Singhal Deepak Kumar, Acharya Shashidhar, Thakur Arun Singh
Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal University, Karnataka, India.
Department of Public Health Dentistry, Government Dental College, Shimla, Himachal Pradesh, India.
Dent Res J (Isfahan). 2016 Jan-Feb;13(1):30-7. doi: 10.4103/1735-3327.174695.
The management of deep carious lesions can be done by various techniques but residual caries dilemma still persists and bacterial reduction in cavities treated by either partial or complete caries removal techniques is debatable. So the objective of the present randomized clinical trial was to compare microbial counts in cavities submitted to complete caries removal and partial caries removal using either hand instruments or burs before and after 3 weeks of restoration.
Primary molars with acute carious lesions in inner half of dentine and vital pulp were randomly divided into three groups of 14 each: Group A: Partial caries removal using hand instruments atraumatic restorative treatment (ART) only; Group B: Partial caries removal using bur; Group C: Complete caries removal using bur and caries detector dye. Dentine sample obtained after caries removal and 3 weeks after restoration, were subjected to microbial culture and counting (colony-forming units [CFU]/mg of dentine) for total viable bacterial count, Streptococcus spp., mutans streptococci, Lactobacillus spp.
Three techniques of caries removal showed significant (P < 0.05) reduction in all microorganisms studied after 3 weeks of evaluation, but there was no statistically significant difference in percentage reduction of microbial count among three groups.
Results suggest the use of partial caries removal in a single session as compared to complete caries removal as a part of treatment of deep lesions in deciduous teeth in order to reduce the risk of pulp exposure. Partial caries removal using ART can be preferred for community settings as public health procedure for caries management.
深龋病变的处理可采用多种技术,但残留龋问题依然存在,采用部分或完全去龋技术治疗的龋洞内细菌减少情况仍存在争议。因此,本随机临床试验的目的是比较在修复3周前后,使用手动器械或牙钻进行完全去龋和部分去龋的龋洞内的微生物数量。
牙本质内层有急性龋病变且牙髓活力正常的乳磨牙随机分为三组,每组14颗:A组:仅使用手动器械进行非创伤性修复治疗(ART)部分去龋;B组:使用牙钻部分去龋;C组:使用牙钻和龋蚀检测染料完全去龋。去龋后及修复3周后获取的牙本质样本进行微生物培养和计数(每毫克牙本质的菌落形成单位[CFU]),以检测总活菌数、链球菌属、变形链球菌、乳酸杆菌属。
三种去龋技术在评估3周后,所有研究的微生物数量均显著(P < 0.05)减少,但三组之间微生物数量减少百分比无统计学显著差异。
结果表明,与完全去龋相比,在乳牙深龋病变治疗中单次采用部分去龋可降低牙髓暴露风险。作为龋病管理的公共卫生程序,在社区环境中,采用ART进行部分去龋可能更受青睐。