Department of Pediatric Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Lasers Med Sci. 2020 Jul;35(5):1185-1191. doi: 10.1007/s10103-020-02967-7. Epub 2020 Jan 22.
The aim of this controlled randomized double-blinded clinical trial was to evaluate the use of a CO laser with or without topical application of acidulated fluorides in the prevention of dental caries in partially erupted first permanent molars. We selected 61 healthy children at high risk of caries, all between 6 and 8 (7.1 ± 0.8) years of age and with 4 partially erupted first permanent molars. A CO laser device emitting at 10.6 μm was used (0.5 W, 0.05 mJ per pulse, 10 kHz). Each first molar in an individual was randomly assigned to one treatment: (L) CO laser (0.066 J/cm); (FL) 1.23% acidulated fluoride gel and CO laser (0.066 J/cm); (V) 5% fluoride varnish, or (S) sealant (control). Patients were followed-up at 3, 6, 12, and 18 months after treatment, through direct visual examination and by an operator blinded to the treatments (kappa ≥ 0.70). The International Caries Detection and Assessment System (ICDAS-II) index was used to assess the soundness of tooth structure or the presence of white spot lesions, cavitated enamel, and/or dentin lesions. The Yildiz Visual Index was used to evaluate sealant retention. Results were evaluated using Kaplan-Meier survival analysis, and the hazard ratio of the treatments was estimated using shared frailty models with a gamma distribution, which considered the patient as a cluster. There were no significant differences among treatments compared to sealants. After 18 months, the use of a CO laser with or without acidulated fluorides was shown to be effective in preventing caries on the occlusal surface of partially erupted permanent first molars in children at high risk for caries.
本对照随机双盲临床试验的目的是评估 CO2 激光联合或不联合应用酸性氟化物在预防部分萌出的第一恒磨牙龋病中的作用。我们选择了 61 名高龋风险的健康儿童，年龄均在 6 至 8 岁之间（7.1±0.8 岁），且均有 4 颗部分萌出的第一恒磨牙。使用了一种发射波长为 10.6μm 的 CO2 激光装置（0.5W，0.05mJ/脉冲，10kHz）。每个个体的第一磨牙随机分配到以下一种治疗组：（L）CO2 激光（0.066J/cm）；（FL）1.23%酸性氟化物凝胶和 CO2 激光（0.066J/cm）；（V）5%氟化物漆，或（S）密封剂（对照组）。治疗后 3、6、12 和 18 个月对患者进行随访，通过直接目视检查和对治疗方案设盲的操作人员进行检查（kappa≥0.70）。采用国际龋病检测和评估系统（ICDAS-II）指数评估牙体结构的完好性或有无白垩斑、釉质龋损和/或牙本质龋损。采用 Yildiz 可视指数评估密封剂保留情况。采用 Kaplan-Meier 生存分析评估结果，采用具有伽马分布的共享脆弱性模型估计治疗的风险比，将患者视为一个群组。与密封剂相比，各组治疗之间无显著差异。18 个月后，CO2 激光联合或不联合酸性氟化物的应用在预防高龋风险儿童部分萌出的第一恒磨牙窝沟区龋病方面是有效的。
