Alternative to Avoid Tooth Discoloration after Regenerative Endodontic Procedure: A Systematic Review

Abstract This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.摘要 本系统评价旨在评估：相较于传统三联抗生素糊剂（triple antibiotic paste，TAP——由甲硝唑、环丙沙星与米诺环素组成）及灰色矿物三氧化物凝聚体（grey mineral trioxide aggregate，GMTA），其替代材料能否在牙髓再生治疗（Regenerative Endodontic Procedure，REP）中避免牙齿着色；同时探究牙科漂白是否能够逆转因REP导致的牙齿变色。本研究遵循系统评价与Meta分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）规范，在Medline via PubMed、Scopus、ISI Web of Science及虚拟健康图书馆（Virtual health library，BVS）共4个数据库中开展文献检索。检索获得的文献被导入EndNote™软件，由2名研究者独立完成研究筛选与数据提取工作。本综述仅纳入以人为研究对象的研究，包括病例报告、病例系列及临床试验。在1122篇潜在符合纳入标准的文献中，83篇被选中进行全文分析，最终38篇被纳入本综述。纳入的研究以病例报告为主，占比达76.3%。上述研究共涉及189颗接受REP治疗的牙齿，其中约54%的牙齿出现了不同程度的着色。多数发生颜色改变的牙齿采用了TAP治疗，尤其是当TAP与GMTA联合使用时。仅有3项研究采用牙科漂白手段恢复牙齿色泽，且所有漂白技术均无法恢复牙冠的原始颜色。使用TAP及GMTA的替代材料，如双联抗生素糊剂、氢氧化钙（Ca(OH)₂）糊剂、白色矿物三氧化物凝聚体或Biodentine™，可降低牙齿着色的发生率。