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补牙的填充物掉了怎么办？｜證據鏈

km 編輯部2026-08-13阅读约 57 分钟
#證據鏈#牙醫KM#台灣#補牙

本頁是〈补牙的填充物掉了怎么办？〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

补牙的填充物掉了怎么办？｜證據鏈

F-Units（事实单元帐）

  • F1｜confidence: verified｜basis: internal_dataset｜period: 2025-03 至 2026-08 GSC｜geo: TW｜span: backlog #46「补牙掉了」（81,369）与「补牙的地方掉了」（7,567）2 词项合计曝光 88,936，单站｜caveat: 曝光为资产级数字、非去重流量；发布转档时本条整条不输出（内部数据不进可见层）
  • F2｜confidence: 结构性整理（编辑框架，非外部事实宣称）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 四路分流（正式充填物／疗程中暂时封填／间接修复体／牙冠与牙桥）、「掉下来是结果不是原因」的提问框架、当下五件事的清单编排、危险信号清单的排序、以及第七节判断面向的整理，皆为本站依 F3 至 F24 各来源整理的沟通用架构｜caveat: 非诊断工具、非分级判准、非决策流程图，不取代牙医检查
  • F3｜confidence: verified｜basis: peer_reviewed（PMID 26091581，系统评价与荟萃分析）｜period: 检索涵盖 1996 至 2015，2015 刊出；版本时效已查（2026-08-06 以 posterior composite survival/longevity/failure 并 meta-analysis[pt] 限 2018 年后检索，回传之近期系统评价与荟萃分析主题为银汞与树脂之失败风险比较、大块填充与分层堆叠之比较等，未见取代本篇「依失败原因排序」之更新版；修复体存留率之现行 canonical 在本站 KM-DENTAL-16 卡）｜geo: universal｜span: 「In this study only prospective, clinical trials with specification of the failure rate according to Class I/II composite fillings were included.」「A total of 88 studies were included for statistical analysis.」「Fracture of the restorations, secondary caries and marginal gap are the main causes for failure in the first 5 years (in descending order), while fracture and secondary caries are similarly distributed in long-term studies.」｜caveat: 人群层级之失败模式组成，非个别修复体之原因判定；纳入限第一类与第二类复合树脂充填之前瞻试验，不含第五类与嵌体；本卡未引用其年失败率数值，该面向 canonical 在 KM-DENTAL-16
  • F4｜confidence: verified｜basis: peer_reviewed（PMID 34481667，系统评价与荟萃分析）｜period: 2021 刊出；版本时效已查（2026-08-06 以 non-carious cervical 并 universal adhesive 限 systematic review/meta-analysis[pt]、2022 年后检索，回传笔数 0，本篇为现行可引用版本；同团队 2022 年另篇 PMID 35151466 为不同 PICO，本卡未引用）｜geo: universal｜span: 「After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis.」「At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups」「Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.」｜caveat: 人群限定为非龋性颈部病灶之复合树脂修复，不可外推至所有补牙；原文对各时间点之确定性评为中等或更低；本卡未引用其风险比数值，亦不作任何粘接程序之优劣建议或对任何一次治疗之评价
  • F5｜confidence: verified｜basis: peer_reviewed（PMID 39547467，系统评价与荟萃分析）｜period: 检索至 2024-05，2025 刊出｜geo: universal｜span: 「Studies were identified through searches in six databases (PubMed, Scopus, Cochrane, Embase, Scielo, Web of Science) up to May 2024.」「Of 1,565 articles identified, 10 met the inclusion criteria. These studies, conducted in five countries, included 411 participants with follow-up periods ranging from 1 to 8 years.」「Meta-analysis found no statistically significant differences between bioactive and conventional resin composites in preventing secondary caries or reducing retention loss (p > 0.05), the two primary outcomes considered in this review for assessing restoration longevity.」｜caveat: 「无统计显着差异」不等于「等效」；纳入试验仅十篇、材料品项有限，本卡不引用亦不评价其中任何商品名
  • F6｜confidence: verified｜basis: peer_reviewed（PMID 2639947，体外力学研究）｜period: 1989 刊出｜geo: universal｜span: 「This study was designed to compare the contributions of endodontic and restorative procedures to the loss of strength by using nondestructive occlusal loading on extracted intact, maxillary, second bicuspids.」「Results on 42 teeth indicate that endodontic procedures have only a small effect on the tooth, reducing the relative stiffness by 5%. This was less than that of an occlusal cavity preparation (20%). The largest losses in stiffness were related to the loss of marginal ridge integrity. MOD cavity preparation resulted in an average of a 63% loss in relative cuspal stiffness.」｜caveat: 体外实验、离体上颚第二小臼齿四十二颗、1989 年；测的是窝洞制备后的相对刚性，不是「充填物掉落后的牙齿」，不可换算为个别牙齿的断裂风险；本卡以此说明窝洞形态是变因，未作任何断裂概率陈述
  • F7｜confidence: verified｜basis: peer_reviewed（PMID 37345582，文献回顾）｜period: 检索 1947 至 2023-03-28，2023 刊出｜geo: universal｜span: 「A search was conducted in PubMed from 1947 to March 28, 2023.」「A total of 72 articles were included in the review, which revealed the variety and complexity of aetiological factors and treatment of food impaction in dentistry, as well as the heterogeneity of previous studies.」「Considering the causal factors of food impaction - including proximal contact loss, occlusal disharmony, morphological deformity, positional abnormality, and interdental papillae loss - different management approaches such as restoration, occlusal adjustment, orthodontic, nonsurgical or surgical treatment could be applied.」｜caveat: 叙述性回顾、非系统性回顾；成因清单为文献整理而非因果证明；本卡未引用其任何处置方法作为建议
  • F8｜confidence: verified｜basis: peer_reviewed（PMID 34956432，文献回顾）｜period: 2021 刊出｜geo: universal｜span: 「Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth.」「While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome.」｜caveat: 叙述性回顾、无统合数据；本卡仅引其「牙裂为独立临床问题且病因讨论含修复处置面」之定位，未引用任何比例，亦不提供辨识牙裂的自我判断方法
  • F9｜confidence: verified｜basis: peer_reviewed（PMID 21689541，系统评价与荟萃分析）｜period: 2011 刊出；版本时效已查（2026-08-06 以 coronal restoration 并 root canal treatment/root filling 与 outcome/success/apical periodontitis、限 systematic review/meta-analysis[pt] 检索，回传 7 笔，主题较接近之新近者为 PMID 41651276 之孔口封填屏障系统性回顾与 PMID 40851324 之修复体类型系统性回顾，两者 PICO 皆不同；未见本篇之更新版）｜geo: universal｜span: 「Nine articles were identified and were reviewed by 3 investigators.」「After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE versus AR/IE (OR = 2.734; 95% confidence interval [CI], 2.61-2.88; P < .001) and AR/AE versus IR/AE (OR = 2.808; 95% CI, 2.64-2.97; P < .001).」「On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these 2 combinations.」｜caveat: 原文比较的是「修复体质量适当 vs 不适当」，不是「有修复体 vs 完全没有修复体」，更不是「充填物掉落若干天」；本卡已于正文明写此界线；纳入研究为观察性设计，胜算比为人群层级估计
  • F10｜confidence: verified｜basis: peer_reviewed（PMID 24392750，十年追踪观察性世代研究）｜period: 1997／2003／2008 三次检查，2014 刊出｜geo: universal（丹麦一般成人人群）｜span: 「The study provides longitudinal, observational information on endodontic status for 327 randomly selected individuals from a general Danish population receiving three consecutive full-mouth radiographic examinations.」「Overall 13% of the root filled teeth had been extracted, 12% had received a revision of the root filling and 42% of root filled teeth present in 2008 had apical periodontitis (AP) after the 10-year follow-up period.」「The probability of persistent AP was higher if the root filling was either short or long (P = 0.001), if there were voids (P < 0.001), or if there were radiographic signs of overhang or open margin of the restoration (P = 0.01). Further, the probability of extraction was high if there were radiographic signs of overhang or open margin of the restoration (P = 0.008)」｜caveat: 观察性研究，显示相关而非因果；人群限定为根管治疗过的牙齿、单一国家；影像上的「悬突或边缘开放」与「充填物整个掉了」不是同一件事，本卡未将两者等同
  • F11｜confidence: verified｜basis: peer_reviewed（PMID 29201596，流行病学综述）｜period: 2017 刊出｜geo: universal｜span: 「Twenty-nine articles reporting data on the prevalence of primary or posttreatment apical periodontitis from all over the world were included.」「The quality of the coronal restoration and the root filling appears to be the major predictors of apical periodontitis.」｜caveat: 叙述性综述、非系统评价与荟萃分析；「预测因子」为相关性描述，非因果；本卡未引用其盛行率区间
  • F12｜confidence: verified｜basis: peer_reviewed（PMID 36375647，长期回溯临床研究）｜period: 单一术者十五年间治疗，追踪 1 至 35 年以上，2023 刊出｜geo: universal｜span: 「Treatments were conducted over a period of 15 years by a single operator.」「In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods.」「The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001).」｜caveat: 人群限定为因深龋导致牙髓暴露、临床诊断为可逆性牙髓炎而接受直接盖髓的成熟恒牙，且为单一术者之回溯数据，不可外推至所有补牙；本卡未引用其成功率数值
  • F13｜confidence: verified｜basis: peer_reviewed（PMID 33378579，系统评价与荟萃分析；同锚＝本站 KM-DENTAL-15 卡 F17）｜period: 检索至 2019-09，2021 刊出｜geo: universal｜span: 「Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease」「The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth.」「The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%)」｜caveat: 作者明载临床异质性高（I² 逾 97%）与偏差风险高，结果须谨慎解读；根尖牙周炎之成因不限于掉落的充填物，本卡未作归因
  • F14｜confidence: verified｜basis: peer_reviewed（PMID 28174365，体外微渗漏研究）｜period: 2017 刊出｜geo: universal｜span: 「Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid.」「Permanent restorations should be given as soon as possible after the completion of root canal therapy.」「All the temporary restorative materials were not able to prevent microleakage after 1 week's time」｜caveat: 体外实验；且「永久性修复体应尽早施作」一句出自该文导言，属作者之背景陈述而非其实验结果，本卡已于正文标明；本卡未引用其各材料间的优劣比较，亦不作任何材料推荐
  • F15｜confidence: verified｜basis: peer_reviewed（PMID 34777500，问卷调查研究）｜period: 2021 刊出｜geo: universal（沙乌地阿拉伯）｜span: 「An online questionnaire was distributed among general dentists, dental specialists, and clinical trainees in undergraduate and postgraduate dental programs.」「The total number of participants who met the inclusion criteria was 525.」「Temporary restoration breakdown or complete loss was a common observation.」「Although the duration between the two RCT visits was 2 weeks or less for 83.6% of participants, only 19.6% of participants claimed that they rarely observed temporization breakdown.」｜caveat: 牙医自陈临床观察之问卷、单一国家，不能作为病人层级的发生率；本卡未引用其各材料使用比例作为任何建议
  • F16｜confidence: verified｜basis: peer_reviewed（PMID 14719578，个案报告；同锚＝本站 KM-DENTAL-38 卡 F12）｜period: 2003 刊出｜geo: universal｜span: 「This article describes how a man attempted to repair damage to his maxillary teeth with super glue. Such action is discouraged, however, because of possible adverse reactions in the hard and soft tissues.」｜caveat: 单一个案报告、证据等级低，该摘要未载明具体不良反应之型态与严重度；本卡引用其结论句之立场（不建议），未推论任何损伤发生率
  • F17｜confidence: verified｜basis: peer_reviewed（PMID 20689240，单一机构回溯调查；同锚＝本站 KM-DENTAL-38 卡 F5）｜period: 2008 会计年度数据，2010 刊出｜geo: universal（日本单一牙科医院）｜span: 「Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested」｜caveat: 单一机构、单一年度之院内事故调查，不可外推为一般发生率；情境为诊间内由专业人员拆除修复体时，与病人在家中口内留有松动碎片不是同一个场景，本卡未以本条把居家碎片说成误吞的典型情境（2026-08-06 CX 对抗审指出原稿此处归属过度，已改写）；误吞误吸之完整分流 canonical 在 KM-DENTAL-38
  • F18｜confidence: verified｜basis: peer_reviewed（PMID 31145805，Cochrane 系统性回顾 pub5；同锚＝本站 KM-DENTAL-15 卡 F19）｜period: 检索至 2019-02-18，2019 刊出｜geo: universal｜span: 「Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care」「there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics」｜caveat: 仅一项小样本试验、证据确定性低；该回顾检定的对象只有抗生素，本卡不得把它扩大读成「所有药物都没有证据」；本条不构成任何用药或停药指示
  • F19｜confidence: verified｜basis: textbook（PMID 30020634，StatPearls 深颈部感染条目；同锚＝本站 KM-DENTAL-15 卡 F21 与 KM-DENTAL-33 卡）｜period: 现行版｜geo: universal｜span: 「Symptoms often result from local pressure effects on the respiratory, nervous, or gastrointestinal tracts, including neck swelling, dysphagia, dysphonia, and trismus」「often involving fever, neck pain, and respiratory distress」｜caveat: 教科书层级（basis 阶梯之下层），非系统性回顾；深颈部感染之来源不限牙源性；本卡仅引其症状清单作为危险信号依据，未引任何发生率或预后数字
  • F20｜confidence: verified｜basis: peer_reviewed（PMID 38777729，叙述性综述；同锚＝本站 KM-DENTAL-15 卡 F22）｜period: 2024 刊出｜geo: universal｜span: 「Left untreated, odontogenic infections can spread to deep spaces of the head and neck and can result in life-threatening complications. The mainstay of treatment includes timely treatment of the affected teeth」｜caveat: 该综述以儿童人群为主题，本卡引其为机转层级之一般陈述，未引任何发生率；叙述性综述非系统性回顾
  • F21｜confidence: verified｜basis: peer_reviewed（PMID 40851324，系统评价与荟萃分析）｜period: 2025 刊出（PROSPERO CRD42024594890）｜geo: universal｜span: 「A total of 2063 articles were screened; eventually, 11 studies were included (Ten cohort studies and one RCT).」「Overall, RFT restored with indirect coronal restorations survived significantly better compared to directly restored RFT (p = 0.01), whereas no statistical difference in periapical healing was demonstrated (p = 0.72).」「Indirect restorations appear to be associated with improved survival in RFT, but this finding should be interpreted cautiously.」｜caveat: 纳入十一项研究中仅一项为随机对照试验、其余为世代研究；作者自载此发现应谨慎解读，本卡照录该限制；人群限定为根管治疗后牙齿，不可读为「充填物掉了就该做间接修复」
  • F22｜confidence: verified（2026-08-06 以 ego-browser 实载医疗器材分类分级查询数据库，简易查询输入关键字「暂时性充填」送出，回传一笔、分类类别栏显示 F-牙科学，逐栏读取代码、中英文名称、鉴别范围与等级；同锚＝本站 KM-DENTAL-38 卡 F24，本卡以不同关键字独立复验命中同一品项）｜basis: official_statement（卫生福利部食品药物管理署委托建置之医疗器材分类分级查询数据库）｜period: 2026-08-06 查询现况｜geo: TW｜span: 代码 F.3275「牙科用水泥(士敏汀)」（Dental cement），鉴别范围逐字：「牙科用水泥(士敏汀)用于作为牙齿的暂时性充填；或作为粘附暂时性牙科补缀物及牙冠或牙桥等牙科器材的基底层；或涂于牙齿上用来保护牙髓。此器材一般是由氧化锌－丁香酚(zinc oxide-eugenol)组成。(1)第一等级: 主要作用成分为氧化锌－丁香酚；(2)第二等级: 主要作用成分非为氧化锌－丁香酚。」等级栏「1,2」，特定的管理规定栏「简化审查(符合性声明书), 制造厂精要模式」｜caveat: 该数据库页面自载「本網站為衛生福利部食品藥物管理署委託建置維護，內容僅供參考，如有差異以衛生福利部食品藥物管理署公告為準」；分类品项之鉴别范围是器材的用途描述，不是临床适应症判定，亦非个别商品之合法性判定，本卡不作法规适用判断
  • F23｜confidence: verified（2026-08-06 以 curl 取回全国法规数据库该条页面，HTTP 200，抽取条文区块逐字比对；同锚＝本站 KM-DENTAL-38 卡 F27）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗器材管理法》第 25 条第 1 项「制造、输入医疗器材，应向中央主管机关申请查验登记，经核准发给医疗器材许可证后，始得为之。但经中央主管机关公告之品项，其制造、输入应以登录方式为之。」｜caveat: 条文引述，非法律意见；个别产品之管理方式以主管机关公告为准
  • F24｜confidence: verified（2026-08-06 自政府数据开放平台该数据集所列之健保署介接端点以 curl 取回 CSV，HTTP 200、1,692,784 bytes、6,098 行含表头，表头逐字为「诊疗项目代码,健保支付点数,生效起日,生效迄日,英文项目名称,中文项目名称,备注」，以 Python csv 逐列解析、命中含「充填」之中文项目名称四十三笔并逐笔读取备注栏；同锚＝本站 KM-DENTAL-36 卡 F26，本卡独立重跑）｜basis: official_statement（卫生福利部中央健康保险署「医疗服务给付项目及支付标准」开放数据）｜period: 2026-08-06 取回之现行清单｜geo: TW｜span: 诊疗项目代码 89008C「后牙复合树脂充填-单面」之备注栏逐字：「1.同颗牙申报复合树脂充填，乳牙一年、恒牙一年半内，不论任何原因，所做任何形式（窝洞及材质）之再充填，皆不得再申报充填(89001C～89005C，89008C～89012C，89014C～89015C，89204C~89205C，89208C~89210C，89212C，89214C~89215C）费用，以同一院所为限。2.应于病历详列充填牙面部位。3.申报面数最高以三面为限。」｜caveat: 本卡不引用任何支付点数；该备注规范的是保险医事服务机构的申报规则，不等于病人端的付费结论，也不是个案给付判定；同类项目各自成文、条件并不完全相同（例如 89013C「复合体充填」之备注为限恒牙牙根龋齿申报、每颗牙一年半内不得重复申报）；清单每日更新，引用时请注明查证日期；费用组成 canonical 在 KM-DENTAL-36
  • F25｜confidence: verified（2026-08-06 以 curl 取回全国法规数据库该条页面，HTTP 200，抽取条文区块逐字比对；同锚＝本站多卡）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗法》第 81 条「醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。」｜caveat: 条文引述，非法律意见
  • F26｜confidence: verified（2026-08-06 以 curl 取回全国法规数据库该条页面，HTTP 200，抽取条文区块逐字比对；同锚＝本站多卡）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗法》第 87 条「广告内容暗示或影射医疗业务者，视为医疗广告。医学新知或研究报告之发表、病人卫生教育、学术性刊物，未涉及招徕医疗业务者，不视为医疗广告。」｜caveat: 条文引述，非法律意见；本卡之健康教育定位依此条
  • F27｜confidence: verified（2026-08-05 由 OP 以 ego-browser 亲验，下拉选单类别逐项读取；本卡未重复实测，沿用 km-compliance/VERIFIED-FACTS.md 之跨卡已验事实）｜basis: official_statement｜period: 2026-08-05 查证现况｜geo: TW｜span: 卫生福利部中央健康保险署「醫材比價網」之两个查询轨（自付差额医材比价、医材收费比价）品项分类皆不含牙科，页面全文无「牙」字｜caveat: 本卡未重复实测；官方数据库可能更新，引用时请注明查证日期。牙科自费费用之查证管道为各县市卫生局核定之牙科收费标准与院所书面报价
  • F28｜confidence: n/a｜basis: 证据缺口声明（editorial，非待验）｜period: 2026-08-06｜geo: universal｜span: 本次检索未取得可引用证据、故本卡不写的项目：①任何金额、区间或行情 ②「补牙掉了几天内必须复诊」之时效数字（以 emergency dental 并 lost restoration/lost filling 检索 PubMed，回传笔数 0）③充填物掉落后放置若干天之后果研究 ④重新充填后之存留率或使用年限 ⑤「自行充填」与「不充填」之头对头比较研究 ⑥充填物脱落在台湾的发生率统计 ⑦「自行充填会把龋齿封起来继续恶化」之直接证据｜caveat: 本条为证据缺口之诚实揭露，非待验 claim；检索局限于 PubMed 与上列检索式，未取得不等于已被推翻；日后若取得可引用来源，须完成三件齐查证后才可补写
  • F29｜confidence: 结构性整理（编辑框架，非外部事实宣称）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 同族卡分工声明——KM-DENTAL-02 负责补牙后的进食与清洁时机；KM-DENTAL-16 负责修复体存留率、年失败率、材质选择与「修补 vs 重做」的证据比较；KM-DENTAL-12 负责「要不要补、怎么补」的决策；KM-DENTAL-36 负责费用组成与报价读法；KM-DENTAL-38 负责假牙、牙冠与牙桥脱落及误吞误吸的完整分流；KM-DENTAL-15 与 KM-DENTAL-33 负责龋齿拖延与牙痛的完整危险信号分级。本卡（KM-DENTAL-46）只处理「充填物已脱落之后的处置、成因型态、后果关联与复诊判断面向」，重叠处只引用结论、不重写｜caveat: 编辑性分工声明，非医学宣称，不得标为待验
  • F30｜confidence: verified｜basis: textbook（PMID 29493976，StatPearls "Ludwig Angina" 条目；PubMed pubtype 为 Study Guide，非同侪审查研究。本卡不代为中译病名，避免以记忆写专有名词——事故簿第 1 条）｜period: 现行版（条目最后更新 2025-06-22）｜geo: universal｜span: 「Ludwig angina is a rare, life-threatening condition characterized by diffuse cellulitis that involves the soft tissues of the floor of the mouth and neck.」「True Ludwig angina originates from an infection of a lower molar tooth.」「Early recognition and treatment are critical, including emergent airway management, intravenous antibiotic therapy, and surgical drainage if an abscess is present.」｜caveat: 教科书层级（basis 阶梯之下层），非系统性回顾；本条在本卡的用途只有一个——为危险信号清单中的「口底肿胀」提供可核对的来源；原文未提供任何发生率，本卡亦不作概率陈述；口底肿胀的来源不限于牙源性，鉴别须由医疗端为之
  • F31｜confidence: verified｜basis: peer_reviewed（PMID 40533920，系统评价与荟萃分析；PubMed pubtype 标示 Systematic Review／Meta-Analysis）｜period: 检索至 2024-06，2025-05 刊出｜geo: universal｜span: 「Teeth exhibiting symptomatic irreversible pulpitis (SIP) were defined as exhibiting spontaneous unprovoked pain, lingering thermal pain, or referred pain, and may have periapical pathosis/involvement or not.」｜caveat: 本卡只引用该文对「症状性不可逆性牙髓炎」的操作型定义句，未引用其任何成功率数值、材料比较或治疗方式建议；该回顾的主题为恒牙活髓治疗、刊于儿童牙科期刊，其定义句为诊断分类之界定，不是病人可自我对照的诊断清单；牙痛的来源不只牙髓一种
  • F32｜confidence: verified｜basis: peer_reviewed（PMID 29735507，个案报告）｜period: 2018 刊出｜geo: universal｜span: 「A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes.」「The patient had a National Early Warning Score of 0 and so was triaged into the 'minors' section of ED.」「Following assessment by the on-call oral and maxillofacial surgeon, an urgent contrast-enhanced CT demonstrated a large parapharyngeal collection, which required urgent anaesthetic and surgical intervention.」｜caveat: 单一个案报告、证据等级低，不能用于估计发生率或个人风险；该病人另有第二型糖尿病病史，本卡未将其结果归因于单一因素；本卡引用它的用途限于两点——颜面肿胀与张口受限、吞咽困难、声音改变同时出现的这一组症状被记录过，以及早期预警评分正常仍需紧急处置，未推论任何比例

来源清单

取用日期均为 2026-08-06。PubMed 条目以 E-utilities efetch（rettype=abstract）取得摘要原文逐字对照，并以 esummary 之 pubtype 逐笔检查撤回状态（22 笔全数无 Retracted Publication 标记、无 WITHDRAWN 标题）；医疗器材分类分级查询数据库以 ego-browser 实载并执行关键字查询、逐栏读取；法规条文以 curl 取回全国法规数据库页面（HTTP 200）后抽取条文区块逐字比对；健保给付项目清单以 curl 自数据集所列端点取回 CSV（HTTP 200、1,692,784 bytes）后以 Python csv 逐列解析比对 [F24]。

  1. Beck F, et al. Survival of direct resin restorations in posterior teeth within a 19-year period (1996-2015): A meta-analysis of prospective studies. Dent Mater. 2015;31(8):958-85. PMID 26091581
  2. Josic U, et al. Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis. Dent Mater. 2021;37(11):e503-e521. PMID 34481667
  3. de Carvalho LF, et al. Effectiveness of bioactive resin materials in preventing secondary caries and retention loss in direct posterior restorations: A systematic review and meta-analysis. J Dent. 2025;152:105460. PMID 39547467
  4. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15(11):512-6. PMID 2639947
  5. Truong VM, Kim S, Yi YJ, Park YS. Food Impaction in Dentistry: Revisited. Oral Health Prev Dent. 2023;21:229-242. PMID 37345582
  6. Li F, et al. Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention. Pain Res Manag. 2021;2021:3788660. PMID 34956432
  7. Gillen BM, et al. Impact of the quality of coronal restoration versus the quality of root canal fillings on success of root canal treatment: a systematic review and meta-analysis. J Endod. 2011;37(7):895-902. PMID 21689541
  8. Kirkevang LL, Vaeth M, Wenzel A. Ten-year follow-up of root filled teeth: a radiographic study of a Danish population. Int Endod J. 2014;47(10):980-8. PMID 24392750
  9. Persoon IF, Ozok AR. Definitions and Epidemiology of Endodontic Infections. Curr Oral Health Rep. 2017;4(4):278-285. PMID 29201596
  10. Ricucci D, et al. Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study. J Endod. 2023;49(1):45-54. PMID 36375647
  11. Tiburcio-Machado CS, et al. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J. 2021;54(5):712-735. PMID 33378579
  12. Srivastava PK, et al. Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study. J Contemp Dent Pract. 2017;18(2):126-130. PMID 28174365
  13. Algahtani FN, et al. Common Temporization Techniques Practiced in Saudi Arabia and Stability of Temporary Restoration. Int J Dent. 2021;2021:4965500. PMID 34777500
  14. Winkler S, Wood R, Facchiano AM, Bergloff JF. Esthetics and super glue: a case report. J Oral Implantol. 2003;29(6):286-288. PMID 14719578
  15. Hisanaga R, et al. Survey of accidental ingestion and aspiration at Tokyo Dental College Chiba Hospital. Bull Tokyo Dent Coll. 2010;51(2):95-101. PMID 20689240
  16. Agnihotry A, et al. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev. 2019;5(5):CD004969. PMID 31145805
  17. Almuhaiza M, et al. Deep Neck Infections. StatPearls. PMID 30020634
  18. Cachovan G, et al. Odontogenic Infections in Children. Review. 2024. PMID 38777729
  19. Kaaber W, Ranjkesh B, Kirkevang LL. Effect of Type of Coronal Restoration on Periapical Healing and Tooth Survival of Root Filled Teeth: Systematic Review and Meta-Analysis. Aust Endod J. 2025;51(3):849-860. PMID 40851324
  20. AL Ghabra Y, Brizuela M, Winters R, Singhal M. Ludwig Angina. StatPearls. 2025 Jun 22. PMID 29493976
  21. Coll JA, et al. Vital Pulp Therapy in Permanent Teeth: A Systematic Review and Meta-Analyses. Pediatr Dent. 2025;47(3):137-150. PMID 40533920
  22. Wates E, Higginson J, Kichenaradjou A, McVeigh K. A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score. BMJ Case Rep. 2018;2018:bcr2018224634. PMID 29735507
  23. 医疗器材分类分级查询数据库（卫生福利部食品药物管理署委托建置维护）
  24. 医疗器材管理法 第 25 条（全国法规数据库）
  25. 医疗法 第 81 条（全国法规数据库）
  26. 医疗法 第 87 条（全国法规数据库）
  27. 政府数据开放平台 数据集「医疗服务给付项目及支付标准(csv档)」（提供机关：卫生福利部中央健康保险署）
  28. 跨卡已验事实：`km-compliance/VERIFIED-FACTS.md`（健保署醫材比價網不含牙科，2026-08-05 OP 亲验）
  29. 内部数据：`analysis/reports/km-dental-backlog.md` #46 附录（词×站×曝光逐笔可对帐）
  30. 编辑框架与证据缺口：本站四路分流、当下处置清单编排、危险信号排序与不写清单（无外部来源，标示为结构性整理）

内部引用链

  • 充填后多久可以吃东西、多久可以刷牙：补牙后多久可以吃东西、多久可以刷牙？（KM-DENTAL-02）——分工声明：术后进食与清洁的时机、术后敏感的判读属该卡的 canonical 范围，本卡只在「掉落后仍要继续清洁」这一点上引用，不重写。
  • 补牙能撑几年、材质怎么选、修补还是重做：复合树脂充填可以撑几年？材质怎么选？（KM-DENTAL-16）——分工声明：修复体存留率、年失败率、材料比较、以及「修补 vs 整个置换」的证据比较属该卡的 canonical 范围，本卡不重写、亦不转载其存留率数值。
  • 要不要补、补牙那一次在做什么：龋齿了一定要补吗？补牙怎么补？（KM-DENTAL-12）——分工声明：修复适应症与去龋策略属该卡的 canonical 范围，本卡不重写。
  • 费用怎么组成、报价怎么读：补牙要多少钱？补牙缝、补缺角各多少？（KM-DENTAL-36）
  • 假牙、牙冠、牙桥掉了（含误吞误吸的完整分流）：假牙／牙套掉了，可以自己黏回去吗？（KM-DENTAL-38）——分工声明：修复体脱落后的粘接问题、误吞误吸的危险信号与影像判读属该卡的 canonical 范围，本卡处理的是直接充填物。
  • 拖延的后果与危险信号分级：龋齿可以拖多久？会自己好吗？（KM-DENTAL-15）
  • 牙痛怎么分辨、什么时候该立刻就医：牙齿痛怎么办？龋齿痛是什么感觉？（KM-DENTAL-33）
发布闸门提醒：本卡为 draft。四语（zh-Hans／en／ja）未产前不得进 km_entries；F27 为沿用之跨卡已验事实（本卡未重复实测），发布前若制度页面有更新须重验；F24 之健保清单每日更新，发布前须重跑取回并确认备注未变。

FAQ

什么情况要立即就医、不能等？
口底或脸部肿胀、发烧、颈部肿胀、颈部疼痛、吞咽困难、声音改变、张口困难或呼吸窘迫时，不要等牙科门诊排程，请立即寻求医疗协助 [F19][F30][F32]。若碎片找不到，而且开始咳嗽或呼吸不顺，这也是急症；呛咳、讲不出话或胸痛亦同。请立即就医，不要等到复诊日 [F2][F29]。
どのような場合に直ちに受診し、待ってはいけませんか？ — 口腔底又は顔面の腫れ、発熱、頸部腫脹、頸部痛、嚥下困難、声の変化、開口困難又は呼吸窮迫がある場合は、歯科外来の予約を待たず、直ちに医療の助けを求めてください [F19][F30][F32]。破片が見つからず、せき又は息苦しさが始まった場合も救急です。むせ、話せない、胸痛でも同じく、直ちに受診し、予約日を待たないでください [F2][F29]。
When should I seek immediate medical care rather than wait? — For swelling of the floor of the mouth or face, fever, neck swelling, neck pain, difficulty swallowing, voice change, difficulty opening the mouth, or respiratory distress, do not wait for a dental appointment; seek medical help immediately [F19][F30][F32]. If the fragment cannot be found and you begin coughing or having trouble breathing, this is also an emergency; the same applies to choking or coughing, inability to speak, or chest pain. Seek medical care immediately; do not wait for the appointment date [F2][F29].
补牙掉了，可以先用市售的暂时充填材料自己补起来吗？
**不建议，请把它当成「复诊之前的问题」而不是「自己解决的问题」。** 在台湾制度上，用于作为牙齿暂时性充填的材料属医疗器材分类分级数据库代码 F.3275「牙科用水泥(士敏汀)」的鉴别范围 [F22]，而依《医疗器材管理法》第 25 条，医疗器材之制造、输入应经查验登记或依公告以登录方式为之 [F23]。**本卡不判定任何个别产品的合法性，也不推荐任何商品** [F26]。更根本的理由是：即使是牙科场合使用的暂时性修复材料，一项体外研究记录所有受测材料在一周之后都无法阻止微渗漏 [F14]；把洞盖起来并不能处理掉落的原因，而原因需要检查才分得开 [F3][F8][F2]。
詰め物が取れた時、市販の暫時充填材料を自分で使ってよい？ — **勧めません。「自分で解決する問題」ではなく、「受診前に持ち込む問題」と考えてください。** 台湾制度上、歯の暫時的充填に用いる材料は、医療機器分類・等級データベースの F.3275「牙科用水泥(士敏汀)」（Dental cement）の識別範囲に入ります [F22]。台湾医療機器管理法第 25 条は、医療機器の製造・輸入には査験登録又は公告に基づく登録を求めます [F23]。**本カードは個別製品の適法性を判定せず、いかなる商品も推奨しません** [F26]。さらに根本的には、歯科で使う暫間修復材料でも、in vitro 研究で全材料が一週間後の微小漏洩を防げませんでした [F14]。穴を覆っても脱落の原因は処理できず、その原因は診察でなければ分かりません [F3][F8][F2]。
My filling fell out. Can I use a store-bought temporary filling material myself first? — **It is not advised. Treat it as a matter for before the dental review, not a problem to solve by yourself.** In Taiwan's system, material for temporary tooth filling is within the identifying scope of code F.3275 “Dental cement” in the medical-device classification and grading database [F22]. Article 25 of Taiwan's Medical Devices Management Act requires medical-device manufacture and import to undergo inspection and registration or registration under an announced route [F23]. **This card does not determine the legality of any individual product and recommends no product** [F26]. More fundamentally, even temporary restorative materials used in dental settings all failed to prevent microleakage after one week in one in-vitro study [F14]. Covering the hole does not address why it came out, and that cause needs examination to be distinguished [F3][F8][F2].
那三秒胶（强力胶）呢？我只是先黏一下。
**文献里的纪录是不建议。** 一篇个案报告描述一位男性以强力胶自行修补上颚牙齿的损坏，该文结论句写明不建议这样做，因为可能对硬组织与软组织造成不良反应 [F16]。**这是单一个案报告、证据等级低，摘要未载明不良反应的型态与严重度**；本卡引用它的立场，不推论任何损伤发生率 [F16][F28]。如果你已经黏过了，复诊时请主动说明用了什么、黏了几次 [F2]。
瞬間接着剤（強力接着剤）は？ ひとまず少し接着したいだけです。 — **文献で記録された結論は、勧めない、です。** 症例報告は、男性が上顎歯の損傷を強力接着剤で自ら修理しようとしたことを記録し、硬組織と軟組織に有害反応を起こす可能性があるため勧めないと結論しました [F16]。**単一症例で根拠水準は低く、抄録は有害反応の種類と重症度を示していません。** 本カードはその立場を引用するだけで、障害の発生率を推定しません [F16][F28]。すでに使った場合は、受診時に何を何回使ったかを自ら伝えてください [F2]。
What about superglue? I only want to stick it for now. — **The recorded literature position is that it is discouraged.** A case report describes a man attempting to repair maxillary-tooth damage himself with superglue and concludes that this is discouraged because it may cause adverse reactions in hard and soft tissues [F16]. **It is one low-level case report and the abstract does not state the type or severity of adverse reactions.** This card follows its position but does not infer any rate of injury [F16][F28]. If you have already used it, tell the dentist what you used and how many times when you attend [F2].

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km 編輯部・《补牙的填充物掉了怎么办？｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/post/reports/dental-filling-fell-out-evidence

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更新 2026-08-13T14:17:17.984Z · server-rendered · four-language · IDAEO 知識庫