深龋病变中选择性去除软牙本质与硬牙本质的临床结局：一项长达5年的随机对照试验
Clinical outcomes of selective removal to soft dentin versus firm dentin for deep caries lesions: a randomized controlled trial up to 5 years.
作者信息
Gözetici-Çil Burcu, Çetin Tuba, Bittar Ahmad, Özcan Mutlu
机构信息
Department of Restorative Dentistry, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5, Esenler, Istanbul, 34250, Turkey.
Clinic for Masticatory Disorders and Dental Biomaterials, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
出版信息
Clin Oral Investig. 2024 Dec 19;29(1):23. doi: 10.1007/s00784-024-06109-z.
OBJECTIVES
This study aimed to compare the success of selective removal to soft dentine (SRSD) with or without calcium silicate (CS) and selective removal to firm dentine (SRFD) in permanent dentition.
MATERIALS AND METHODS
Between November 2018 and March 2020, 165 posterior deep caries lesions in 134 patients were included in the study and randomly assigned into test (n = 101) and control (n = 64) groups. The control group (n = 46) received the treatment of SRFD with CS, while the test group was further randomized into two groups to receive SRSD with CS (n = 45) and SRSD without CS (n = 45). An additional group (PE) consisted of teeth with exposed pulps during caries removal (n = 29). The primary outcome of the study was to assess the vitality of the teeth based on clinical and radiographic examination after five years. The secondary outcome of the study was to evaluate the influence of baseline variables and CS application on treatment outcome. The success rates of different treatment strategies were compared (Pearson chi-squared and Log-rank tests). The impact of baseline variables and treatment strategies on failure and dentin bridge formation was analyzed using binary logistic regression model.
RESULTS
The success rate for SRSD with or without CS (94.1-100%) was significantly higher compared to SRFD (75.8%) and PE (81.8%) after five years (P = 0.012). Failure was less likely for premolars. Cavity type and depth had an influence on dentin bridge formation.
CONCLUSION
A five-year follow-up in this study demonstrated better clinical outcome for SRSD with or without CS compared to SRFD technique, irrespective of age, pre-op sensitivity, cavity type, radiographic depth and activity of the caries. Application of CS after SRSD in deeper cavities provided better healing in terms of dentin bridge formation.
CLINICAL RELEVANCE
SRSD might be more advantageous over SRFD for the management of deep caries lesions.
目的
本研究旨在比较恒牙列中采用或不采用硅酸钙（CS）进行选择性去除至软牙本质（SRSD）与选择性去除至硬牙本质（SRFD）的成功率。
材料与方法
在2018年11月至2020年3月期间，134例患者的165个后牙深龋病变被纳入研究，并随机分为试验组（n = 101）和对照组（n = 64）。对照组（n = 46）接受采用CS的SRFD治疗，而试验组进一步随机分为两组，分别接受采用CS的SRSD（n = 45）和不采用CS的SRSD（n = 45）。另一组（PE）由在龋病去除过程中牙髓暴露的牙齿组成（n = 29）。该研究的主要结局是在五年后根据临床和影像学检查评估牙齿的活力。该研究的次要结局是评估基线变量和CS应用对治疗结局的影响。比较不同治疗策略的成功率（Pearson卡方检验和对数秩检验）。使用二元逻辑回归模型分析基线变量和治疗策略对失败和牙本质桥形成的影响。
结果
五年后，采用或不采用CS的SRSD成功率（94.1 - 100%）显著高于SRFD（75.8%）和PE（81.8%）（P = 0.012）。前磨牙失败的可能性较小。洞型和深度对牙本质桥形成有影响。
结论
本研究的五年随访表明，与SRFD技术相比，采用或不采用CS的SRSD在临床结局方面更好，无论年龄、术前敏感性、洞型、影像学深度和龋病活动情况如何。在较深龋洞中进行SRSD后应用CS在牙本质桥形成方面提供了更好的愈合。
临床意义
对于深龋病变的管理，SRSD可能比SRFD更具优势。
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