Blum Igor Robert, Özcan Mutlu
1King's College Hospital & King's College London Dental Institute, Division of Primary Dental Care and Maurice Wohl Dental Centre, Department of Restorative Dentistry, University of London, Bessemer Road, Denmark Hill, London, SE5 9RS UK.
2Division of Dental Materials, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, University of Zurich, Zurich, Switzerland.
Curr Oral Health Rep. 2018;5(4):264-269. doi: 10.1007/s40496-018-0191-1. Epub 2018 Sep 15.
Defective dental restorations are amongst the most common encounters in general dental practice. Replacement of defective restorations is often costly and commonly results in the sacrifice of sound tooth structure, thereby compromising the vitality of the dental pulp, potentially resulting in the acceleration of the restoration cycle and premature loss of the restored tooth. With advances in adhesive dentistry, 'reparative dentistry' is becoming an important area of minimally invasive dentistry. This article highlights the detrimental biological effects of restoration replacement and provides an overview of current knowledge and understanding of restoration repair as a safe and effective alternative approach to replacement.
The literature reviewed showed that a growing body of evidence from clinical studies indicates that repaired restorations have similar survival outcomes in patients with low and medium caries risk compared to replaced restorations and are clinically acceptable over a 12-year follow-up of clinical service. Teeth with repaired restorations are less likely to require aggressive interventions such as endodontic treatment or extraction compared to those with replaced restorations.
Repair options should be carried out wherever possible as minimally interventional procedures in order to increase the longevity of the remaining part of the restoration and the restored tooth unit. Restoration replacement should be considered as the last resort when there are no other viable alternatives.
在普通牙科诊疗中，修复体出现问题是最为常见的情况之一。替换有问题的修复体往往成本高昂，并且通常会导致健康牙体组织受损，进而影响牙髓活力，可能加速修复周期，导致修复牙过早缺失。随着牙体粘接修复技术的发展，“修复性牙科学”正成为微创牙科学的一个重要领域。本文着重介绍了替换修复体所带来的有害生物学影响，并概述了目前关于修复修复体作为一种安全有效的替代替换方法的知识和理解。
综述的文献表明，越来越多的临床研究证据显示，与替换修复体相比，修复后的修复体在低、中度龋风险患者中具有相似的存留结果，并且在12年的临床随访服务中在临床上是可接受的。与替换修复体的牙齿相比，修复后的修复体牙齿不太可能需要进行诸如牙髓治疗或拔牙等积极干预。
只要有可能，应尽可能采用微创操作进行修复，以延长修复体剩余部分和修复牙单位的使用寿命。当没有其他可行选择时，才应考虑替换修复体。
