墨西哥的无创伤性修复治疗（ART）策略：ART 封闭剂和修复体的两年随访。
The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations.
机构信息
Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P,O Box 9101, Nijmegen 6500 HB, The Netherlands.
出版信息
BMC Oral Health. 2013 Sep 8;13:42. doi: 10.1186/1472-6831-13-42.
BACKGROUND
The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years.
METHODS
18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction.
RESULTS
The 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4.
CONCLUSIONS
The ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.
背景
在过去的二十年中，由于在墨西哥大规模使用预防措施，龋齿的发病率大幅下降。然而，仍然存在大量未满足的修复治疗需求。本文介绍了制定一项策略的步骤，该策略作为一般卫生政策的一部分，在墨西哥公共卫生服务中使用非创伤性修复治疗 (ART) 来解决这个问题。目的是评估在 2 年时间内，为来自贫困地区的小学生的乳牙和恒牙进行的 ART 修复和窝沟封闭的效果。
方法
来自 6 个人类发展指数最低的州的 13 个市的 18 名牙医在学校场地为 304 名 6 至 13 岁的学龄儿童进行了 ART 窝沟封闭和 ART 修复（单表面）。使用 Ketac Molar Easymix 作为填充材料。使用 frailty 校正的 PHREG 模型估计 2 年的生存率。
结果
完全和部分保留的 ART 窝沟封闭剂在乳牙和恒牙上的 2 年累积生存率分别为 73.1%（乳牙）和 48.8%（恒牙）。ART 窝沟封闭剂在 2 年内对乳牙和恒牙牙本质龋损的失败率分别为 0%和 2.5%。乳牙和恒牙单表面 ART 修复体的 2 年累积生存率分别为 74%和 80.9%。在 6 颗已修复的乳牙（2.1%）和 1 颗已修复的恒牙（1.3%）中出现继发性龋损。一个州所有放置在乳牙上的修复体均存活，而在其余 5 个州中的 1 个州中，这些修复体的失败率明显高于其他 4 个州。
结论
ART 治疗程序的质量很高，在很大程度上防止了来自社会经济贫困地区的这些儿童新的牙本质龋病的发展。
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