這種deep caries, 活隨治療算是近期會比較在乎的問題

最近在西班牙的診所

蛀牙很深，到底要根管還是capping? 還是拔掉

雖然當時在念美國國考的時候就已經被摧殘過

但這塊領域我覺得要up to date, 因為大家都還在嘗試階段

今天讀的是這篇

Bjørndal, L, Simon, S, Tomson, PL, Duncan, HF. Management of deep caries and the exposed pulp. International Endodontic Journal, 52, 949–973, 2019.

IEJ 大咖文獻，來看看這篇

引言

以往我們都習慣把蛀牙挖乾淨，但近年來Selective (partial) caries removal 越來越盛行，常見的包含VPT, Stepwise等等

Intro

前面主要在複習蛀牙的成因，後面帶到了本篇第一個重點

A圖為 Deep carious lesion reaching pulpal quarter with a zone of dentine separating the lesion from the pulp

B圖為 extremely deep penetrating the entire thickness of the dentine

Dentin 刺激生成

前面介紹了很多理論，包含各種激素，但這不是我關心的，我在乎的是後面這段

The ability of ethylenediaminetetraacetic acid (EDTA) (Graham et al. 2006, Galler et al. 2016a), hydraulic calcium silicate cements (Tomson et al. 2007), calcium hydroxide (Graham et al. 2006), dental resins (Ferracane et al. 2013), ultrasonic agitation (Widbiller et al. 2017) and epigenetic modifying agents (Duncan et al. 2017), to sequester DMCs and augment the regenerative response, has been demonstrated. Irrigation strategies aimed at biological response, rather than disinfection capacity, have used EDTA demonstrated to release TGF-β family members from the extracellular matrix of dentine (Galler et al. 2016a). Conversely, sodium hypochlorite (NaOCl) had a deleterious effect on SC survival and differentiation ability, leading to suggestions that at least in revitalization procedures the final rinse should be with a 17% EDTA solution (Martin et al. 2014). In VPT, however, EDTA irrigation (although releasing DMCs) may stimulate renewed pulpal bleeding.

總結來說，17%的EDTA可以促進牙本質生成，但有可能會讓PULP流血

次氯酸鈉(NaOCl) 會deleterious effect on SC survival and differentiation ability,

後面越看越無聊，完全了心意

Direct pulp capping 適合用在年輕，咬合面的問題

RCT比較適合在40歲以上，有INTERPROXIMAL EXPOSURE