乳臼歯におけるコンポジットレストレーションは、う蝕の全除去後と選択的除去後の生存率が高いか？

Do composite restorations in primary molar teeth have a higher survival rate following total or selective caries removal?

抄録

研究デザイン 2009年6月から2011年6月にかけて、ブラジルの歯学部の小児歯科科で実施された二重盲検無作為化臨床試験である。臨床的またはX線写真上、歯髄の炎症や壊死、臨床的可動性が認められた歯は除外した。臨床的処置と成功基準 コイントスにより、120歯を2群に無作為に割り付けた：全う蝕除去（TCR）群55歯と選択的う蝕除去（SCR）群65歯。処置は3人の小児歯科医が局所麻酔下で行い、ラバーダム下でコンポジットレジストを積層法で修復した。修復物は、3ヵ月、6ヵ月、12ヵ月、18ヵ月、24ヵ月、36ヵ月後に、米国公衆衛生局（USPHS）スケールを用いて、単盲検で較正された検査者によって評価された。USPHSスケールで、修復物の辺縁にチャーリーまたはデルタスコアがあれば、修復不良とみなした。歯肉出血スコア、窩洞のタイプ（1面または2面）、う蝕の有無（活動性または非活動性）が副次的アウトカムとして記録されたが、存在のみでは修復物の失敗とは見なされなかった。結果 全歯の36ヵ月後の修復物の平均残存率は68％であり、SCRはTCRの81％と比較して57％と統計的に有意に低かった（p = 0.004）。SCRとTCRの年間失敗率は、それぞれ17.3％と6.7％であった。2面修復物は、1面修復物（87％）と比較して生存率が低かった（58％）（p = 0.02）。結論小臼歯のSCR後に修復したコンポジットレストレーションは、TCR後に修復したものと比較して、失敗する頻度が高いことが判明した。二面性窩洞と歯肉の健康状態の悪さは、修復の成功にマイナスの影響を与えた。

Study design A double-blind randomised clinical trial, conducted between June 2009 and June 2011, in a paediatric dental department in a Brazilian dental school.Study selection Children aged 3-8 years, in good general health, with deep carious lesions (caries radiographically located in the inner quarter of dentine) affecting either one or two surfaces in primary molars were eligible for inclusion. Teeth were excluded if clinical or radiographic evidence of pulpal inflammation or necrosis or clinical mobility were observed. Pre-cooperative children were also excluded.Clinical procedures and success criteria Following a coin toss, 120 teeth were randomly assigned to two groups: 55 in the total caries removal (TCR) group and 65 in the selective caries removal (SCR) group. Procedures were carried out by three paediatric dentists under local anaesthesia and restored, using a layering technique, with composite under rubber dam. Restorations were evaluated at 3, 6, 12, 18, 24 and 36 months, using the US Public Health Service (USPHS) scale, by a single-blinded and calibrated examiner. A Charlie or Delta score, on the USPHS scale, at the margins of the restorations was considered as restoration failure. Gingival bleeding score, type of cavity (one or two surfaces) and presence of caries (active or inactive) were recorded as secondary outcomes; however, presence alone did not constitute restoration failure.Results Average survival rate of restorations across all teeth was 68% after 36 months, with SCR statistically significantly lower at 57% compared to TCR at 81% (p = 0.004). Annual failure rates for SCR and TCR were 17.3% and 6.7%, respectively. Two-surface restorations had lower survival rates (58%) compared to single-surface restorations (87%) (p = 0.02). Type of cavity and gingival bleeding statistically influenced the chance of restoration failure at 36 months.Conclusions Composite restorations placed after SCR in primary molars were found to fail more often compared to those restored after TCR. Two-surface cavities and poor gingival health negatively impacted restoration success.