J Dent Res:自限与常规龋坏去除的比较:一项临床随机试验

2018-05-16 lishiting MedSci原创

这项单盲临床随机对照试验的目的是为了比较化学机械Carisolv凝胶/手术显微镜的自限龋坏移除方案(自限)与旋转牙钻选择性移除硬质牙本质(对照)的方法对罹患深龋和有症状的可复性牙髓炎患者治疗效果的比较。随后,所有试验牙齿均通过MTA护髓,玻璃离子水门汀垫底复合树脂充填,所有诊疗均为单次完成。

这项单盲临床随机对照试验的目的是为了比较化学机械Carisolv凝胶/手术显微镜的自限龋坏移除方案(自限)与旋转牙钻选择性移除硬质牙本质(对照)的方法对罹患深龋和有症状的可复性牙髓炎患者治疗效果的比较。随后,所有试验牙齿均通过MTA护髓,玻璃离子水门汀垫底复合树脂充填,所有诊疗均为单次完成。

除了治疗时移除后的细菌组织浓度差异比较,所有受试牙齿的牙髓敏感度和根尖周健康情况均在术后12个月进行评估。通过CBCT/根尖周X线影像在术前(M0)和术后12个月(M12)评估根尖周的可透射性。

总体来讲,研究共对86名患者进行了101例修复治疗,收集了成对的表面下及深(移除后)牙本质样本。提取DNA并通过定量聚合酶链式反应检测细菌特异性的16S核糖体RNA基因。自限(96.3% reduction)和对照方案(97.1%, P = 0.33)按照牙本质量标准化的细菌拷贝数量之间没有明显差异。自限方案12个月后治疗成功的可能性是对照方案的4倍(odds ratio [OR] = 4.33; confidence interval [CI], 1.2-15.6; P = 0.025),牙髓存活率分别为90%和73.3% ( P = 0.049)。磨牙治疗成功的可能性是前磨牙的4倍(OR, 4.17; CI, 1.17-14.9; P = 0.028),症状的严重程度并不能有效的预测疗效(OR, 0.41; CI, 0.12-13.9, P = 0.153)。术前,CBCT比X线影像(PA)能够检测出更多的PA损伤( P < 0.001)。

结论:与旋转牙钻移除龋坏相比,显微镜下自限挖除龋损的方案可以增加牙髓存活的几率。

原始出处

Ali AH, Koller G, et al. Self-Limiting versus Conventional Caries Removal: A Randomized Clinical Trial. J Dent Res. 2018 May 1:22034518769255. doi: 10.1177/0022034518769255.

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