深龋治疗中龋坏去除程度的循证病案讨论.pdfVIP

国际口腔医学杂志 第35 卷 第6 期 2008 年11 月 International Journal of Stomatology Vol.35 No.6 Nov. 2008 · · 615 深龋治疗中龋坏去除程度的循证病案讨论 薛 晶，张凌琳，邹 玲，李 伟 （ 口腔疾病研究国家重点实验室， 四川大学 四川 成都 610041 ） [摘要] 目的 针对深龋治疗中龋坏去除程度检索其当前最佳证据，为深龋的临床合理治疗提供依据。方法 计算机检索OVID-All EBM Reviews-Cochrane DSR ，ACP Journal Club ，DARE，CCTR （4th Quarter 2006），以 龋病（dental caries）和龋坏去除（excavation）为检索关键词。结果 临床证据表明，部分去除龋坏可降低露髓的 风险，对以后的牙髓炎症的发生无不利影响，部分去除龋坏后是否需2 次去龋还需要进一步的长期临床试验研 究。结论 对于无牙髓症状的乳牙和恒牙，部分去除龋坏可降低牙髓暴露的风险，部分去除龋坏不会对患者的 牙髓症状产生不利影响。 [关键词] 龋病；治疗；循证医学 [中图分类号] R781.1 [文献标识码] A Evidence-based case discussion of excavation of deep caries XUE Jing, ZHANG Ling-lin, ZOU Ling, LI Wei. （State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China） [Abstract] Objective To analyze and explain how to treat a patient with deep caries based on best evidence. Methods Used dental caries and excavation as key words to search OVID-All EBM reviews-cochrane DSR, ACP journal club, DARE, and CCTR （4th Quarter 2006）to find the best clinical evidence and evaluated the quality of evidence. Results According to the evidence, we found that partial caries removal would appear to be preferable to complete caries removal in the deep lesion, in order to reduce the risk of carious exposure. We found no evi－ dence that partial caries removal is deleterious in terms of signs and symptoms of pulpitis or necrosis in the im－ mediate to long term. It needs further clinical trial to decide whether cavity need re-entered at a second visit to allow the remaining decay to be removed. Conclusion Partial caries removal in symptomless, primary or perma－ nent teeth reduces the risk of pulp exposure. We found no de