Jokstad Asbjørn
Department of Clinical Dentistry, Faculty of Health Sciences, UiT, The Arctic University of Norway, Hansine Hansens v 86, 9019 Tromsø, Norway.
Dent Mater. 2016 Jan;32(1):11-25. doi: 10.1016/j.dental.2015.09.006. Epub 2015 Sep 28.
To critically appraise experimental ex vivo research that has focused on secondary caries, and to offer possible explanations for the seemingly poor correlation to clinical observations.
The literature relating to the etiopathogenesis or prevention of secondary caries gained from experimental ex vivo research was reviewed, with particular emphasis on microleakage and artificial caries-like lesions.
It is doubtful whether a caries wall lesion can exist independently of an outer enamel caries lesion. Microleakage experiments apparently continue to emerge regardless of multiple reviews questioning the reliability and validity of the method. Several of the approaches used to generate artificial caries-like lesions are very aggressive. Remarkably little discussion has evolved about how these aggressive approaches create microenvironments that do not occur in reality. Corrosion- and biodegradation products may influence the biofilm qualitatively and quantitatively and it is difficult to replicate these variables in any ex vivo environment. Clinical data sampling method, patient demography as well as study methodology influences the incidence and prevalence estimates of secondary caries. Clinical results based on clinical work in settings where cost per unit time is of nominal concern do not provide any indications on how the restorative material will perform when placed by the average dentists in the mouths of their spectrum of patients during a busy workday.
The term "wall lesion" including its variants is ill defined, has been, and is still being used indiscriminately. Stakeholders should avoid using this ambiguous label due to its connotation to an entity that does not exist per se.
对聚焦于继发龋的体外实验研究进行批判性评价，并对其与临床观察结果之间看似不佳的相关性提供可能的解释。
回顾从体外实验研究中获得的与继发龋的病因发病机制或预防相关的文献，特别强调微渗漏和人工龋样病变。
龋壁病变是否能独立于外层釉质龋病变而存在令人怀疑。尽管有多项综述质疑微渗漏实验方法的可靠性和有效性，但此类实验仍不断出现。用于产生人工龋样病变的几种方法极具侵袭性。令人惊讶的是，对于这些激进方法如何创造出现实中不存在的微环境，几乎没有展开讨论。腐蚀和生物降解产物可能在质量和数量上影响生物膜，并且在任何体外环境中都难以复制这些变量。临床数据采样方法、患者人口统计学以及研究方法都会影响继发龋的发病率和患病率估计。基于在单位时间成本不太受关注的环境中的临床工作得出的临床结果，无法表明修复材料在忙碌工作日由普通牙医放置在其各类患者口中时的性能表现。
“壁病变”及其变体术语定义不明确，过去一直且仍在被随意使用。由于其暗示不存在的实体，利益相关者应避免使用这个模糊的标签。
