微创牙科学:文献回顾与最新进展

微创牙科学是指采用生物学方法而不是传统的牙体手术处理龋病,以最大限度地减少对牙体结构的破坏。这种新的龋病处理方法,将过去强调的视龋损为“洞”而反复充填的理念,转变为视龋损为口腔生态失衡而促使生物膜产生生物学变化。微创牙科学的目的在于阻止龋病进程,然后修复缺失的牙体结构和功能,最大限度地发挥牙体的愈合潜能。微创牙科学的处理方法可概括为3个步骤:(1)判定患者的患龋风险;(2)再矿化,即防止龋损形成并逆转未形成“洞”的浅龋;(3)修复,即控制龋活性,使愈合潜能最大化并修复龋损。龋病并非仅仅是牙体脱矿,而是一个因生物膜与牙界面生态和化学平衡失衡而致的反复的脱矿过程(生态菌斑学说)。饮食和生活方式(尤其是碳水化合物的摄入频次)、饮水、吸烟是导致生物膜生态和致病性的重要因素。椅旁评价菌斑和唾液的方法的问世,使得龋病危险评估和监测患者的顺从性成为可能。唾液的再矿化特性,可以通过使用能够释放Ca2 、P5 、F1-的再矿化剂(CPP-ACPandCPP-ACFP)而予强化。使用某些化学制剂(氟、氯已定和木糖醇),可改变菌斑的致病性。采用微创治疗方案,可修复早期龋损,增进患者的理解力和顺从性。本文从3个方面,详细论述了微创牙科学的概念、理论基础和操作方法。

Minimally invasive dentistry: A review and update

The term "Minimal Invasive (MI) Dentistry" can best be defined as the management of caries with a biological approach, rather than with a traditional (surgical) operative dentistry approach. Where operative dentistry is required, this is now carried out in the most conservative manner with minimal destruction of tooth structure. This new approach to caries management changes the emphasis from diagnosing carious lesions as cavities (and a repeating cycle of restorations), to one of diagnosing the oral ecological imbalance and effecting biological changes in the biofilm. The goal of MI is to stop the disease process and then to restore lost tooth structure and function, maximizing the healing potential of the tooth. The thought process which underpins this new minimal invasive approach can be organized into three main categories: (1) Recognize, which means identify patient caries risk, (2) Remineralize, which means prevent caries and reverse non-cavitated caries, and (3) Repair, which means control caries activity, maximize healing and repair the damage. The disease of dental caries is not just demineralization, but a process of repeated demineralization cycles caused by an imbalance in the ecological and chemical equilibrium of the biofilm /tooth interface (the ecological plaque hypothesis). Dietary and lifestyle patterns, especially carbohydrate frequency, water intake and smoking, play an important role in changing the biofilm ecology and pathogenicity. Tools for chairside assessment of saliva and plaque, allow risk to be assessed and patient compliance monitored. The remineralizing properties of saliva can be enhanced using materials which release biologically available calcium, phosphate and fluoride ions (CPP-ACP and CPP-ACFP). Use of biocides can also alter the pathogenic properties of plaque. Use of these MI treatment protocols, can repair early lesions and improve patient understanding and compliance. This review article introduces some of the key concepts and practical aspects of minimally invasive dentistry.