Bader James D, Shugars Daniel A
Operative Dentistry, University of North Carolina, Chapel Hill, NC, USA.
J Evid Based Dent Pract. 2006 Mar;6(1):91-100. doi: 10.1016/j.jebdp.2005.12.004.
To assess the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries.
Nine detection and intervention decision points were identified as being central to the management of early occlusal caries and suspected occlusal dentinal caries, or suspicious areas. For each decision point, the evidence for effectiveness was assessed, using existing systematic reviews when available, and nonsystematic review methods when necessary.
For the 2 detection decisions (early occlusal caries and suspicious areas) the strength of the evidence was weak. Accuracy in detecting early occlusal caries was extremely variable within and across detection methods. Approximately 50% of suspicious areas identified had dentinal caries. The strength of the evidence for effectiveness of nonsurgical approaches for the management of early occlusal caries was weak for all 3 management strategies examined (doing nothing, sealants, remineralization). This evidence suggested that sealants were highly effective, with remineralization reflecting moderate effectiveness. For the management of suspicious areas, the strength of the evidence was still weaker and reflected the same relative effectiveness. For the surgical management strategy for suspicious areas, operative treatment, the evidence was strong and reflected high effectiveness for preventive resin restorations, but no evidence was available for minimally invasive techniques.
Identification methods for early occlusal caries are not accurate. The strength of the evidence for effectiveness of nonsurgical management strategies for early occlusal caries is at best, weak. The available evidence suggests that sealing both enamel caries and suspected occlusal dentinal caries is the most effective management approach if subsequent maintenance of the sealed surfaces can be assured.
评估描述早期咬合面龋和可疑咬合面牙本质龋检测及管理替代策略有效性的证据强度。
确定了九个检测和干预决策点，这些决策点对于早期咬合面龋、可疑咬合面牙本质龋或可疑区域的管理至关重要。对于每个决策点，评估其有效性证据，如有可用的现有系统评价则使用之，必要时使用非系统评价方法。
对于两个检测决策（早期咬合面龋和可疑区域），证据强度较弱。在不同检测方法内部和之间，检测早期咬合面龋的准确性差异极大。所确定的可疑区域中约50%存在牙本质龋。对于所研究的三种早期咬合面龋管理策略（不采取任何措施、使用窝沟封闭剂、再矿化），非手术方法有效性的证据强度均较弱。该证据表明窝沟封闭剂非常有效，再矿化显示出中等有效性。对于可疑区域的管理，证据强度仍然较弱，且反映出相同的相对有效性。对于可疑区域的手术管理策略，即手术治疗，预防性树脂修复的证据有力且显示出高效性，但对于微创技术则没有证据。
早期咬合面龋的识别方法不准确。早期咬合面龋非手术管理策略有效性的证据强度充其量较弱。现有证据表明，如果能够确保对封闭表面的后续维护，对釉质龋和可疑咬合面牙本质龋进行封闭是最有效的管理方法。
