Department of Pediatric Dentistry, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre, Brazil.
Caries Res. 2017;51(5):466-474. doi: 10.1159/000478535. Epub 2017 Aug 29.
The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure.
The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors.
A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07).
In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.
本回顾性研究旨在分析高龋经验儿童的乳牙选择性龋去（SCR）治疗的生存概率和潜在的治疗失败相关因素。
本研究纳入了在大学牙科服务处接受非镇静或全身麻醉的前牙和后牙 SCR 治疗的儿童。采用 Kaplan-Meier 生存分析估计修复体的耐久性，采用共享脆弱性的多变量 Cox 回归评估风险因素。
共分析了 88 名高龋经验儿童（年龄 5.2 ± 1.91 岁）的 284 例 SCR 治疗（平均 dmft/DMFT = 11.1 ± 5.04）。3 年生存率达到 48.8%，年失败率为 21.2%。与牙髓并发症（n = 12）相比，修复体失败（n = 60）更为常见。前牙的 SCR 更易失败（风险比 = 3.6，95%CI：1.94; 6.71）。有更多可见牙菌斑的患者 SCR 治疗失败的风险更高（风险比 3.0，95%CI：1.27; 7.07）。
在这项回顾性研究中，SCR 的生存情况与其他前瞻性临床试验相比受到限制。患者相关因素，特别是儿童的年龄较小和高龋经验，可能对修复体的生存构成挑战。无论采用何种龋蚀去除技术或修复材料，致龋生物膜都会对修复体的生存产生负面影响，可能通过直接作用于材料劣化，特别是对快速进展的新龋损的发展产生影响。
