J Am Dent Assoc. 2020 Aug;151(8):568-575. doi: 10.1016/j.adaj.2020.04.015.
The authors examined time to need new treatment of primary second molars in very young children treated under general anesthesia (GA).
During this retrospective chart review, the authors examined patients aged 2 through 4 years with severe early childhood caries (ECC) who received dental treatment under GA. Primary second molars were tracked in periodic recall visits after GA for 6 through 89 months. Using a random-effects Cox proportional hazards model, the authors compared hazards of teeth requiring new treatment based on treatments received at GA.
Of 3,166 primary second molars included in the study, 367 (12%) were not erupted, 77 (2%) received topical fluoride only, 873 (28%) received a pit and fissure sealant, 242 (8%) received a composite restoration, and 1,607 (50%) received a stainless steel crown (SSC) at GA. SSCs had a survival probability of 98% by 84 months after GA, significantly higher than all other groups (P < .0001). The second molars that were not erupted at GA had the highest hazard, especially within the first 24 months after GA. Teeth that received sealant had longer time to need new treatment than nonsealed teeth; however, at 84 months after GA, only 33% of the sealed teeth did not require additional treatment.
Preventive or restorative treatments other than SSCs resulted in need for new treatment in a substantial number of teeth. SSCs had the highest success in this population with severe ECC treated under GA and should be chosen over other restorative options to reduce risk of undergoing repeat dental treatment.
Aggressive treatment with SCC should be considered for young children with severe ECC especially those who are treated under GA at a young age.
作者研究了在全身麻醉（GA）下治疗的非常年幼的儿童中，原发性第二磨牙需要新治疗的时间。
在这项回顾性图表审查中，作者检查了年龄在 2 至 4 岁之间患有严重婴幼儿龋（ECC）且在 GA 下接受牙科治疗的患者。在 GA 后 6 至 89 个月的定期随访中，对原发性第二磨牙进行跟踪。使用随机效应 Cox 比例风险模型，作者比较了基于 GA 时接受的治疗，需要新治疗的牙齿的风险。
在研究的 3166 颗原发性第二磨牙中，有 367 颗（12%）未萌出，77 颗（2%）仅接受局部氟化物治疗，873 颗（28%）接受窝沟封闭剂治疗，242 颗（8%）接受复合修复体治疗，1607 颗（50%）在 GA 时接受不锈钢冠（SSC）治疗。SSC 在 GA 后 84 个月的生存率为 98%，明显高于所有其他组（P<.0001）。GA 时未萌出的第二磨牙风险最高，尤其是在 GA 后前 24 个月内。接受封闭剂治疗的牙齿比未封闭的牙齿需要新治疗的时间更长；然而，在 GA 后 84 个月时，只有 33%的封闭牙不需要额外治疗。
除 SSC 以外的预防性或修复性治疗在相当数量的牙齿中导致需要新的治疗。在接受 GA 治疗的严重 ECC 人群中，SSC 取得了最高的成功，应选择 SSC 作为其他修复选择，以降低接受重复牙科治疗的风险。
对于患有严重 ECC 的幼儿，尤其是那些在幼年时接受 GA 治疗的幼儿，应考虑积极采用 SCC 治疗。
