Leksell E, Ridell K, Cvek M, Mejàre I
Department of Pedodontics, Stockholm, Sweden.
Endod Dent Traumatol. 1996 Aug;12(4):192-6. doi: 10.1111/j.1600-9657.1996.tb00513.x.
The aim was to assess the prevalence of pulp exposure after stepwise versus direct complete excavation of permanent posterior teeth with deep carious lesions. The material, representing 116 patients aged 6-16 yrs (mean = 10.2 yrs), consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if direct complete excavation was performed. Teeth with clinical symptoms, other than transient pain shortly before treatment, were not accepted. The teeth were randomly selected for either treatment procedure. Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide, followed by sealing of the cavity with zinc-oxide eugenol cement. After a period of 8-24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide, zinc-oxide-eugenol (ZOE) and a restorative material. Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above. In case of pulp exposure, pulp treatment was performed. The pulp was exposed in 40 of the teeth treated by direct complete excavation. The corresponding figure for those treated by stepwise excavation was 17.5%. The difference was statistically significant. The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up (mean = 43 months).
目的是评估对患有深龋病变的恒牙后牙进行逐步与直接完全去龋后牙髓暴露的发生率。该材料来自116名6至16岁（平均10.2岁）的患者，包括127颗牙齿，其X光片显示龋损深度达到如果进行直接完全去龋则可能导致牙髓暴露的程度。除治疗前短暂疼痛外有临床症状的牙齿不被纳入。这些牙齿被随机分配接受其中一种治疗方法。逐步去龋意味着去除大部分龋坏组织并应用氢氧化钙，随后用氧化锌丁香油粘固剂封闭窝洞。8至24周后，去除剩余的龋坏牙本质，并用氢氧化钙、氧化锌丁香油（ZOE）和修复材料封闭窝洞。直接完全去龋则是去除所有龋坏牙本质，然后按上述方法封闭。如果发生牙髓暴露，则进行牙髓治疗。在直接完全去龋治疗的牙齿中，有40颗发生了牙髓暴露。逐步去龋治疗的相应比例为17.5%。差异具有统计学意义。在直接或逐步去龋后未发生牙髓暴露的牙齿在最后一次检查（平均43个月）时临床和X光片情况正常。
