渗透树脂作用于早期人工釉质龋渗透性的体外研究

发布时间：2018-09-03 14:11

【摘要】：背景龋病是人类口腔中发病率较高的一种常见疾病。早期釉质龋牙体外观看似无龋坏,但釉质内部已出现脱矿,部分釉柱结构已遭到破坏,从而出现孔隙,致龋微生物以这些孔隙为通道向釉牙本质界方向渗入,加快釉质的进一步破坏,在牙表面出现点状或者块状的颜色异常,称为白垩斑,此区域的牙釉质亮度及透明度均较正常牙釉质低。在临床上,白垩斑(vhite spot lesions)是釉质早期龋的一种表现,多见于正畸矫形的人群。现阶段,口腔医生针对早期非龋洞性釉质龋(包括釉质白垩斑)已提出两个微创治疗方案：一是在釉质脱矿的基础上,利用药物使已溶解的有机物还原,即再矿化；二是用流动性大的树脂材料沿着已破坏的釉柱孔隙渗入到龋损部位,充填其中,从而隔断致龋微生物向釉质深处进展。在临床上,常用的再矿化药物为含氟制剂,对于氟能促进早期龋再矿化的研究已硕果累累。然而,关于堵塞脱矿区孔隙的研究甚少,尚未得到口腔医生的一致认可,此区可谓空白。近年来,对于非龋洞性釉质龋的治疗,出现了一种微创新技术——渗透。树脂渗透是一项阻断龋进展的微创技术,渗透树脂在治疗非龋洞性釉质龋过程中不需备洞,避开了传统充填治疗过程中对龋损周围正常牙釉质地切削。综合国内外的大量文献发现,国内外关于渗透树脂在早期釉质龋方面的治疗,报道很少。本研究借助国外学者的研究方法,创新性地开展渗透树脂在乳牙方面的研究,同时从渗透时间、酸蚀剂的选择以及粘结剂的应用三方面研究了渗透树脂的渗透性,为渗透树脂在临床上更有效地应用在一定程度上提供了参考依据。目的通过对渗透树脂渗透时间、酸蚀剂的选择以及粘结剂的应用等渗透性的体外研究,为临床正畸白垩斑以及早期釉质龋提供理论依据和一种无痛微创的治疗选择。材料和方法1.渗透树脂在不同渗透时间对早期人工釉质龋渗透深度的影响：选择正畸拔除的健康无龋的前磨牙制成釉质块,先制备人工釉质龋模型,随机分成5组,每组10个标本,用渗透树脂分别渗透1min,2min,2.5min,3min,4min,然后光固化60s。然后再切片打磨制成标本,用倒置荧光显微镜观察标本,测量龋损深度LD和渗透深度PD,计算渗透百分数PP(PP=PD/LD×100%),采用多样本秩和检验统计分析渗透深度和时间的关系。2.不同酸蚀剂作用于乳牙早期人工釉质龋对渗透树脂渗透深度的影响：选取60颗正常替换拔除的健康无龋的第一乳磨牙,先制备人工釉质龋模型,随机分成A、B两组,每组30个标本,在组内又分为3组,分别用15%HCL和37%H3P04的酸蚀剂酸蚀60s,90s,120s,均涂布渗透树脂渗透3min,光固化60s。再切片制成标本,用倒置荧光显微镜观察并测量龋损深度LD和渗透深度PD,计算渗透百分数PP,采用SPSS13.0软件统计分析不同酸蚀剂不同酸蚀时间对渗透深度的影响。3.粘结剂作用于早期人工釉质龋对渗透树脂渗透深度的影响：选择正畸拔除的健康无龋无裂纹的第一前磨牙30颗,先制备人工釉质龋模型,再用15%盐酸酸蚀2min,罗丹明染色后,随机分成3组,每组10个标本,第一组涂布粘结剂和渗透树脂,第二组只涂布粘结剂,第三组只涂布渗透树脂3min,均光固化60s。然后再打磨成标本,在倒置荧光显微镜下观察并测量龋损深度LD和渗透深度PD,计算渗透百分数PP,采用SPSS13.0统计分析粘结剂对渗透深度影响。结果1.渗透树脂在1min的渗透深度明显小于3min的渗透深度。渗透树脂在2.5min时能够达到最大脱矿深度的90%,在3min时能基本达到釉质脱矿深度,再增加渗透时间对渗透深度不会产生明显影响,差异无统计学意义。2.磷酸组的渗透深度明显小于盐酸组,渗透百分比也明显低于盐酸组,37%H3PO4酸蚀120s后渗透树脂的渗透深度能达到乳牙釉质脱矿深度的60%,而15%HCL酸蚀60s后渗透树脂的渗透深度能达到乳牙釉质脱矿深度的70%,在酸蚀90s和120s渗透树脂基本能完全渗透,两者之间的差异无统计学意义。3.粘结剂组的渗透深度明显小于渗透树脂组以及粘结剂和渗透树脂结合组,渗透树脂组的渗透深度稍小于粘结剂和渗透树脂结合组,两组之间无明显统计学差异。粘结剂的渗透能达到釉质龋脱矿深度的20%,渗透树脂组以及粘结剂和渗透树脂结合组均能达到最大的渗透深度。结论1.3min的渗透时间基本能达到早期釉质龋的最大脱矿深度。2.用15%盐酸酸蚀90s-120s可以有效去除乳牙早期釉质龋表面的玷污层,使渗透树脂能基本达到最大的渗透。3.粘结剂的应用没有阻碍渗透树脂的渗透,不会减小渗透树脂的渗透深度。
[Abstract]:BACKGROUND Caries is a common disease in human oral cavity with a high incidence. Early enamel caries appear to be caries-free in vitro, but demineralization has occurred in the enamel, and some enamel column structures have been destroyed, resulting in pores. These pores are used by cariogenic microorganisms to infiltrate into the enamel-dentin boundary, accelerating the further destruction of enamel. Point or patchy color abnormalities, called chalk spots, occur on the surface of teeth, where enamel brightness and transparency are lower than normal enamel. Clinically, chalk spots are a manifestation of early enamel caries, most commonly seen in orthodontic populations. At this stage, dentists target early non-carious cavitary enamel caries (including dental caries). Two minimally invasive treatments have been proposed for enamel chalk stains: one is to reduce dissolved organic matter by medication on the basis of enamel demineralization; the other is to infiltrate the damaged enamel column pores into the caries lesion site with a highly fluidized resin material and fill it, thereby isolating cariogenic microorganisms from the enamel depths. In clinical practice, fluoride-containing agents are commonly used as remineralization agents, and Research on the effect of fluoride on remineralization of early caries has been fruitful. However, little research has been done on blocking the pores of demineralization areas, which has not been accepted by dentists. In recent years, a micro-innovative technique has emerged for the treatment of non-cavitary enamel caries. Penetration. Resin penetration is a minimally invasive technique to block the progress of caries. Penetration resin does not need to prepare cavities in the treatment of non-cavitary enamel caries. It avoids cutting the normal enamel around the caries in the traditional filling treatment. With the help of the research methods of foreign scholars, this study carried out innovative research on penetrating resin in deciduous teeth. At the same time, the permeability of penetrating resin was studied from three aspects: penetrating time, the choice of etchant and the application of binder, which provided reference for more effective clinical application of penetrating resin. Objective To provide a theoretical basis and a painless and minimally invasive treatment for orthodontic chalk spot and early enamel caries by in vitro study on penetration time of penetrating resin, selection of acid etching agent and application of binder. Materials and methods 1. penetrating resin penetrating into early artificial enamel caries at different penetrating time. The influence of penetration depth: The healthy decayed premolars were selected to make enamel blocks, then the artificial enamel caries models were prepared and divided into 5 groups randomly. Each group of 10 specimens was infiltrated with penetration resin for 1 min, 2 min, 2.5 min, 3 min, 4 min, and then cured by light for 60 s. Then the specimens were polished and observed with inverted fluorescence microscope. The relationship between penetration depth and time was analyzed by multiple rank sum test. 2. The effect of different etchants on penetration depth of enamel caries at early stage of deciduous teeth: 60 healthy first deciduous molars without caries were replaced. The model of artificial enamel caries was prepared and randomly divided into two groups A and B. Each group of 30 specimens was divided into three groups. Each group was etched with 15% HCL and 37% H3P04 for 60 s, 90 s and 120 s respectively. The specimens were coated with penetrating resin for 3 min, cured by light for 60 s. Percentage PP, SPSS 13.0 software statistical analysis of different etching agents and different etching time on the penetration depth of penetration resin. 3. The effect of binder on the penetration depth of early artificial enamel caries: choose 30 healthy caries-free and crack-free first premolars extracted by orthodontic treatment, first prepare artificial enamel caries model, then use 15% hydrochloric acid. After acid etching for 2 minutes and staining with rhodamine, 10 specimens were randomly divided into 3 groups. The first group was coated with binder and osmotic resin, the second group was coated with binder, the third group was coated with osmotic resin for 3 minutes, and cured for 60 seconds. The effect of binder on penetration depth was analyzed by SPSS 13.0. Results 1. The penetration depth of penetrating resin in 1 minute was obviously less than that in 3 minutes. The penetrating resin reached 90% of the maximum demineralization depth in 2.5 minutes, and reached the enamel demineralization depth in 3 minutes. The penetration depth of the resin in phosphoric acid group was significantly lower than that in hydrochloric acid group, and the penetration percentage was also significantly lower than that in hydrochloric acid group. There was no significant difference between the two groups. 3. The penetration depth of the binder group was significantly lower than that of the penetration resin group and the binder and penetration resin group. The penetration depth of the penetration resin group was slightly lower than that of the binder and penetration resin group. There was no significant difference between the two groups. The penetration of binder can reach 20% of the demineralization depth of enamel caries, and the penetration resin group and the combination of binder and penetration resin group can reach the maximum penetration depth. Conclusion The penetration time of 1.3 min can basically reach the maximum demineralization depth of early enamel caries. The dirt layer makes the penetrating resin reach the maximum penetration basically. 3. The application of binder does not hinder the penetration of penetrating resin, and does not reduce the penetrating depth of penetrating resin.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R781.1

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