Clinical diagnosis of recurrent caries.
Clinical diagnosis of recurrent caries.
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DOI：
10.14219/jada.archive.2005.0057
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发表时间：
2005-10
影响因子：
3.9
通讯作者：
I. Mjör
中科院分区：
文献类型：
--
作者：
I. Mjör
背景在一般牙科实践中，复发性龋的临床诊断是更换所有类型的牙釉质的最常见原因。已报道了病变诊断的显著变化。通过使用释放氟化物的修复材料来预防复发性病变并不成功。作者重点关注文献中基于实践的研究。这些研究在科学上并不严谨，但它们反映了“真实生活”的牙科实践。关于复发性龋损的体内实验研究很少，但细菌学研究表明其病因与原发性龋相似。结果复发性龋损多位于II类至V类牙列的龈缘。复发性龋很少在I类龋损中诊断出来。诊断是困难的，重要的是要区分复发性龋损和树脂基复合牙面染色的边缘。悬突，即使是微小的大小，也易于牙菌斑积累和复发性龋齿的发展。复发性病变的发生与微渗漏无关。临床意义由于复发性龋损是局部的和有限的，替代治疗修复更换建议。抛光可能就足够了。如果没有，在局部缺损附近的修复材料中进行探查性准备可以揭示病变的范围。这些检查总是显示病变不会沿着牙齿-修复体界面发展。因此，可以修复缺陷，而不是完全更换。修复和翻新的牙列保存牙齿结构。这些简单的程序也增加了修复体的寿命。
BACKGROUND The clinical diagnosis of recurrent caries is the most common reason for replacement of all types of restorations in general dental practice. Marked variations in the diagnosis of the lesions have been reported. The prevention of recurrent lesions by the use of fluoride-releasing restorative materials has not been successful. TYPES OF STUDIES REVIEWED The author focused on practice-based studies in the literature. These studies are not scientifically rigorous, but they reflect "real-life" dental practice. Few experimental studies on recurrent carious lesions in vivo have been reported, but bacteriological studies indicate that the etiology is similar to that of primary caries. RESULTS Recurrent carious lesions are most often located on the gingival margins of Class II through V restorations. Recurrent caries is rarely diagnosed on Class I restorations. The diagnosis is difficult, and it is important to differentiate recurrent carious lesions from stained margins on resin-based composite restorations. Over-hangs, even minute in size, are predisposed to plaque accumulation and the development of recurrent caries. The development of recurrent lesions is unrelated to microleakage. CLINICAL IMPLICATIONS As recurrent carious lesions are localized and limited, alternative treatments to restoration replacement are suggested. Polishing may be sufficient. If not, exploratory preparations into the restorative material adjacent to the localized defect can reveal the extent of the lesion. Such explorations invariably show that the lesion does not progress along the tooth-restoration interface. The defect, therefore, may be repaired in lieu of being completely replaced. Repair and refurbishing of restorations save tooth structure. These simple procedures also increase the life span of the restoration.