不完全去龋法治疗深龋临床效果的Meta分析

目的 评价不完全去龋法治疗深龋的临床效果.方法 计算机检索PubMed、Embase、Cochrane library、知网和万方等数据库,查找治疗深龋的相关文献.通过Meta分析评价不完全去龋法与完全去龋法治疗深龋临床效果的差异,并进一步分析部分去龋法、逐步去龋法治疗深龋的临床效果.结果 共纳入13篇相关文献.Met...     

三种手术方案治疗儿童乳磨牙深龋的随机对照临床研究

目的:探讨完全去龋、选择性去龋法与Hall技术治疗儿童乳磨牙深龋的临床疗效。方法:选择我院2021年6月～2022年1月收治的135例乳磨牙深龋患儿(254颗患牙),按随机数字表法分3组,每组45例。A组(82颗患牙)给予完全去龋法治疗,B组(87颗患牙)给予选择性去龋法治疗,C组(85颗患牙)给予Hall技术治疗。比较3组治疗后3、6、12个月内治疗成功率,治疗过程中疼痛程度、依从性及耐受程度。治疗后12个月评价3组患儿家长的满意度。结果:治疗后12个月内,A组治疗成功率87.80%,B组成功率96.55%,C组成功率97.65%;B、C组成功率均显著高于A组(P<0.05),B、C组成功率差异无统计学意义(P>0.05)。3组患儿治疗过程中疼痛程度逐渐减轻,C组疼痛程度显著低于A、B组,B组显著低于A组(P<0.05)。3组患儿治疗过程中Frankl治疗依从性量表(FBRS)和Houpt行为量表(HBS)评分均逐渐升高,C组FBRS和HBS评分均显著高于A、B组,B组评分均显著高于A组(P<0.05)。3组患儿家长满意度分别为77.78%、93.33%、95...     

银合金粉玻璃离子充填材料治疗恒磨牙深龋的疗效

目的：评价银合金粉玻璃子充填材料对恒磨牙深龋充填治疗的临床效果。方法：临床上选取937例共1032颗牙髓活力正常的深龋恒磨牙，采用银玻璃离子材料充填治疗。结果：随访3年，其中995颗牙治疗成功，37颗牙治疗失败，成功率为96.41％。结论：银玻璃离子材料充填治疗恒磨牙深龋是一种较理想的材料。     

部分去腐治疗乳牙急性龋的Meta分析

目的比较部分和完全去腐治疗乳牙急性龋的效果。方法计算机检索The Cochrane Library、Pub Med、EMbase、Wan Fang Data、CBM、CNKI数据库,查找相关随机对照实验(RCT),检索时限为1978年—2015年8月。由2位评价员独立筛选文献、提取资料和评价研究质量后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入6个RCT,共计562例患者,758个患牙。Meta分析结果显示:部分去腐的牙髓暴露可能性低于完全去腐,差异有统计学意义[RR=0.13,95%CI(0.05,0.37)];在术后牙髓病变(RR=0.92,95%CI(0.34,2.50))和修复失败(RR=1.07,95%CI(0.67,1.70))方面,两者差异没有统计学意义。结论部分去腐法治疗乳牙急性龋的效果是肯定的,值得在临床工作中推广使用。由于纳入研究设计存在一些缺陷,还需要今后开展更多高质量,大样本的随机对照实验来验证此结论。     

Carisolv对年轻恒磨牙深龋的疗效探讨

笔者从2003年1月通过对80颗年轻下颌第一恒磨牙深龋(急性、慢性)分别采用Carisolv和传统牙钻去腐,观察Carisolv治疗后并发症发生情况,提供临床资料和经验。一、临床资料与方法1.材料:Carisolv凝胶,商品名伢典(由瑞士MediteamDental AB生产),分两组份:3种氨基酸的混合体,低浓度的次氯酸钠,光固化材料:垫底氢氧化钙、复合树脂由登士柏公司生产,常规高、低速手机及车针。2.病例选择与分组:2003年1月至2005年2月间来武汉市儿童医院牙体牙髓科就诊下颌第一恒磨牙患者为实验的抽样对象,选择标准:年龄6～10岁,平均年龄6岁9个月。全身健康无特殊…     

伢典三代凝胶微创治疗乳磨牙深龋的疗效观察

摘要：目的 对比分析伢典凝胶微创去腐与传统牙钻去腐方案对乳磨牙深龋的治疗效果,以指导临床治疗疾病。方法 纳入2015年4月至2016年4月于我院接受治疗的乳磨牙深龋患儿132例（218颗）为对象,采用随机数字表法将患儿均分为2组。观察组66例（110颗）接受伢典凝胶微创治疗;对照组66例（108）颗接受传统牙钻去腐。对比每颗牙处理时间、处理期间患儿疼痛情况,术后2周监测牙髓活力,术后1年复查监测牙髓活力及治疗相关并发症情况。结果 观察组患牙处理时间（11.3±5.2）min,明显长于对照组（9.8±3.2）min,期间患儿疼痛感觉明显轻于对照组,随访1年时观察组继发龋、充填物松动、牙髓炎发生率分别为2.7%、1.8%、0.0%,均明显低于对照组16.7%、9.3%、6.5%,上述差异均有统计学意义（P＜0.05）。结论 伢典凝胶微创治疗乳磨牙深龋,虽会明显增加患牙处理时间,但可明显减轻术中疼痛、降低术后并发症,优势明显。     

伢典化学机械去龋法治疗老年人根面龋的疗效观察

目的观察伢典(Carisolv)化学机械去腐法治疗老年人根面龋的疗效。方法门诊老年根面龋患者76例,随机分为伢典治疗组38例,对照组38例,分别采用伢典(Carisolv)凝胶与传统牙钻去龋,去龋后两组均行FujilⅡ玻璃离子水门汀充填,记录患者在治疗过程中的疼痛程度,比较1年后的治疗效果。结果 2组患者治疗1年后复查,成功率比较差异无统计学意义(P>0.05);2组患者去龋治疗时的疼痛程度比较差异有统计学意义(P<0.05)。结论伢典(Carisolv)化学机械去龋法治疗老年人根面龋安全、有效,大大减少患者治疗过程中的疼痛和不适,可推广应用。     

深龋综合治疗法的疗效

本文采用随机分组对照试验，以常规单纯垫底充填为对照，观察脱敏治疗配合垫底充填的综合方法治疗深龋的临床效果。现将结果报告如下。     

部分活髓切断术在年轻恒磨牙龋源性露髓治疗中的应用

目的：应用部分活髓切断术治疗年轻恒磨牙龋源性露髓并评价其临床效果。方法：对35例41颗因龋病引起的年轻恒磨牙露髓的病例采用部分活髓切断术治疗并定期观察。结果：采用部分活髓切断术治疗年轻恒磨牙龋源性露髓成功率为92.68%。结论：对于龋源性露髓的年轻恒磨牙,部分活髓切断术是成功而有效的治疗方法。     

恒磨牙邻面龋充填治疗的疗效评价

目的：评价用银汞合会、町乐丽菲露AP-X复合树脂及Beautifil氟化玻璃聚合体对恒磨牙邻面龋进行充填治疗的临床效果。方法：选择58-71岁门诊患者176例416颗恒磨牙邻面龋患牙，按龋损部位分为龈缘组和龈上组，每组随机分为3组，分别用银汞合金、可乐丽菲露AP-X及Beautifil氟化玻璃聚合体按各闩洞型制备要求备涧后进行充填。银汞合金组深龋用聚羧酸锌水门汀垫底后充填；可乐丽菲露AP-X组及Beautifil氟化玻璃聚合体组深龋用Ionosit-Baseliiler垫底后充填。随访18-24个月观察治疗效果。结果：患者复查回访率为86．93％。龈缘组中，银汞合金组成功率92．31％；可乐丽菲露AP-X组成功率92．65％；Beautifil氟化玻璃聚合体组成功率87．76％。经χ2检验，3组差异均兀显著性。龈上组中，银汞合金组成功率91．30％；町乐丽菲露AP—X组成功率97．44％；Beautifil氟化玻璃聚合体组成功率95．77％。经χ2检验，3组差异均无显著性。结论：银汞合金、可乐丽菲露AP-X及Beautifil氟化玻璃聚合体修复恒磨牙邻面龋的临床嫂果良好，3组之间无明显茺异。     

Conventional caries removal and sealed caries in permanent teeth: a microbiological evaluation

Objectives

The aim of this study was to compare microbiological infection after conventional carious dentine removal with incomplete carious dentine removal and sealing.

Methods

Eighty-seven patients (12–50 years of age) under treatment at the Dental Clinics of the Federal University of Rio Grande do Sul (UFRGS), Brazil, participated in the study. The patients presented 90 posterior permanent teeth with primary caries. The lesions were coronal, active, and reached at least the middle third of the dentine. None of the teeth exhibited spontaneous pain, sensitivity to percussion or apical pathology (detected through radiographic exams). Pulp sensibility was confirmed by the cold test. The lesions were divided into 2 experimental groups: complete caries removal (CCR) based on hardness criteria (n = 60 lesions) and incomplete caries removal (ICR) and sealing (n = 32 lesions). Microbiological samples were obtained from the initial demineralized dentine, after CCR and after ICR-Seal.

Results

The number of anaerobic and aerobic bacteria, lactobacilli, and mutans streptococci decreased at the end of treatment (p < 0.05). Significantly less anaerobic bacteria (p < 0.01), aerobic bacteria (p = 0.02), and mutans streptococci (p < 0.01) growth was observed after ICR-Seal compared to CCR. The difference in lactobacilli was insignificant (p = 0.08). The amount of bacteria detected after conventional caries removal was higher than that which remained in sealed caries lesions.

Conclusions

The results suggest it is not necessary to remove all carious dentine before the restoration is placed because over time, sealing of carious dentine results in lower levels of infection than traditional dentine caries removal.

Clinical significance

The results of this study indicate that sealed carious dentine was less infected than the remaining dentine left after conventional caries removal and sealing. Our results support treatment of deep carious lesions in one session with incomplete removal of carious dentine.     

Carisolv去腐对155例牙科畏惧症患儿影响的观察

目的　比较Carisolv去腐和传统车针去腐对牙科畏惧症患儿的影响。方法　选择门诊龋齿患儿300例,其中采用Carisolv去腐155例,传统车针去腐145例,比较2组患儿的CFSS-DS评分值、术中行为分级、疼痛情况和去腐时间。结果　2组患儿CFSS-DS评分值治疗前无显著性差异,治疗后有显著性差异;2组患儿术中行为分级、疼痛率和去腐时间均有显著性差异。结论　Carisolv去腐可有效缓解儿童对牙科的畏惧,值得临床推广。     

Selective versus non-selective removal for dental caries: a systematic review and meta-analysis

Objective: Selective and non-selective methods for caries removal were controversial so far, thus we aimed to compare the efficacy of selective and non-selective caries removal by conducting meta-analysis of randomized controlled trials (RCTs).

Materials and methods: Eligible RCTs studies comparing selective caries removal with non-selective caries removal were retrieved by searching PubMed, EMBASE and Cochrane Library till 15 July 2017. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcome indictors, including pulpal exposure, pulpal symptoms and failure using Inverse variance-random effects or Mantel-Haenszel-fixed effects models.

Results: Totally, seven studies were eligible for the meta-analysis. Compared with the non-selective caries removal group, the risk of pulpal exposure was significantly reduced in the selective caries removal group (OR?=?0.11, 95% CI: 0.04–0.30). No significant difference was observed in pulpal symptoms (OR?=?0.79, 95% CI: 0.30–2.12) and failure (OR?=?1.40, 95% CI: 0.69–2.84) between the groups.

Conclusions: The efficacy of selective caries removal appears comparable to that of non-selective caries removal in children, with similar pulpal symptoms and failure, but selective caries removal may result in a low incidence of pulpal exposure. However, larger-scale RCTs with long-term follow-up are required to confirm this conclusion.     

Carisolv(伢典)微创化学机械去龋法治疗老年人龋齿的临床研究

目的:评价伢典微创化学机械去龋法治疗老年人龋齿的有效性和安全性.方法:门诊老年龋齿病人48例,随机分为伢典治疗组30例和对照组18例,分别采用伢典凝胶去龋和常规磨牙去龋,比较两组病人的感受,治疗所用时间,治疗效果.结果:伢典治疗组病人痛苦小,安全,但所用时间长于对照组.结论:伢典化学机械去龋法治疗老年人龋齿安全、有效、无痛.     

Carisolv化学机械去龋技术治疗乳牙龋病的临床评价

目的：评价Carisolv化学机械去龋技术用于乳牙龋病治疗的临床疗效。方法：选取169个龋损乳牙，实验组104个采用Carisolv化学机械去龋，对照组73个采用牙钻去龋。去龋后每组再随机分成A、B两组，分别使用玻璃离子和复合体充填。比较临床治疗效果。结果：与对照组相比，Cafisolv化学机械去龋痛苦小（P〈0．01），在去龋时间、继发龋形成及充填体脱落方面两组无明显差异，而对牙髓的不良影响对照组高于实验组（P〈0．01）。使用不同充填材料的两组在术后并发症方面无明显差异。结论：在乳牙龋病的治疗中，使用Carisolv化学机械去龋较牙钻去龋更具优势。     

Caries in fissures of permanent first molars as a predictor for caries increment

A group of 268 children were checked for caries experience at the age of 7.2 yr later at the age of 9 and 4 yr later at the age of 11 yr. Caries experience of fissures in permanent first molars at the age of 7 yr served as a screening criterion for caries increment between the ages of 7 and 11 yr. This screening resulted in a sensitivity of 0.62, a specificity of 0.82, and a diagnostic power of 0.83 for total caries increment in the permanent dentition and in a sensitivity of 0.68, a specificity of 0.80, and a diagnostic power of 0.78 for caries increment in fissures of permanent first molars. It was concluded that this screening offered the best method available for identifying children at risk from fissure caries in their permanent first molars. Cost effectiveness of preventive treatment directed towards individuals, for instance the application of fissure sealants, can be improved by using this screening method.     

Control of occlusal caries in the first permanent molars by oral hygiene

Abstract Caries of the pits and fissures of permanent teeth continues to be a problem for children, newly erupted permanent molars being particularly at risk. Oral hygiene measures have been shown to be able to reduce the incidence of caries. The aim of this study was to compare the caries-preventive effects on newly erupted first permanent molars of a professional tooth cleaning and oral health education program (test) with a standard preventive program (control), comprising selective fissure sealing and application of topical fluorides. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to four test or four control clinics. Schoolchildren, mean age 6.3±0.3 (s) years with sound, newly erupted first permanent molars were included in the study (207 test, 197 control). After 12 months, 186 test and 163 control children were examined by an examiner who was ‘blind’ to the test or control status of the children. Caries of the first permanent molars developed in 34 test and 35 control children; the estimated risk ratio was 0.86 (95% CI 0.56, 1.30). Children in the test group had an average DFT score of 0.26±0.62 compared with 0.29±0.64 DFT in the control group (t-test, P=0.67). The 12-month results suggest that there was no statistically significant difference between the caries-preventive effects of a professional tooth cleaning and oral health education program and a program based on selective fissure sealing and application of topical fluorides.     

Relative effects of pre- and posteruption water fluoride on caries experience of permanent first molars

OBJECTIVES: Previous studies have attributed the caries-preventive effects of preeruption (PRE) and posteruption (POST) exposure to fluoridated water based on data collected before and after the commencement or discontinuation of water fluoridation. This study aims to determine the relative pre- and posteruption exposure effects of fluoridated water on caries experience of 6-15-year-old Australian children based on individual residential histories. METHODS: Parental questionnaires covering residential history of participants were linked to their oral examinations conducted between June 1991 and May 1992 by the School Dental Services of South Australia and Queensland. Percentage of lifetime exposed to optimally fluoridated water PRE and POST was calculated with respect to the eruption age for first permanent molars. Combined pre- and posteruption categories were created to test PRE against POST exposure: PRE & POST = 0, PRE < POST, PRE = POST in the range 0-90 percent of lifetime exposure, PRE > POST, and PRE & POST > or = 90 percent lifetime exposure. These categories were used as indicator variables with PRE and POST = 0 as reference in an analysis of first permanent molar DMFS scores. The linear regression model controlled for important potential confounders. RESULTS: Participation rates were 69.7 percent in South Australia and 55.6 percent in Queensland with 9,690 and 10,195 participants, respectively. Pre- and posteruption exposures were strongly correlated (r =. 74; P < .01). Compared to the reference, the categories PRE > POST, PRE = POSTin the range 0-90 percent, and PRE and POST > or = 90 percent showed significantly lower caries levels. CONCLUSIONS: The findings indicated that preeruption exposure was required for a caries-preventive effect and that exposure after eruption alone did not lower caries levels significantly. However, the maximum caries-preventive effects of fluoridated water were achieved by high pre- and posteruption exposure.     

Management of deep caries and the exposed pulp

Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future.