深龋的治疗策略  

Treatment strategies for deep caries

作　　者：张露[1] 陈智[1] Zhang Lu;Chen Zhi(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,Key Laboratory of Oral Biomedicine Ministry of Education,Hubei Key Laboratory of Stomatology,School&Hospital of Stomatology,Wuhan University,Wuhan 430079,China)

机构地区：[1]武汉大学口腔医(学)院、口颌系统重建与再生全国重点实验室、口腔生物医学教育部重点实验室、口腔医学湖北省重点实验室,武汉430079

出　　处：《中华口腔医学杂志》2024年第1期23-29,共7页Chinese Journal of Stomatology

基　　金：国家重点研发计划(2018YFC1105103)。

摘　　要：龋病进展到牙本质深层时即为深龋,进一步发展存在牙髓暴露的风险,严重危害牙髓活力,影响牙齿寿命。目前深龋的诊断缺乏客观标准,其治疗方案强调彻底去尽龋坏组织,导致牙髓暴露的风险较高。去龋后如何处理剩余牙本质观点不一,深龋露髓后多直接采用根管治疗。近年由于牙髓生物学、生物活性盖髓材料和临床循证医学的发展,深龋的治疗原则转变为优先保护牙髓。本文基于国际上最新研究进展、循证医学证据和专家共识,对深龋的命名、深龋下的牙髓病理学变化和牙髓修复防御机制、深龋的治疗原则、去龋的技术策略以及深龋露髓后治疗方案的选择等进展进行梳理,旨在加深口腔医师对深龋的认识和理解,为深龋的临床诊疗提供依据。Deep caries occurs when caries progresses to the deep dentin layer,and further progression has the risk of pulp exposure,which may affect pulp vitality and tooth longevity.Currently,there are no objective standards for the diagnosis of deep caries.In addition,traditional therapy for deep caries emphasizes complete debridement of the decayed tissue,resulting in an incremental high risk of pulp exposure.There are different views on how to deal with the remaining dentin after caries removal,and root canal treatment is often adopted directly after pulp exposure.In recent years,due to advances in dental pulp biology,bioactive pulp-capping materials,and clinical evidence-based medicine,the principle of deep caries treatment has shifted to pulp protection.Based on the latest international research progress,evidence-based medicine and expert consensus,we present a series of advancements in this article,including the terminology of deep caries,pathological changes and defense mechanisms of the pulp close to the deep caries,treatment principles of deep caries,technical strategies for carious tissues removal,and the decision-making of treatment protocols after pulp exposure,with the aim of enhancing the understanding of deep caries among dentists,as well as providing a reference for the clinical diagnosis and treatment of deep caries.

关 键 词：龋齿 牙髓 牙髓暴露 深龋 治疗方案 分步去龋 选择性去龋 

分 类 号：R781.1[医药卫生—口腔医学]