Kopel H M
Section of Pediatric Dentistry, School of Dentistry, Center for the Health Sciences, University of California, Los Angeles 90095-1668, USA.
ASDC J Dent Child. 1997 Sep-Oct;64(5):327-33.
The purpose of this review is to "revisit" an earlier paper (1992) on the subject of direct pulp capping in primary teeth and bring some new considerations for the procedure by the use of dentin bonding adhesives. It has come to be recognized that the customary employment of calcium hydroxide for this therapy has some shortcomings that reduce the prognosis for a favorable outcome. For at least a decade, many investigations have found that postoperative sensitivity, thermal stimuli, pulp inflammation and pathosis can be attributed not to the composition of various dental materials and their insertion techniques, but to microleakage with subsequent bacterial invasion at the enamel/restoration and the dentin/pulp interfaces. It is imperative, as pointed out, that there be an impervious resinous bond between the dentin and the dentinopulpal complex which can be achieved by the use of dentinal adhesive agents to eliminate microleakage outward movement of pulpal fluids. Various steps in the bonding technique for the treatment of deep dentin caries and/or a pulp exposure has raised some concerns for their effect on the pulp. This review discusses these concerns, which can lead to the conclusion that the use of dentinal bonding adhesives is a safe and biologically feasible procedure, whether it be in permanent or primary teeth.
本综述的目的是“重新审视”一篇早期（1992年）关于乳牙直接盖髓术的论文，并通过使用牙本质粘结剂为该手术带来一些新的思考。人们已经认识到，在这种治疗中常规使用氢氧化钙存在一些缺点，这些缺点会降低获得良好预后的可能性。至少在过去十年中，许多研究发现，术后敏感性、热刺激、牙髓炎症和病变并非归因于各种牙科材料的成分及其插入技术，而是归因于釉质/修复体以及牙本质/牙髓界面处的微渗漏以及随后的细菌入侵。如前所述，至关重要的是，牙本质与牙髓复合体之间要有一个不透水的树脂粘结，这可以通过使用牙本质粘结剂来消除牙髓液的微渗漏和向外流动来实现。治疗深龋和/或牙髓暴露的粘结技术中的各个步骤对牙髓的影响引发了一些担忧。本综述讨论了这些担忧，得出的结论是，无论在恒牙还是乳牙中，使用牙本质粘结剂都是一种安全且生物学上可行的方法。
