不同牙型中副根管的垂直分布：系统评价与荟萃分析

摘要(中文译文)

系统分析不同牙型中副根管的垂直分布并提出潜在的根端切除水平。副根管的比例分布（PD-AC）以1 mm为间隔，2 mm和3 mm内的累积比例（CP-AC和CP-AC），副根管孔至根尖或主根管孔的平均距离（MD-AF），以及二维横截面中副根管的检出率（PR-AC-2D）。对电子数据库进行了系统性检索，截止日期为2025年12月25日。该综述已在PROSPERO注册（CRD420251107855）。两名评价者独立进行研究筛选、数据提取，并使用AQUA工具进行偏倚风险评估。共纳入19项研究进行定性综合，其中11项提供了足够的数据进行荟萃分析。采用随机效应模型，并按牙型、副根管类型和国家进行亚组分析。在距根尖0-1 mm、1-2 mm、2-3 mm和3-4 mm范围内，分别有41.5%、34.3%、9.9%和4.4%的副根管分布。磨牙在2 mm内（90.0% vs. 72.4%）和3 mm内（96.9% vs. 87.5%）的比例均显著高于前牙。在根尖分支中，86.4%位于2 mm以内。合并的MD-AF为1.472 mm。PR-AC-2D从1 mm处的29.3%降至5 mm处的1.3%。所有研究均呈现中至高度偏倚风险。2 mm的根端切除水平对磨牙可能足够，而前牙可能需要更高的水平。需要进一步的随机对照试验。2 mm的切除可能足以暴露或去除磨牙中的大多数副根管，在保持治疗效果的同时可能保留更多牙根长度。在前牙中，在获得进一步证据之前，传统的3 mm切除仍然值得推荐。

Abstract

To systematically analyze the vertical distribution of accessory canals and propose potential root-end resection levels in different tooth types. Proportional distribution of accessory canals (PD-AC) in 1 mm intervals, cumulative proportions within 2 mm and 3 mm (CP-AC and CP-AC), mean distance from accessory foramen to root apex or main foramen (MD-AF), and prevalence of accessory canals in 2D cross-sections (PR-AC-2D). A systematic search of electronic databases was conducted through December 25, 2025. The review was registered in PROSPERO (CRD420251107855). Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the AQUA tool. Nineteen studies were included for qualitative synthesis, of which eleven provided sufficient data for meta-analysis. A random-effects model was used, and subgroup analyses were stratified by tooth type, accessory canal type, and country. Within 0-1 mm, 1-2 mm, 2-3 mm, and 3-4 mm from the apex, 41.5%, 34.3%, 9.9%, and 4.4% of accessory canals were located, respectively. Molars had significantly higher proportions than anterior teeth both within 2 mm (90.0% vs. 72.4%) and 3 mm (96.9% vs. 87.5%). Of apical ramifications, 86.4% were within 2 mm. The pooled MD-AF was 1.472 mm. PR-AC-2D decreased from 29.3% at 1 mm to 1.3% at 5 mm. All studies presented moderate to high risk of bias. A 2 mm root-end resection level may be sufficient for molars, whereas anterior teeth may require a higher level. Further randomized controlled trials are needed. A 2 mm resection may adequately expose or remove most accessory canals in molars, potentially preserving more root length while maintaining treatment efficacy. In anterior teeth, a traditional 3 mm resection remains advisable until further evidence becomes available.

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