Dos Santos Nicole Marchioro, Leal Soraya Coelho, Gouvea Daiana Back, Sarti Caroline Simão, Toniolo Julia, Neves Matheus, Rodrigues Jonas Almeida
Federal University of Rio Grande Do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
University of Brasília, UnB, Brasília, Distrito Federal, Brazil.
Clin Oral Investig. 2022 Jan;26(1):1017-1024. doi: 10.1007/s00784-021-04085-2. Epub 2021 Jul 21.
This two-arm, parallel-group, tooth-randomised, controlled noninferiority clinical trial aimed to compare survival rates between the sealing and restoring of cavitated occlusal carious lesions in dentine [International Caries Detection and Assessment System (ICDAS) 5] of deciduous molars using resin-modified glass-ionomer cement (RMGIC) and to assess caries progression radiographically.
A total of 68 molars with ICDAS 5 occlusal lesions were randomly allocated into two groups, a sealing group (n = 31), in which RMGIC was placed directly over the carious lesion, and a restoration group (n = 37), in which a restoration with the same material was placed after selective caries removal. During the baseline and follow-up visits, dental caries was registered and caries activity was assessed according to a visuotactile criterion. At baseline, patient caries status (dmf-t) and cavity depth and extent (mesiodistal and buccolingual) were measured before RMGIC placement. An independent and blinded examiner evaluated the treated teeth using the USPHS criteria after one and two years. Standardised interproximal radiographs were taken for caries progression assessments.
During the follow-up period, no lesion progression was observed radiographically. After one year (n = 60; 27 sealed and 33 restored) and two years (n = 48; 23 sealed and 25 restored) of follow-up, the treatment success rates were 78.8% and 76.0% in the restoration group and 59.3% and 47.8% in the sealing group, respectively. Multivariate Cox regression showed that lesions smaller than 2 mm in the mesiodistal extent were less prone to fail after one year (p = 0.03). However, survival curves (log-rank test) were statistically significantly different only after two years (p < 0.001).
Sealing ICDAS 5 occlusal lesions of deciduous molars using RMGIC achieved lower survival rates than restorations. Both sealing and restoration effectively arrested caries progression for two years. Clinical relevance Sealing dentine carious lesions can be effective for treating lesions involving the inner and outer half of the dentine. Ultraconservative treatments can arrest carious lesions presenting obvious cavitation in primary molars.
ReBEC Register no. RBR-225n35.
本双臂、平行组、牙齿随机、对照非劣效性临床试验旨在比较使用树脂改性玻璃离子水门汀（RMGIC）对乳牙磨牙牙本质中已出现龋洞的咬合面龋损（国际龋病检测与评估系统[ICDAS]5级）进行封闭和修复后的生存率，并通过影像学评估龋病进展情况。
共有68颗患有ICDAS 5级咬合面龋损的磨牙被随机分为两组，即封闭组（n = 31），将RMGIC直接置于龋损上方；修复组（n = 37），在选择性去除龋坏组织后用相同材料进行修复。在基线和随访期间，记录龋齿情况，并根据视觉触觉标准评估龋病活动度。在基线时，在放置RMGIC之前测量患者的龋病状况（dmf-t）以及龋洞深度和范围（近远中向和颊舌向）。一名独立且不知情的检查者在1年和2年后使用美国公共卫生署（USPHS）标准对治疗后的牙齿进行评估。拍摄标准化邻面X线片以评估龋病进展情况。
在随访期间，影像学上未观察到病变进展。随访1年（n = 60；27颗封闭，33颗修复）和2年（n = 48；23颗封闭，25颗修复）后，修复组的治疗成功率分别为78.8%和76.0%，封闭组分别为59.3%和47.8%。多变量Cox回归分析显示，近远中范围小于2mm的病变在1年后失败的可能性较小（p = 0.03）。然而，生存曲线（对数秩检验）仅在2年后有统计学显著差异（p < 0.001）。
使用RMGIC封闭乳牙磨牙的ICDAS 5级咬合面龋损的生存率低于修复治疗。封闭和修复均能有效阻止龋病进展达两年。临床意义封闭牙本质龋损对于治疗累及牙本质内外半层的病变可能有效。超保守治疗可阻止乳牙中出现明显龋洞的龋病病变。
ReBEC注册号RBR-225n35。
