Frencken J E
Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Medical Centre, Nijmegen, The Netherlands.
Br Dent J. 2017 Aug 11;223(3):183-189. doi: 10.1038/sj.bdj.2017.664.
Too many people worldwide suffer from the consequences of untreated dentine carious lesions. This finding reflects the inability of the currently used traditional mode of treatments to manage such lesions. A change is needed. Dental training institutions should depart from the traditional 'drill and fill' treatments and embrace the holistic oral healthcare approach that is minimal intervention dentistry (MID) and includes within it minimally invasive operative skills. Dental caries is, after all, a preventable disease. The atraumatic restorative treatment (ART) concept is an example of MID. ART consists of a preventive (ART sealant) and a restorative (ART restoration) component. ART sealants using high-viscosity glass-ionomer (HVGIC) have a very high dentine carious lesion preventive effect. The survival rate of these sealants is not significantly different from that of sealants produced with resin. The survival rate of ART/HVGIC restorations matches those of amalgam and resin composite in single- and multiple-surface cavities in primary teeth and in single-surface cavities in permanent teeth. The principles of carious tissue removal within a cavity recommended by the International Caries Consensus Collaboration are in line with those of treating a cavity using ART. Owing to its good performance and the low levels of discomfort/pain and dental anxiety associated with it, ART and/or other evidence-based atraumatic care procedures should be the first treatment for a primary dentine carious lesion. Only if the use of ART is not indicated should other more invasive and less-atraumatic care procedures be used in both primary and permanent dentitions.
全球有太多人因未治疗的牙本质龋损而受苦。这一发现反映出当前使用的传统治疗模式无法应对此类龋损。变革势在必行。牙科培训机构应摒弃传统的“钻牙补牙”治疗方法，采用整体口腔保健方法，即微创牙科（MID），其中包括微创操作技能。毕竟，龋齿是一种可预防的疾病。非创伤性修复治疗（ART）理念就是微创牙科的一个范例。ART包括预防性（ART封闭剂）和修复性（ART修复体）两个部分。使用高粘度玻璃离子体（HVGIC）的ART封闭剂对牙本质龋损具有很高的预防效果。这些封闭剂的存留率与树脂封闭剂的存留率并无显著差异。在乳牙的单表面和多表面龋洞以及恒牙的单表面龋洞中，ART/HVGIC修复体的存留率与汞合金和树脂复合体修复体的存留率相当。国际龋病共识协作组织推荐的龋洞内龋坏组织去除原则与使用ART治疗龋洞的原则一致。由于ART性能良好，且与之相关的不适/疼痛程度和牙科焦虑水平较低，ART和/或其他循证非创伤性治疗程序应作为原发性牙本质龋损的首选治疗方法。只有在不适合使用ART时，才应在乳牙和恒牙列中使用其他侵入性更强、创伤性更小的治疗程序。
