Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Department of Restorative Dentistry, School of Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil.
J Dent. 2024 Aug;147:105099. doi: 10.1016/j.jdent.2024.105099. Epub 2024 May 24.
This randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period.
Inclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc).
The follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03).
This study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months.
SCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.
本随机对照临床试验旨在评估选择性去龋至软化牙本质（SCRSD）或逐步去龋（SW）后 18 个月复合树脂修复的临床性能。
纳入标准为患有深龋（牙本质厚度≥50%）的恒牙和/或前磨牙患者。牙齿接受 SCRSD（n=76）或 SW（n=76）治疗。根据 FDI（世界牙科联合会）标准进行评估。采用生存分析估计修复体的生存率及其与临床变量和社会人口特征的关系（调整威布尔回归模型）。该研究已在巴西临床试验注册处（ReBEC 65ntbc）注册。
随访时间为 6 至 18 个月（平均±标准差 16.3±3.4 个月）。患者年龄为 9 至 55 岁（平均±标准差 29±10.5 岁）。共评估了 101 名患者的 135 颗牙齿（SCRSD=72 颗；SW=63 颗）。SCRSD 组有 4 颗修复体失败（2 颗需更换的修复体丢失，2 颗需修复的边缘折裂），SW 组有 2 颗（需修复的折裂）。解释变量与修复体失败的相关性显示，SW（99.4%）和 SCRSD（97.9%）的成功率相似（p=0.16）。患有牙龈炎（≥20%的探诊出血位点）的患者失败风险是牙龈炎＜20%的患者的 8.50 倍（p=0.03）。
本研究表明，在软牙本质（SCRSD 后）上放置复合树脂修复体在 18 个月后不会影响其临床性能。
SCRSD 是一种可行的治疗方法，可用于治疗恒牙深龋，因为它在不影响修复体寿命的情况下保留了牙齿活力和牙体结构。
