Bailleul Laura, Ceballos Laura, Doméjean Sophie, Fuentes Victoria
Faculty of Health Sciences, IDIBO Research Group, Universidad Rey Juan Carlos, Madrid, Spain.
Clermont Auvergne University, Clermont-Ferrand, France.
Int Endod J. 2025 Feb;58(2):239-256. doi: 10.1111/iej.14159. Epub 2024 Oct 30.
To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.
A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X tests were carried out.
A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.
Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.
评估西班牙牙医对恒牙深龋去腐和露髓的处理偏好。
通过社交媒体和该项目的特定网站，对在西班牙执业的牙医开展了一项基于网络的开放式匿名调查。问卷包含40个问题，分为五个部分：（1）人口统计学数据和专业活动；（2）龋坏组织去除；（3）露髓的决策；（4）直接盖髓术；（5）恒牙的活髓切断术。对结果进行描述性分析。进行了逻辑回归（95%置信区间）分析和X检验。
共收到538份回复。一半的受访者（53.7%）倾向于对浅、中度龋坏牙本质病变进行完全龋洞预备，对深龋病变则选择性预备至硬牙本质（57.8%）。选择去除至软牙本质和逐步去除的比例则低得多（分别为15.4%和10.9%）。无症状牙齿的露髓采用直接盖髓术治疗（超过80%），在存在可逆性牙髓炎症状时比例降低（57.1%）。如果诊断为不可逆性牙髓炎，分别有53.5%和89.9%的受访者会对未成熟恒牙和成熟恒牙进行根管治疗。只有26.4%的临床医生常规进行活髓切断术。在进行直接盖髓术和活髓切断术时，患者的态度和优先事项是最相关的标准，同时还有疼痛史和出血情况。关于临床操作，更倾向于使用干棉球止血，而BioDentine是首选材料。
在西班牙执业的牙医对龋病去腐的偏好和露髓处理与牙髓保存治疗指南存在偏差，主要体现在适应证和病例选择方面。无症状病例的露髓采用直接盖髓术处理，而诊断为牙髓炎时，未成熟恒牙更倾向于活髓切断术的适应证。大多数临床医生使用水硬性硅酸钙水门汀，特别是BioDentine进行牙髓保存治疗。龋病病变管理和牙髓保存治疗方面的研究生培养和继续教育与更保守和更新的决策始终相关。
