Bjørndal Lars
Department of Cariology and Endodontics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Endod. 2008 Jul;34(7 Suppl):S29-33. doi: 10.1016/j.joen.2008.02.035.
Various treatment concepts have been suggested to solve the deep carious lesion dilemma. Recent systematic reviews are presented. Their conclusions are based on very few studies, and the main message is that optimal randomized clinical studies are lacking. Observational studies on indirect pulp treatment and stepwise excavation demonstrate that these treatments avoid pulp exposures, but it cannot be said which approach is best. A less invasive modified stepwise excavation approach is described, focusing on changing an active lesion into an arrested lesion even without performing an excavation close to the pulp. In Denmark and Sweden a randomized clinical multi-center trial is currently taking place, the Caries and Pulp (CAP) trial. This trial is investigating the effects of stepwise excavation over 2 visits versus 1 complete excavation of deep caries in permanent teeth. Guidelines for treatment are presented.
为解决深龋病变的难题，人们提出了各种治疗理念。本文呈现了近期的系统评价。其结论基于极少的研究，主要信息是缺乏最佳的随机临床试验。关于间接盖髓术和逐步去龋的观察性研究表明，这些治疗可避免穿髓，但无法确定哪种方法最佳。本文描述了一种侵入性较小的改良逐步去龋方法，重点是即使不接近牙髓进行去龋，也要将活动性病变转变为静止性病变。丹麦和瑞典目前正在进行一项随机临床多中心试验，即龋病与牙髓（CAP）试验。该试验正在研究恒牙深龋分两次逐步去龋与一次完全去龋的效果。本文还给出了治疗指南。
