修复管理诊断策略:为期 70 个月的临床试验

Journal of dental research Pub Date : 2024-07-01 Epub Date: 2024-05-16 DOI:10.1177/00220345241247773
V H Digmayer Romero, C Signori, J L S Uehara, A F Montagner, F H van de Sande, G S Maydana, E T Chaves, F Schwendicke, M M Braga, M-C Huysmans, F M Mendes, M S Cenci
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引用次数: 0

摘要

我们的目的是评估用于评估继发龋和管理永久性后牙修复体的两种视觉诊断策略对长期存活率的影响。我们进行了一项诊断分组随机临床试验,分为两个平行组,使用不同的诊断策略:(C+AS)基于FDI(世界牙科联盟)标准的龋坏评估、边缘适应性和边缘染色方面;(C)基于国际龋病检测和评估系统(ICDAS)描述的与修复体或封闭剂相关的龋坏(CARS)标准进行龋坏评估。根据所分配的诊断策略做出的决定进行修复治疗。然后对修复体进行长达 71 个月的临床再评估。主要结果是修复失败(包括牙齿层面的失败:疼痛、牙髓治疗和拔牙)。在意向治疗人群中进行了共享虚弱的 Cox 回归分析,得出了危险比 (HR) 和 95% 置信区间 (95%CI)。我们纳入了 185 名参与者的 727 个修复体,并在随访期间重新评估了 502 个(69.1%)修复体。评估时间为 6 至 71 个月。在基线阶段,与 C+AS 策略相比,C 导致的干预减少了近 4 倍。C 组共评估了 371 个修复体,其中 31 个(8.4%)进行了修复或更换。相比之下,C+AS 组共评估了 356 个修复体,其中 113 个(31.7%)进行了修复或更换。在随访期间,在意向治疗人群中,C组和C+AS组分别有34颗(9.2%)和30颗(8.4%)修复体出现失败,组间差异不显著(HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435,C+AS为参照)。总之,以边缘缺损为重点的诊断策略会导致更多的初始干预,但与以龋齿为重点的策略相比,并不能提高寿命,这表明需要采取更保守的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic Strategies for Restorations Management: A 70-Month RCT.

We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.

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