Fontana Margherita, Gonzalez-Cabezas Carlos, Tenuta Livia M A
J Am Dent Assoc. 2024 Dec;155(12):1000-1011. doi: 10.1016/j.adaj.2024.09.007. Epub 2024 Nov 2.
A high level of scientific evidence supports several nonrestorative strategies for the control of caries, with the goal of reducing progression of mineral loss and arresting existing lesions. The authors provide an overview of evidence for nonrestorative caries control and considerations in the decision making for selecting nonrestorative options.
The authors discuss findings from existing reviews, systematic reviews, and evidence-based guidelines (particularly from the American Dental Association) describing the effectiveness of nonrestorative strategies available in the US market for remineralization and arrest of caries lesions.
Studies support a wide range of products for arresting caries lesions, such as fluorides, sealants, infiltration resins, and chlorhexidine varnish, among others, depending on the tooth surface, primary or permanent dentition, and whether lesions are noncavitated or cavitated. Decisions should be based on appropriate detection, diagnosis, and risk assessment.
Effective nonrestorative strategies should be used to manage active, noncavitated caries lesions in primary and permanent teeth, and can be considered for managing active cavitated lesions when restorative intervention is not feasible. These lesion-centered interventions should be part of the required overall management of the caries disease process and existing modifiable risk variables at the patient level. They must be monitored over time and reapplied periodically, as needed.
大量科学证据支持多种控制龋齿的非修复性策略，目标是减少矿物质流失的进展并阻止现有病变。作者概述了非修复性龋齿控制的证据以及选择非修复性方法时决策中的考虑因素。
作者讨论了现有综述、系统评价和循证指南（特别是美国牙科协会的指南）中的研究结果，这些研究描述了美国市场上可用于再矿化和阻止龋损的非修复性策略的有效性。
研究支持多种用于阻止龋损的产品，如氟化物、窝沟封闭剂、渗透树脂和洗必泰 varnish 等，具体取决于牙齿表面、乳牙或恒牙列以及病变是否为非龋洞型或龋洞型。决策应基于适当的检测、诊断和风险评估。
应使用有效的非修复性策略来管理乳牙和恒牙中的活动性非龋洞型龋损，在修复干预不可行时也可考虑用于管理活动性龋洞型病变。这些以病变为中心的干预措施应成为龋齿疾病过程和患者层面现有可改变风险变量所需的整体管理的一部分。必须对其进行长期监测，并根据需要定期重新应用。
