Oral & Maxillofacial Pathology, Radiology and Medicine, College of Dentistry, New York University, New York City, NY 10010, USA.
J Am Dent Assoc. 2012 Apr;143(4):377-85. doi: 10.14219/jada.archive.2012.0180.
Members of the practice-based research network Practitioners Engaged in Applied Research and Learning (PEARL) Network investigated the dentin caries activity in early occlusal lesions and its relationship to patient age, preoperative tooth sensitivity and radiographic appearance, as well as its influence on preparation depth and volume.
PEARL Network practitioner-investigators (P-Is) (n = 45), general dentists who were trained but whose methods were not calibrated, conducted a study regarding postoperative hypersensitivity in resin-based composite restorations. The P-Is enrolled as study participants 613 patients with occlusal carious lesions that, in the P-Is' clinical judgment, required restoration. The P-Is used baseline radiographs to assess the depth and extent of the lesions. Data for 671 restorations included baseline sensitivity; ranking of dentin caries activity on the opening of the enamel; radiographic visibility (n = 652); and measurements of preparation depth, width and length.
P-Is found rapidly progressing dentin caries in 38.5 percent (258 of 671) of lesions and slowly progressing (and potentially inactive dentin) caries in the remainder of the lesions. Rapidly progressing caries was not related to the participant's age or participant-reported preoperative hypersensitivity but was related to the lesion depth as seen radiographically (P < .001) and depth (P < .001) and volume (P < .001) of the preparation. Molars had slightly higher but not statistically significant levels of caries activity.
Rapidly progressing dentin caries, while present in only 38.5 percent of lesions, was related to the lesion's radiographic appearance but not to the participant's age or the study tooth's pre-operative sensitivity.
On the basis of the low level of rapidly progressing dentin caries in this study population and the fact that slowly progressing caries can be inactive or remineralizing, the authors advise sealing versus operative treatment of early or shallow occlusal lesions.
实践为基础的研究网络从业者参与应用研究和学习（PEARL）网络的成员调查了早期咬合面龋损的牙本质龋活性及其与患者年龄、术前牙齿敏感性和放射影像表现的关系，以及对预备深度和体积的影响。
PEARL 网络从业者调查员（P-Is）（n = 45），未经校准的培训普通牙医，进行了一项关于树脂基复合材料修复术后敏感性的研究。P-Is 将 613 名患有咬合面龋损的患者纳入研究参与者，这些患者在 P-Is 的临床判断中需要进行修复。P-Is 使用基线射线照相术评估病变的深度和范围。671 个修复体的数据包括基线敏感性；在釉质开口处牙本质龋活动的等级评定；放射可见性（n = 652）；以及预备深度、宽度和长度的测量。
P-Is 在 671 个病变中的 38.5%（258 个）发现快速进展的牙本质龋，其余病变为缓慢进展（和潜在非活动的牙本质）龋。快速进展的龋与参与者的年龄或参与者报告的术前敏感性无关，但与放射影像所见的病变深度（P <.001）以及预备的深度（P <.001）和体积（P <.001）有关。磨牙的龋活性略高，但无统计学意义。
虽然快速进展的牙本质龋仅在 38.5%的病变中存在，但与病变的放射影像表现有关，而与参与者的年龄或研究牙的术前敏感性无关。
根据本研究人群中快速进展的牙本质龋的低水平，以及缓慢进展的龋可能处于非活动或再矿化状态的事实，作者建议对早期或浅的咬合面病变进行密封而非手术治疗。
