Purpose

To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment.

Methods

The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach.

Results

The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI–13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI–1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI–1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low.

Conclusion

Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

中文翻译：

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通过碎片重新附着来管理冠折前牙中粘合碎片丢失的风险：系统评价和荟萃分析

目的

旨在确定影响通过碎片重新附着处理的冠折前牙粘合碎片丢失风险的因素。

方法

该研究方案遵循循证医学的最佳实践，并在 PROSPERO 中注册。于 2023 年 9 月 18 日在六个数据库（PubMed、Embase、SCOPUS、Web-of-Science、Lilacs 和 Cochrane）中以电子方式进行了全面的文献检索。它被保存在 EndNote-online 中并删除了重复项。文章的选择分两个阶段进行，随后是数据提取、偏倚风险评估、数据分析和荟萃分析。结果的证据质量通过 GRADE 方法进行评估。

结果

该研究包括六篇具有相似选择方案的文章，但从创伤到治疗的持续时间和观察期各不相同。只有一项研究采用了附着前片段准备，三项研究进行了附着后加固。片段总体丢失率为 20% (95%CI–13,30%)。当比较修复体或碎片丢失的风险比时，发现简单的冠骨折为 2.21 (95%CI–1.52,3.21)，复杂的冠骨折为 2.54 (95%CI–1.35,4.79)。两项研究的偏倚风险较低，四项研究的偏倚风险为中等。所有结果的证据等级都非常低。

结论

在已进行加固的简单冠骨折中，碎片损失最低；在未加固的复杂冠骨折中，在进行粘接时碎片损失最高。碎片丢失的风险高于复合修复体丢失的风险。