Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany.
Clin Oral Investig. 2020 May;24(5):1623-1636. doi: 10.1007/s00784-020-03201-y. Epub 2020 Apr 18.
For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults".
Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded.
Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam.
Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity.
Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
为了达成 ORCA/EFCD 的共识，本系统评价旨在探讨“如何针对青少年和成年人邻面龋的早期龋损进行干预”这一问题。
本研究将初始龋和龋损进展性邻面龋的管理分开，通过 Medline（PubMed）数据库检索了非手术/非侵入性、微创/微侵袭性和修复治疗相关文献。首先纳入了系统评价或随机对照试验（RCT），其次为队列研究。在提取数据后，根据研究类型评估了潜在的偏倚风险，并对结论的证据质量进行分级。
在非侵入性/非手术性护理（NOC）方面，未发现系统评价或 RCT。在队列研究（n=12）中，证据水平较低，NOC 如生物膜管理和氟化物的应用与初始邻面龋损进展的低比例和低速度相关。微创/微侵袭性（MI）治疗，如邻面封闭或树脂渗透（四项系统评价/荟萃分析）与非侵入性/安慰剂对照相比，具有中等证据水平的有效性。修复治疗的数据证据水平较低（五项系统评价，十三项 RCT）；由于缺乏直接比较研究，II 类修复体的加权平均年失败率在 1.2%（大体积复合树脂）至 3.8%（陶瓷）之间变化，该数据受到了限制。基于一项 RCT，II 类复合树脂修复体的失败风险可能高于银汞合金。
根据病变阶段和龋病活性，邻面龋损可以通过非手术、微创和修复治疗成功管理。
应根据个体情况考虑邻面龋的治疗选择，如非手术、微创和修复治疗。
