BAŞLANGIÇ PROKSIMAL ÇÜRÜK LEZYONLARINDA KONSERVATIF TEDAVI YAKLAŞIMLARI

Yıl 2022, Cilt: 32 Sayı: 2, 173 - 180, 17.04.2022

Gülce Esentürk Elif Ballıkaya Gizem Erbaş Ünverdi Buğra Özen Zafer Cavit Çehreli

Öz

Diş çürüğü, bilinen en yaygın infeksiyöz hastalıklardandır ve diş sert dokularında kavitasyon evresine ulaştığında medikal ve restoratif yöntemlerle tedavi edilmesi gerekmektedir. Çürüğün önlenmesi, çürük yönetim planının temel hedefidir ve başlangıç aşamasındaki proksimal lezyonlar toplumda oldukça yaygın görülmektedir. Mevcut çürük lezyonunun restorasyonu için farklı tedavi yaklaşımları uygulanabilmektedir. Konservatif tedavi yaklaşımlarının amacı, süreci lezyon düzeyinde yönetmek ve sağlam diş yapısının kaybını en aza indirmektir. Araştırma gruplarının vardığı ortak görüş, erken proksimal çürük lezyonlarının, lezyonun bulunduğu aşamaya ve çürük aktivitesine bağlı olarak non-invaziv veya mikro-invaziv yöntemler ile başarılı bir şekilde tedavi edilebileceğidir. Diyet kontrolü, biyofilm kontrolü veya de- ve remineralizasyonun kontrolünden oluşan non-invaziv önlemlerde, çürük lezyonunun uzaklaştırılması yerine kontrol altına alınması amaçlanmaktadır. Non-invaziv yaklaşımların etkinliğinin hasta uyumuna bağlı olması, koruyucu önlemlere alternatif bir tedavi protokolü olarak mikro-invaziv yaklaşımları öne çıkarmıştır. Mikro-invaziv yaklaşımlarda, lezyon üzerinde (lezyon örtümü) ya da içinde (lezyon infiltrasyonu) difüzyon bariyeri oluşturarak diş sert dokularının daha fazla demineralize olmasının engellenmesi amaçlanmaktadır. Bu yöntemler sıklıkla birlikte uygulanabilmektedir. Bu yöntemlerin birbirlerine üstünlüğünün, yapılan araştırmalardaki başarı ve başarısızlık nedenlerinin bilinmesi, kullanılan güncel materyallerin tartışılması; yaygın görülen başlangıç proksimal çürüklerin etkili biçimde tedavi edilmesini sağlayacaktır. Bu derlemenin amacı, süt ve daimi dişlerde başlangıç aşamasındaki proksimal lezyonların klinik yönetiminde uygulanabilecek farklı konservatif tedavi yöntemleri ile ilgili bilgi vermektir.
Anahtar Kelimeler: Konservatif tedavi, diş remineralizasyonu, diş çürükleri

Abstract
Dental caries is the most prevalent infectious disease and requires medical and operative treatment when cavitation occurs on dental hard tissues. Caries prevention is the ultimate goal of the caries management and early proximal lesions are very common in the community. Different treatment approaches can be applied for the restoration of the carious lesion. The purpose of conservative treatment approaches is to manage to stabilize the process and to minimize the loss of a tooth structure. The common opinion of the researchers is that early proximal caries lesions can be successfully treated with non-invasive or micro-invasive methods depending on the level of the lesion and patient’s caries activity. Non-invasive treatments involving the control of diet, biofilm and de-remineralisation; aim at 'managing' rather than removing caries lesions. Micro-invasive treatments have arisen as an alternative to non-invasive ones since the effectiveness of non-invasive treatments is dependent on patient cooperation. Micro-invasive approaches install a barrier either on top (sealing) or within (infiltrating) the lesion and thereby preventing the further loss of minerals from within the tooth is aimed. These two approaches could often be used together. Learning the superiority of these methods to each other and the reasons for success and failures in the studies, discussing the materials that are currently available will provide to manage the common initial proximal caries effectively. The aim of this review is to give information about different conservative treatment methods that can be applied for clinical management of early proximal lesions in primary and permanent teeth.
Keywords: Conservative treatment, dental caries, tooth remineralization

Anahtar Kelimeler

diş remineralizasyonu, diş çürükleri, Konservatif tedavi

Kaynakça

• 1. Kassebaum N, Smith A, Bernabé E, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380-387. [Crossref]
• 2. Brantley CF, Bader JD, Shugars DA, Nesbit SP. Does the cycle of rerestoration lead to larger restorations? J Am Dent Assoc. 1995;126(10):1407-1413. [Crossref]
• 3. Schwendicke F, Meyer-Lueckel H, Stolpe M, Dörfer CE, Paris S. Costs and effectiveness of treatment alternatives for proximal caries lesions. PloS One. 2014;9(1):86992. [Crossref]
• 4. Martignon S, Chavarría N, Ekstrand KR. Caries status and proximal lesion behaviour during a 6-year period in young adult Danes: an epidemiological investigation. Clinical Oral Investig. 2010;14(4):383-390. [Crossref]
• 5. Mejàre I, Stenlund H, Zelezny-Holmlund C. Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden. Caries Res. 2004;38(2):130-141. [Crossref]
• 6. Mejàre I, Källestål C, Stenlund H. Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: a prospective radiographic study. Caries Res. 1999;33(2):93-100. [Crossref]
• 7. Paris S, Hopfenmuller W, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy randomized trial. J Dent Res. 2010;89(8):823-826. [Crossref]
• 8. Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database Syst Rev. 2015;5(11):1-49. [Crossref]
• 9. Doméjean S, Muller-Bolla M, Featherstone JD. Caries preventive therapy. Clin Dent Rev. 2018;2(1):14. [Crossref]
• 10. Claydon NC. Current concepts in toothbrushing and interdental cleaning. Periodontol 2000. 2008;48(1):10-22. [Crossref]
• 11. Wesley MBSMP, Tasket R, Nelson B. Evaluation of the plaque removal efficacy of two commercially available dental floss devices. J Clin Dent. 2007;18(1):1-6.
• 12. Zimmer S, Kolbe C, Kaiser G, Krage T, Ommerborn M, Barthel C. Clinical efficacy of flossing versus use of antimicrobial rinses. J Periodontol. 2006;77(8):1380-1385. [Crossref]
• 13. Cortelli JR, Aquino DR, Cortelli SC, et al. Etiological analysis of initial colonization of periodontal pathogens in oral cavity. J Clin Microbiol. 2008;46(4):1322-1329. [Crossref]
• 14. Teles RP, Teles FRF. Antimicrobial agents used in the control of periodontal biofilms: effective adjuncts to mechanical plaque control? Braz Oral Res. 2009;23:39-48. [Crossref]
• 15. Poklepovic T, Worthington HV, Johnson TM, et al. Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database of Syst Rev. 2013;18(12):1-55. [Crossref]
• 16. Marsh P. In sickness and in health-what does the oral microbiome mean to us? An ecological perspective. Adv Dent Res. 2018;29(1):60-65. [Crossref]
• 17. Urquhart O, Tampi MP, Pilcher L, et al. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res. 2019;98(1):14-26. [Crossref]
• 18. Slayton RL, Urquhart O, Araujo MW, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837-849. [Crossref]
• 19. Petersson L, Magnusson K, Andersson H, Almquist B, Twetmana S. Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptible teenagers: A 3-year clinical study. Caries Res. 2000;34(2):140-143. [Crossref]
• 20. Haukali G, Poulsen S. Effect of a varnish containing chlorhexidine and thymol (Cervitec®) on approximal caries in 13-to 16-year-old schoolchildren in a low caries area. Caries Res. 2003;37(3):185-189. [Crossref]
• 21. Gisselsson H, Birkhed D, Björn A-L. Effect of professional flossing with chlorhexidine gel on approximal caries in 12-to 15-year-old schoolchildren. Caries Res. 1988;22(3):187-192. [Crossref]
• 22. Johansson E, Claesson R, Van Dijken J. Antibacterial effect of ozone on cariogenic bacterial species. J Dent. 2009;37(6):449-453. [Crossref]
• 23. Reddy S, Reddy N, Dinapadu S, Reddy M, Pasari S. Role of ozone therapy in minimal intervention dentistry and endodontics-A review. J Int Oral Health. 2013;5(3):102-108.
• 24. Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention. J Am Dent Assoc. 2013;144(11):1279-1291. [Crossref]
• 25. Nordström A, Birkhed D. Preventive effect of high-fluoride dentifrice (5,000 ppm) in caries-active adolescents: a 2-year clinical trial. Caries Res. 2010;44(3):323-331. [Crossref]
• 26. Trairatvorakul C, Techalertpaisarn P, Siwawut S, Ingprapankorn A. Effect of glass ionomer cement and fluoride varnish on the remineralization of artificial proximal caries in situ. J Clin Pediatr Dent. 2009;34(2):131-134. [Crossref]
• 27. Marinho VC, Chong LY, Worthington HV, Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2016;7(7):1-114. [Crossref]
• 28. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;11(7):1-80. [Crossref]
• 29. Sköld UM, Birkhed D, Borg E, Petersson LG. Approximal caries development in adolescents with low to moderate caries risk after different 3-year school-based supervised fluoride mouth rinsing programmes. Caries Res. 2005;39(6):529-535. [Crossref]
• 30. Twetman S, Keller MK. Fluoride rinses, gels and foams: an update of controlled clinical trials. Caries Res. 2016;50(Suppl. 1):38-44. [Crossref]
• 31. Marinho V, Higgins J, Logan S, Sheiham A. Systematic review of controlled trials on the effectiveness of fluoride gels for the prevention of dental caries in children. J Dent Educ. 2003;67(4):448-458. [Crossref]
• 32. Modeer T, Twetman S, Bergstrand F. Three-year study of the effect of fluoride varnish (Duraphat) on proximal caries progression in teenagers. Scand J Dent Res. 1984;92(5):400-407. [Crossref]
• 33. Rosenblatt A, Stamford T, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet”. J Dent Res. 2009;88(2):116-125. [Crossref]
• 34. Cai F, Manton D, Shen P, et al. Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ. Caries Res. 2007;41(5):377-383. [Crossref]
• 35. Morgan M, Adams G, Bailey D, Tsao C, Fischman S, Reynolds E. The anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes on approximal caries determined using digital bitewing radiography. Caries Res. 2008;42(3):171-184. [Crossref]
• 36. Twetman S. Consistent evidence to support the use of xylitol-and sorbitol-containing chewing gum to prevent dental caries. Evid Based Dent. 2009;10(1):10-11. [Crossref]
• 37. Splieth C, Kanzow, P, Wiegand A, et al. How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis. Clin Oral Investig. 2020;24(5):1623-1636. [Crossref]
• 38. Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent. 2018;77:8-17. [Crossref]
• 39. Abuchaim C, Rotta M, Grande RHM, Loguercio AD, Reis A. Effectiveness of sealing active proximal caries lesions with an adhesive system: 1-year clinical evaluation. Braz Oral Res. 2010;24(3):361-367. [Crossref]
• 40. Martignon S, Tellez M, Santamaría RM, Gomez J, Ekstrand KR. Sealing distal proximal caries lesions in first primary molars: efficacy after 2.5 years. Caries Res. 2010;44(6):562-570. [Crossref]
• 41. Martignon S, Ekstrand K, Gomez J, Lara J, Cortes A. Infiltrating/sealing proximal caries lesions: a 3-year randomized clinical trial. J Dent Res. 2012;91(3):288-292. [Crossref]
• 42. Tanaka M, Matsunaga K, Kadoma Y. Use of fluoride-containing sealant on proximal surfaces. J Med Dent Sci. 2000;47(1):49-53.
• 43. Martignon S, Ekstrand KR, Ellwood R. Efficacy of sealing proximal early active lesions: an 18-month clinical study evaluated by conventional and subtraction radiography. Caries Res. 2006;40(5):382-388. [Crossref]
• 44. Ammari MM, Soviero VM, da Silva Fidalgo TK, et al. Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis. J Dent. 2014;42(10):1217-1227. [Crossref]
• 45. Liang Y, Deng Z, Dai X, Tian J, Zhao W. Micro-invasive interventions for managing non-cavitated proximal caries of different depths: A systematic review and meta-analysis. Clin Oral Investig. 2018;22(8):2675-2684. [Crossref]
• 46. Dayila JM, Buonocore MG, Greeley CB, Provenza DV. Adhesive penetration in human artificial and natural white spots. J Dent Res. 1975;54(5):999-1008. [Crossref]
• 47. Gomez SS, Basili CP, Emilson CG. A 2-year clinical evaluation of sealed noncavitated approximal posterior carious lesions in adolescents. Clin Oral Investig. 2005;9(4):239-243. [Crossref]
• 48. Meyer-Lueckel H, Balbach A, Schikowsky C, Bitter K, Paris S. Pragmatic RCT on the efficacy of proximal caries infiltration. J Dent Res. 2016;95(5):531-536. [Crossref]
• 49. Trairatvorakul C, Itsaraviriyakul S, Wiboonchan W. Effect of glass-ionomer cement on the progression of proximal caries. J Dent Res. 2011;90(1):99-103. [Crossref]
• 50. Dunne S, Goolnik J, Millar B, Seddon R. Caries inhibition by a resin-modified and a conventional glass ionomer cement, in vitro. J Dent. 1996;24(1-2):91-94. [Crossref]
• 51. Tyas MJ. Cariostatic effect of glass ionomer cement: a five-year clinical study. Aust Dent J. 1991;36(3):236-239. [Crossref]
• 52. Hatibovic-Kofman S, Koch G, Ekstrand J. Glass ionomer materials as a rechargeable fluoride-release system. Int J Paediatr Dent. 1997;7(2):65-73. [Crossref]
• 53. Alkilzy M, Berndt C, Splieth CH. Sealing proximal surfaces with polyurethane tape: three-year evaluation. Clin Oral Investig. 2011;15(6):879-884. [Crossref]
• 54. Schmidlin PR, Zehnder M, Zimmermann MA, Zimmermann J, Roos M, Roulet JF. Sealing smooth enamel surfaces with a newly devised adhesive patch: a radiochemical in vitro analysis. Dent Mater. 2005;21(6):545-550. [Crossref]
• 55. Schmidlin PR, Klück I, Zimmermann J, Roulet JF, Seemann R. Caries-preventive potential of an adhesive patch after thermomechanical loading--a microbial-based in vitro study. J Adhes Dent. 2006;8(1):7-12.
• 56. Paris S, Meyer-Lueckel H. Inhibition of caries progression by resin infiltration in situ. Caries Res. 2010;44(1):47-54. [Crossref]
• 57. Kielbassa AM, Mueller J, Gernhardt CR. Closing the gap between oral hygiene and minimally invasive dentistry: a review on the resin infiltration technique of incipient (proximal) enamel lesions. Quintessence Int. 2009;40(8):663-681.
• 58. Meyer-Lueckel H, Chatzidakis A, Naumann M, Dörfer CE, Paris S. Influence of application time on penetration of an infiltrant into natural enamel caries. J Dent. 2011;39(7):465-469. [Crossref]
• 59. Paris S, Schwendicke F, Seddig S, Müller WD, Dörfer C, Meyer-Lueckel H. Micro-hardness and mineral loss of enamel lesions after infiltration with various resins: influence of infiltrant composition and application frequency in vitro. J Dent. 2013;41(6):543-548. [Crossref]
• 60. Meyer-Lueckel H, Paris S, Kielbassa A. Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration. Caries Res. 2007;41(3):223-230. [Crossref]
• 61. Peters MC, Hopkins Jr AR, Yu Q. Resin infiltration: An effective adjunct strategy for managing high caries risk-A within-person randomized controlled clinical trial. J Dent. 2018;79:24-30. [Crossref]
• 62. Meyer-Lueckel H, Bitter K, Paris S. Randomized controlled clinical trial on proximal caries infiltration: three-year follow-up. Caries Res. 2012;46(6):544-548. [Crossref]
• 63. Arthur RA, Zenkner JE, Júnior JCdOP, Correia RT, Alves LS, Maltz M. Proximal carious lesions infiltration-a 3-year follow-up study of a randomized controlled clinical trial. Clin Oral Investig. 2018;22(1):469-474. [Crossref]
• 64. Krois J, Goestemeyer G, Reda S, Schwendicke F. Sealing or infiltrating proximal carious lesions. J Dent. 2018;74:15-22. [Crossref]
• 65. Ekstrand K, Bakhshandeh A, Martignon S. Treatment of proximal superficial caries lesions on primary molar teeth with resin infiltration and fluoride varnish versus fluoride varnish only: efficacy after 1 year. Caries Res. 2010;44(1):41-46. [Crossref]
• 66. Rai P, Pandey R, Khanna R. Qualitative and quantitative effect of a protective chlorhexidine varnish layer over resin-infiltrated proximal carious lesions in primary teeth. Ped Dent. 2016;38(4):40-45.
• 67. Meyer-Lueckel H, Paris S, Mueller J, Cölfen H, Kielbassa AM. Influence of the application time on the penetration of different dental adhesives and a fissure sealant into artificial subsurface lesions in bovine enamel. Dent Mater. 2006;22(1):22-28. [Crossref]
• 68. Schmidlin P, Sener B, Attin T, Wiegand A. Protection of sound enamel and artificial enamel lesions against demineralisation: caries infiltrant versus adhesive. J Dent. 2012;40(10):851-856. [Crossref]
• 69. Mueller J, Yang F, Neumann K, Kielbassa AM. Surface tridimensional topography analysis of materials and finishing procedures after resinous infiltration of subsurface bovine enamel lesions. Quintessence Int. 2011;42(2):135-147.
• 70. Ulrich I, Mueller J, Wolgin M, Frank W, Kielbassa AM. Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions. Clin Oral Investig. 2015;19(6):1473-1483. [Crossref]
• 71. Pitts N. Temporary tooth separation with special reference to the diagnosis and preventive management of equivocal approximal carious lesions. Quintessence Int. 1987;18:563-573.
• 72. Hendrik Meyer-Lueckel SP. Caries Infiltration. In: Hendrik Meyer-Lueckel SP, Kim R. Ekstrand, eds. Caries management: Science and clinical practice. 1st ed. Stuttgart: Thieme; 2013. p.246-55. [Crossref]
• 73. Altarabulsi MB, Alkilzy M, Splieth CH. Clinical applicability of resin infiltration for proximal caries. Quintessence Int. 2013;44(2):97-104.
• 74. Ekiz E, Odabaş M. Evaluation of resin infiltration technique as a treatment option of initial caries lesions. Curr Res Dent Sci. 2015;25(Suppl):86-91. [Crossref]
• 75. Milgrom P, Horst JA, Ludwig S, et al. Topical silver diamine fluoride for dental caries arrest in preschool children: a randomized controlled trial and microbiological analysis of caries associated microbes and resistance gene expression. J Dent. 2018;68:72-78. [Crossref]
• 76. Youravong N, Carlen A, Teanpaisan R, Dahlén G. Metal-ion susceptibility of oral bacterial species. Lett Appl Microbiol. 2011;53(3):324-328. [Crossref]
• 77. Mei ML, Li Ql, Chu CH, Lo EM, Samaranayake LP. Antibacterial effects of silver diamine fluoride on multi-species cariogenic biofilm on caries. Ann Clin Microbiol Antimicrob. 2013;12(4):1-7. [Crossref]
• 78. Featherstone JD. The science and practice of caries prevention. J Am Dent Assoc. 2000;131(7):887-899. [Crossref]
• 79. Crystal YO, Niederman R. Silver diamine fluoride treatment considerations in children’s caries management. Pediatr Dent. 2016;38(7):466-471.
• 80. Zhao IS, Gao SS, Hiraishi N, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018;68(2):67-76. [Crossref]
• 81. dos Santos Jr VE, Vasconcelos Filho A, Targino AGR, et al. A new “Silver-Bullet” to treat caries in children-Nano Silver Fluoride: a randomised clinical trial. J Dent. 2014;42(8):945-951. [Crossref]
• 82. Targino AGR, Flores MAP, dos Santos Junior VE, et al. An innovative approach to treating dental decay in children. A new anti-caries agent. J Mater Sci Mater Med. 2014;25(8):2041-2047. [Crossref]
• 83. Akyildiz M, Sönmez I. Comparison of remineralising potential of nano silver fluoride, silver diamine fluoride and sodium fluoride varnish on artificial caries: An in vitro study. Oral Health Prev Dent. 2019;17(5):469-477.