.14,1.24),P < 0.05].The difference was statistically significant.Moreover,they had more advantages in promoting the increase of tube wall thickness [MD = 0.28,95 %CI(0.25,0.30),P < 0.05],root extension [MD = 1.47,95 % CI(1.25,1.70),P < 0.05] and incidence of complications [RR = 0.39,95 % CI(0.29,0.53),P < 0.05].The results of sensitivity analysis showed that,after excluding any one study,the minimum value of RR was[RR = 1.18,95 % CI(1.13,1.23)],and the maximum value was [RR = 1.21,95 % CI(1.16,1.26)],the overall conclusion was unchanged,and the study result was stable.A funnel plot was drawn and publication bias was analyzed using Egger’s method.It was concluded that there was publication bias among the 17 included studies.The funnel plot was treated with cut-and-make method and meta-analysis was conducted again,and the results showed that there was no significant difference from the previous results.Conclusion When irreversible damage occurs to the pulp of young permanent teeth,the success rate of treatment with endodontic revascularization is higher than that with traditional apexification,and the endodontic revascularization has a better effect in promoting the continuous development of the root of young permanent teeth,such as thickening of the tube wall,lengthening of the root,and less postoperative complications.Therefore,endodontic revascularization can be used as the first choice for the diagnosis and treatment of irreversible damage to the pulp of young permanent teeth with obviously insufficient root length. |
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