蛀牙了一定要補嗎？補牙怎麼補？｜證據鏈

蛀牙了一定要補嗎？補牙怎麼補？｜證據鏈

F-Units（事實單元帳）

• F1｜本題選題依據＝14 診所站 GSC 全量對帳，「蛀牙」「補牙」「蛀牙補牙」「補蛀牙」「補牙過程」「輕微蛀牙需要補嗎」6 詞項合計曝光 235,930、2 站｜來源 #19｜confidence=high｜basis=internal_dataset｜period=GSC 保留窗（2025-03-22 起）｜geo: TW｜caveat：曝光為屬性級數字、非去重流量；本欄為內部數據，非醫學宣稱，發布轉檔時整條剝除。
• F2［結構性整理］｜「未成窩洞／已成窩洞／已近牙髓」三段分期框架、「疾病層級 vs 牙齒層級」對照、補牙六步流程骨架，以及「網路兩種極端說法各自對應不同階段」之歸納，均為本站依 F3 至 F20 文獻整理的溝通用結構｜來源 #21｜confidence=n/a｜basis=editorial_framework｜period=2026-08-05｜geo: universal｜caveat：非診斷工具、非臨床指引，不得標為待驗；本欄不含任何療效或時程宣稱。
• F3｜國際齲齒共識合作組織術語共識：齲齒為疾病之名、齲齒病灶為疾病之後果與表現；「齲齒管理」限於病人層級以預防與非侵入手段控制疾病，「齲齒病灶管理」則於牙齒層級控制症狀；去齲術式定義為選擇性去除（至軟化／至硬實牙本質）、分次去除、非選擇性去除至硬牙本質（即過去之完全去齲，標註已不再被建議）｜來源 #1｜confidence=verified｜basis=clinical_guideline（PMID 27099357，國際共識聲明）｜period=2016｜geo: universal｜span:「Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease」「Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended)」｜caveat：PubMed 摘要呈現有詞間空白遺失（如 Dental cariesis），此處逐字照錄未代為補空白；共識文件非隨機試驗，屬專家共識層級。
• F4｜國際齲齒共識合作組織去齲臨床建議：應盡可能避免進入修復循環；只有當已形成窩洞的病灶無法清潔或無法再被封填時，修復性介入才有指徵；去除齲齒組織純粹是為了創造長期耐用修復物的條件，靠近牙髓之受細菌污染或去礦化組織不需移除；淺／中深窩洞病灶依選擇性去除至硬實牙本質，深層窩洞病灶（乳牙與恆牙）依選擇性去除至軟化牙本質，恆牙另有分次去除選項｜來源 #2｜confidence=verified｜basis=clinical_guideline（PMID 27099358，國際共識聲明）｜period=2016｜geo: universal｜span:「Entering the restorative cycle should be avoided as far as possible」「Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated」「Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed」｜caveat：專家共識層級，非隨機試驗；2016 年版本，與 F14（2024 RCT）方向存在張力，本卡並陳未取捨。
• F5｜美國牙醫學會非修復性治療實證臨床指引：專家小組針對兒童與成人以非修復性治療停止或逆轉未成窩洞與已成窩洞齲齒做系統性回顧，形成 11 條建議，每條對應特定病灶型態、牙面與齒列；在較有效的介入中建議使用 38% 氟化二胺銀、窩溝封填、5% 氟化鈉護漆、1.23% 酸化磷酸氟凝膠、5000 ppm 氟（1.1% 氟化鈉）牙膏或凝膠等；並對 10% CPP-ACP 提出不建議使用之建議｜來源 #3｜confidence=verified｜basis=clinical_guideline（PMID 30261951，ADA 實證臨床指引，採 GRADE）｜period=2018｜geo: universal｜span:「The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition」「Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others」「The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate」｜caveat：美國指引，非台灣或日本規範；建議係逐條綁定病灶型態與牙面，本卡不得概括為「所有蛀牙都能不補」；藥劑濃度為指引原文所載，非本站用藥指示。
• F6｜美國牙醫學會修復性治療實證臨床指引：針對活髓、未經根管治療之乳牙與恆牙的中度與進展期已成窩洞齲齒，形成 16 條建議與良好實務聲明（4 條為依病灶深度區分之去齲方式、12 條為依牙齒位置與涉及牙面區分之直接充填材料）；對保守去齲方式給予條件性建議，尤其進展期病灶；對所有納入之直接充填材料給予條件性建議，並於特定臨床情境對部分材料排序｜來源 #4｜confidence=verified｜basis=clinical_guideline（PMID 37380250，ADA 實證臨床指引，採 GRADE）｜period=2023｜geo: universal｜span:「The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved」「The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions」「The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects」｜caveat：條件性建議（conditional）非強建議；作者用語為「may decrease」，本卡照錄「可能」不上修。
• F7｜Cochrane 系統性回顧（8 項隨機試驗、365 位受試者，全採半口設計）：微創處置相較非侵入性專業處置（如氟漆）或口腔衛生指導（如牙線），顯著降低鄰接面病灶前進之勝算比（OR 0.24，95% CI 0.14 至 0.41；602 個病灶、7 項研究、I²=32%）；證據品質評為中等；適用對象為未成窩洞之琺瑯質病灶與初期牙本質病灶（影像上侷限於牙本質外三分之一）；4 項有評估不良事件的研究未報告微創處置後之不良事件｜來源 #5｜confidence=verified｜basis=peer_reviewed（PMID 26545080，Cochrane 系統性回顧）｜period=2015（檢索至 2014-12）｜geo: universal｜span:「micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%)」「The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph)」｜caveat：7 項研究被判高整體偏差風險（主要因無法盲化）；4 項研究受產業支持，其中 1 項由介入發明人執行；不適用於已成窩洞病灶。
• F8｜Cochrane 系統性回顧（22 項試驗、12455 位受試者隨機分派）：氟漆相較安慰劑或未處置，恆牙面合併預防分數 43%（95% CI 30% 至 57%，13 項試驗）、乳牙面 37%（95% CI 24% 至 51%，10 項試驗）；證據品質評為中等｜來源 #6｜confidence=verified｜basis=peer_reviewed（PMID 23846772，Cochrane 系統性回顧）｜period=2013｜geo: universal｜span:「the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001)」「The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate」｜caveat：結果指標為預防新病灶，非逆轉既有窩洞；異質性可觀（I²=75%），納入研究多屬高偏差風險；關於不良反應與接受度的資訊很少。
• F9｜Cochrane 系統性回顧（38 項試驗、7924 位兒童）：樹脂類窩溝封填劑用於恆牙臼齒咬合面可預防兒童與青少年齲齒；24 個月量測點的中等品質證據顯示相較未封填可降低齲齒 11% 至 51%；僅 4 項試驗評估不良事件且未見不良事件報告｜來源 #7｜confidence=verified｜basis=peer_reviewed（PMID 28759120，Cochrane 系統性回顧）｜period=2017｜geo: universal｜span:「Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months」｜caveat：結果指標為預防新病灶；所有試驗在結果評估的盲化上被評為高偏差風險（封填劑肉眼可辨）；玻璃離子封填劑與不同封填劑相互比較的證據不足。
• F10｜質性訪談研究（蘇格蘭兩個 NHS 轄區、14 位牙科專業人員、15 次半結構訪談）：受訪者提到的主要氟化二胺銀缺點與使用障礙，為其造成停止進展病灶的黑色染色｜來源 #8｜confidence=verified｜basis=peer_reviewed（PMID 32933507，質性研究）｜period=2020｜geo: universal｜span:「However, SDF-induced black staining of arrested carious lesions was most commonly reported as the main disadvantage and greatest barrier to using it in practice」｜caveat：質性訪談、樣本 14 人、單一國家、受訪對象為專業人員而非病人結果指標；本卡僅引用「染色是已知取捨」，不引為療效或安全性證據。
• F11｜瑞典前瞻性影像追蹤研究（536 位兒童，11 至 22 歲，每年咬翼片；該族群採以再礦化為基礎而非修復為基礎之治療策略）：各牙面之齲齒發生率與存活時間變異相當大；健康牙面 75% 於 6.3 年內未達狀態 2；狀態 2 者 75% 於 4.8 年內未達牙本質外半部（狀態 4）；狀態 3（琺瑯質－牙本質交界）者 75% 僅 1.3 年內未達狀態 4，狀態 3 至 4 之存活時間中位數 3.1 年；11 至 12 歲時鄰接面 DMFS 大於 1 者，新生鄰接面琺瑯質病灶風險為 DMFS 0 至 1 者之 2.5 倍｜來源 #9｜confidence=verified｜basis=peer_reviewed（PMID 9892776，前瞻性世代研究）｜period=1999｜geo: universal｜span:「Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel-dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years」「The results showed a considerable variation between the surfaces in both caries rates and survival time」｜caveat：1999 年、單一國家、青少年族群、僅鄰接面、且在特定照護策略下取得；為族群層級存活曲線，不可作為個別牙齒之進展預測。
• F12｜系統性回顧與統合迴歸（納入 192 篇兒童研究與 186 篇 5 歲以上族群研究）：2010 年估計全球約 24 億人有未經治療的恆牙齲齒、約 6.21 億名兒童有未經治療的乳牙齲齒；1990 至 2010 年間年齡標準化盛行率與發生率大致持平｜來源 #10｜confidence=verified｜basis=peer_reviewed（PMID 25740856，系統性回顧與統合迴歸）｜period=2015（資料年 1990、2010）｜geo: universal｜span:「In 2010, untreated caries in permanent teeth was the most prevalent condition worldwide, affecting 2.4 billion people, and untreated caries in deciduous teeth was the 10th-most prevalent condition, affecting 621 million children worldwide」｜caveat：全球模型估計值、資料年為 2010，非現時值亦非任何單一國家值；本卡僅引為流行程度背景，不引為「拖延無害」之依據。
• F13［舊版，2013；現行最新版見 F23］｜Cochrane 系統性回顧（8 項試驗、934 位受試者、1372 顆牙）：分次去齲相較完全去齲，牙髓暴露發生率降低 56%（RR 0.44，95% CI 0.33 至 0.60），中等品質證據，4 項研究中完全去齲組平均牙髓暴露率 34.7%、分次去齲組 15.4%；部分去齲相較完全去齲降低 77%（RR 0.23，95% CI 0.08 至 0.69），中等品質證據，2 項研究中完全去齲組 21.9%、部分去齲組 5%；所有納入試驗均被評為高偏差風險；在牙髓疾病徵象與症狀上，部分去齲與完全去齲之差異證據不足｜來源 #11｜confidence=verified｜basis=peer_reviewed（PMID 23543523，Cochrane 系統性回顧）｜period=2013｜geo: universal｜span:「Stepwise caries removal resulted in a 56% reduction in incidence of pulp exposure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.33 to 0.60, P < 0.00001, I(2) = 0%) compared to complete caries removal based on moderate quality evidence」「In these four studies, the mean incidence of pulp exposure was 34.7% in the complete caries removal group and 15.4% in the stepwise groups」「Partial caries removal reduced incidence of pulp exposure by 77% compared to complete caries removal (RR 0.23, 95% CI 0.08 to 0.69, P = 0.009, I(2) = 0%)」「All of the trials were assessed at high risk of bias」｜caveat：主要結果指標為「牙髓暴露發生率」，不等於「牙髓長期存活」——後者見 F14 之反向結果；多數研究追蹤期短。
• F14｜雙盲隨機臨床試驗（124 顆影像上齲齒深達牙本質三分之二以上、無自發性牙髓炎、診斷為可逆性牙髓炎之成熟恆牙；選擇性去齲 63 顆、完全去齲 61 顆）：完全去齲組 17 顆（28%）出現牙髓暴露並當場以活髓治療處理；12 個月牙髓存活率完全去齲組 98.4%、選擇性去齲組 82.5%（P = 0.003）；多變量分析顯示去齲方式與術前疼痛程度（是否達 5/10）為顯著預後因子；作者臨床意涵建議在此情境下完全去齲至硬牙本質以取得可預期之牙髓存活｜來源 #12｜confidence=verified｜basis=peer_reviewed（PMID 39442480，隨機對照試驗，註冊編號 NCT05144711）｜period=2024｜geo: universal｜span:「17/ 61 teeth (28%) in the TCR had pulp exposure, managed by VPT and were successful at recall」「Multivariate analysis revealed the type of procedure (SCR vs TCR) and the preoperative pain levels (above or below 5/10) as significant prognostic factors」「In deep carious lesions of mature permeant teeth with revrsible pulpitis, total caries removal to hard dentine is recommended for a predictable pulp survival」｜caveat：單中心、追蹤 12 個月、僅成熟恆牙且限可逆性牙髓炎；原文結論句含拼寫誤植（permeant／revrsible），此處逐字照錄；與 F4、F6 之共識方向相反，本卡並陳不取捨；同 KM-DENTAL-02 卡 F18 錨。
• F15｜歐洲牙髓病學會深部齲齒與牙髓暴露處置立場聲明：以維持牙髓健康且保有活性、預防根尖周炎、發展微創且以生物學為基礎之治療為當代臨床牙髓學核心主題；文件明白標示該領域存在爭議、低品質證據與不確定性｜來源 #13｜confidence=verified｜basis=clinical_guideline（PMID 30664240，學會立場聲明）｜period=2019｜geo: universal｜span:「Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics」「In presenting these findings, areas of controversy, low-quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest」｜caveat：2019 年版本，作者已載明將於 5 年內更新；歐洲學會立場，非台灣或日本規範。
• F16｜繖狀回顧（納入 6 篇系統性回顧）：恆牙齲齒性牙髓暴露的活髓治療中，部分牙髓切除術與全牙髓切除術在 2 年以上觀察到高於且較可預期於直接蓋髓的成功率；結論為活髓治療是可靠的治療選項但仍需更多高品質研究佐證，且可被視為根管治療的替代選項｜來源 #14｜confidence=verified｜basis=peer_reviewed（PMID 33970319，umbrella review）｜period=2021｜geo: universal｜span:「Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp-exposed permanent human teeth as compared to direct pulp capping」「Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding」「Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp-exposed permanent teeth」｜caveat：僅納入 6 篇回顧、預後因子結果互相衝突；未提供可套用於個別病例的成功率數值，本卡亦不代為換算。
• F17｜Cochrane 系統性回顧概觀（14 篇回顧、57 篇原始研究；優先採用 6 篇回顧、23 篇原始研究在追蹤期末的資料）：大塊填充型與分層堆疊型複合樹脂之修復物失敗風險可能無差異且低於 5%（RD 0.00，95% CI −0.03 至 0.03；7 項研究、511 個修復物、追蹤 1 至 10 年，中等確定性）；銀汞合金相較複合樹脂之修復物失敗風險可能少 7%（RD 0.07，95% CI 0.05 至 0.09；2 項研究、3010 個修復物、追蹤 5 至 7 年，低確定性，原始研究自 1990 年代末收案）；一篇回顧報告兩組術後疼痛與不適皆約 5%（極低確定性）；水俁公約建議牙科逐步減少汞齊使用且無汞直接充填材料已可取得；僅約 10% 原始研究於一般執業場域進行｜來源 #15｜confidence=verified｜basis=peer_reviewed（PMID 42444634，Cochrane overview of systematic reviews）｜period=2026（檢索至 2025-04）｜geo: universal｜span:「The risk of restoration failure is likely to be low, and no different between groups, at less than 5% (RD 0.00, 95% CI -0.03 to 0.03; 7 studies, 511 restorations; 1 to 10 years follow-up)」「One Cochrane review reported low-certainty evidence that the risk of restoration failure may be 7% less with dental amalgam than RBC (RD 0.07, 95% CI 0.05 to 0.09; 2 studies, 3010 restorations; 5 to 7 years follow-up; class I and II restorations)」「The Minamata Convention on Mercury recommends a phase-down of amalgam use in dentistry」「Very few primary studies (about 10%) were conducted in general practice」｜caveat：群體層級數字，非個人機率；銀汞比較之原始研究年代較早，作者已標可推論性受限；同 KM-DENTAL-02 卡 F14 錨。
• F18｜Cochrane 系統性回顧（4 項研究、1270 位受試者，其中 233 位失訪；1 項因資料不一致排除於分析）：非常低品質證據顯示，直接充填治療使用橡皮障相較棉捲隔離，修復物失敗率可能較低｜來源 #16｜confidence=verified｜basis=peer_reviewed（PMID 27648846，Cochrane 系統性回顧）｜period=2016｜geo: universal｜span:「We found some very low-quality evidence, from single studies, suggesting that rubber dam usage in dental direct restorative treatments may lead to a lower failure rate of the restorations, compared with the failure rate for cotton roll usage」｜caveat：所有納入研究均高偏差風險、證據等級為非常低；無研究評估不良事件、成本或病人接受度；本卡不得引為「必須使用橡皮障」之依據。
• F19｜以執業場域為基礎之回溯研究（44 位成人、306 顆後牙複合樹脂填補物，追蹤 10 至 18 年）：30% 失敗，其中 82% 出現在具 1 至 2 項風險因子之病人；蛀牙高風險族群主要失敗原因為續發齲齒，咬合壓力風險族群主要失敗原因為斷裂｜來源 #17｜confidence=verified｜basis=peer_reviewed（PMID 23690354，回溯性臨床研究）｜period=2013｜geo: universal｜span:「In total, 30% of the restorations failed, of which 82% were found in patients with 1 or 2 risk factors」「Secondary caries was the main reason of failure within caries-risk patients, whereas fracture was the main reason in "occlusal-stress-risk" patients」｜caveat：回溯設計、單一執業場域、病人數少；為長期壽命指標，不可讀為個人失敗機率；同 KM-DENTAL-02 卡 F19 錨。
• F20｜回溯性研究：有邊緣懸突的鄰接面填補物，其牙周囊袋較無懸突之金屬填補物深 0.42 毫米｜來源 #18｜confidence=verified｜basis=peer_reviewed（PMID 7806672，回溯性臨床研究）｜period=1994｜geo: universal｜span:「Periodontal pockets at proximal sites with marginal overhangs were significantly deeper (0.42 mm) compared to sites with metal restorations without overhangs」｜caveat：轉診族群之回溯資料，屬關聯性非因果；本卡引為「邊緣不密合值得檢查」的依據；同 KM-DENTAL-02 卡 F20 錨。
• F21｜《醫療法》第 87 條第 2 項：醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告｜來源 #20｜confidence=verified（2026-08-05 實測 200、逐字對得上）｜basis=law｜period=現行條文｜geo: TW｜caveat：本卡發布定位依據，屬台灣制度，非醫學事實；其他地區讀者請以所在地規範為準。
• F23｜Cochrane 系統性回顧 2021 年更新版（本題現行最新版，取代 2013 年 CD003808 之範圍）：納入 27 項研究、3,350 位受試者、4,195 顆牙／病灶，11 國、1977–2020 年發表；結論為與完全去齲相比，乳牙以 Hall Technique 與選擇性去齲失敗數較低、恆牙以選擇性去齲與分次去齲失敗數較低，惟多數研究高偏誤風險、樣本小、失敗事件少，多數比較之證據確定性為低或極低｜confidence=verified（2026-08-05 E-utilities efetch 取回摘要逐字比對）｜basis=peer_reviewed（PMID 34280957）｜period=2021-07-19 發表；檢索日 2026-08-05｜geo: universal｜span:「We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020」「Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition」「Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons」｜caveat：版本時效已查——F13 之 2013 年版（PMID 23543523）保留為歷史對照，本題現行引用以本條為準；證據確定性低或極低，禁據此對個別病人做療效推估
• F22［結構性整理］｜證據缺口聲明：本站於 2026-08-05 以 PubMed E-utilities 檢索，下列項目未取得可引用的直接證據——①以「monitoring versus restoration cavitated caries lesion adults randomized trial long-term」檢索，回傳筆數 0；②以「non-restorative cavity control cavitated lesions adults arrest cleansable」檢索，回傳筆數 0（即成人已成窩洞病灶「只監控不修復 vs 立即修復」之長期隨機比較試驗）；③牙齒可修復性（restorability）之量化判準研究；④「深蛀牙一定要／一定不要去乾淨」之定論（現有證據為 F4、F6 共識與 F13 回顧對 F14 隨機試驗之張力）｜來源 #21｜confidence=n/a｜basis=editorial_framework｜period=2026-08-05｜geo: universal｜caveat：檢索侷限於 PubMed 英文文獻與上列檢索式，未取得不等於已被推翻；本欄為編輯性陳述，不得標為待驗 claim。本卡所有預防性指標（F8、F9）皆為「預防新病灶」的結果指標，禁與「逆轉既有窩洞」互推。

來源清單

取用日期均為 2026-08-05；PubMed 條目以 E-utilities efetch 取得摘要原文逐字比對，並逐條實測條目頁回應 200。

1. Innes NP, Frencken JE, Bjørndal L, et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res. 2016;28(2):49-57. PMID 27099357
2. Schwendicke F, Frencken JE, Bjørndal L, et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res. 2016;28(2):58-67. PMID 27099358
3. Slayton RL, Urquhart O, Araujo MWB, 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.e19. PMID 30261951
4. Dhar V, Pilcher L, Fontana M, et al. Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. J Am Dent Assoc. 2023;154(7):551-566.e51. PMID 37380250
5. 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;2015(11):CD010431. PMID 26545080
6. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;2013(7):CD002279. PMID 23846772
7. Ahovuo-Saloranta A, Forss H, Walsh T, et al. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017;7(7):CD001830. PMID 28759120
8. Seifo N, Cassie H, Radford J, Innes N. "It's really no more difficult than putting on fluoride varnish": a qualitative exploration of dental professionals' views of silver diamine fluoride for the management of carious lesions in children. BMC Oral Health. 2020;20(1):257. PMID 32933507
9. 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. PMID 9892776
10. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015;94(5):650-658. PMID 25740856
11. Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database Syst Rev. 2013;(3):CD003808. PMID 23543523
12. Taha NA, Ali MM, Abidin IZ, Khader YS. Pulp survival and postoperative treatment needs following selective vs. total caries removal in mature permanent teeth with reversible pulpitis: A randomized clinical trial. J Dent. 2024;151:105408. PMID 39442480
13. European Society of Endodontology (ESE); Duncan HF, Galler KM, Tomson PL, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019;52(7):923-934. PMID 30664240
14. Leong DJX, Yap AU. Vital pulp therapy in carious pulp-exposed permanent teeth: an umbrella review. Clin Oral Investig. 2021;25(12):6743-6756. PMID 33970319
15. Lewis SR, Walsh T, Glenny AM, et al. Restorative materials for direct coronal restoration of permanent posterior teeth: an overview of systematic reviews. Cochrane Database Syst Rev. 2026;7(7):CD016279. PMID 42444634
16. Wang Y, Li C, Yuan H, et al. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. 2016;9(9):CD009858. PMID 27648846
17. van de Sande FH, Opdam NJ, Rodolpho PA, et al. Patient risk factors' influence on survival of posterior composites. J Dent Res. 2013;92(7 Suppl):78S-83S. PMID 23690354
18. Jansson L, Ehnevid H, Lindskog S, Blomlöf L. Proximal restorations and periodontal status. J Clin Periodontol. 1994;21(9):577-582. PMID 7806672
19. 內部數據：`analysis/reports/km-dental-backlog.md` #12 附錄（6 詞項×2 站×曝光逐筆可對帳，合計 235,930）
20. Schwendicke F, Walsh T, Lamont T, et al. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev. 2021;7(7):CD013039. PMID 34280957
21. 醫療法 第 87 條（全國法規資料庫）
22. 編輯框架：本站三段分期結構、補牙流程骨架與證據缺口聲明（無外部來源，標示為結構性整理）

內部引用鏈

• 補完之後的時間問題（多久可以吃東西、多久可以刷牙、材料差異）：補牙後多久可以吃東西、多久可以刷牙？（KM-DENTAL-02）（材料證據錨 F17＝該卡 F14、風險因子錨 F19＝該卡 F19、邊緣懸突錨 F20＝該卡 F20、深齲隨機試驗錨 F14＝該卡 F18）
• 蛀到牙齦下、邊緣露不出來而補不住時會被提到的手術：牙冠增長術是什麼？費用、保險、會不會痛（KM-DENTAL-17）
• 牙齒終究留不住、拔掉之後補不補的比較：臼齒拔掉可以不補嗎？會怎樣？（KM-DENTAL-34）
• 拔牙之後傷口與時間軸：拔牙的洞要多久才會長好？（KM-DENTAL-01）

發布閘門提醒：本卡為 draft。四語（zh-Hans／en／ja）未產前不得進 km_entries；地域聲明四語版本必齊（global 卡措辭見 ANK-DENTAL-SPEC.md）。F22 的證據缺口聲明若日後檢索到直接證據，須改寫該節而非保留「未取得」字樣；F4／F6 共識與 F14 隨機試驗的張力若被新的系統性回顧收斂，深蛀牙爭議段須整段重寫。