Department of Endodontics, Fluminense Federal University, Niterói, Brazil.
Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil.
Int Endod J. 2022 May;55 Suppl 3:531-587. doi: 10.1111/iej.13696. Epub 2022 Feb 20.
In the last decades, the move of medicine towards minimally invasive treatments is notorious and scientifically grounded. As dentistry naturally follows in its footsteps, minimal access preparation have also becume a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach such as minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in situ laboratory model or a large and well-controlled clinical trial to solve this matter.
在过去的几十年中，医学向微创治疗的转变是众所周知的，也是有科学依据的。由于牙科自然紧随其后，微创预备也成为了牙髓学领域的一个热门话题。这种方法旨在最大限度地保留牙本质组织，其背后的理念是，这是减少治疗后牙齿断裂发生率的有效方法。然而，通过对这个主题的证据评估，可以观察到一些关键点：(a) 需要标准化命名法，(b) 需要特殊工具，如超灵活器械、视觉放大、更好的照明和三维成像技术，(c) 微创治疗似乎不会影响器械进入的位置和机械预备，只要使用适当的器械，但它可能会影响到根管的清洁、消毒和填充程序，(d) 并且对于增强牙齿强度的能力与传统入口腔相比显示出矛盾的结果。尽管如此，不可否认的是，一些使用离体牙的基础研究的方法学缺陷可能是导致数据冲突的原因，因此需要更复杂的设备/设施和专门设计的研究，以试图阐明入口大小/设计对长期牙齿生存的作用。此外，微创牙髓入口腔这种需要复杂工具和熟练且经验丰富的操作人员的临床方法不可避免地引发了对其教育影响的质疑，尤其是在面对相互矛盾的科学成果时，最终对其作为常规技术的实施进行了成本效益分析。此外，本文还讨论了微创入口腔的当前科学和临床状况，旨在对其背后的原理进行深入和客观的分析，不仅揭示了相关的概念和科学缺陷，还为研究和临床实践指明了未来的方向。结论试图避免从强调当前证据不足和不完整的激烈争论中跳出来，而是要求开发一种接近原位的实验室模型或大型、精心控制的临床试验来解决这个问题。
