대한소아치과학회지 (Journal of the korean academy of Pediatric Dentistry)

  • 제36권1호
  • /
  • Pages.30-37
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  • 2009
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  • 1226-8496(pISSN)
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  • 2288-3819(eISSN)
대한소아치과학회 (Korean Academy of Pediatric Dentistry)
권호 표지

평활면 초기 우식병소의 표면처리에 따른 조직상 및 접착제의 침투 양상 비교

HISTOLOGIC FEATURE AND INFILTRATION OF ADHESIVE RESIN ACCORDING TO PRETREATMENT ON PROXIMAL EARLY CARIES LESION

  • 김인영 (부산대학교 치의학전문대학원 소아치과학교실) ;
  • 정태성 (부산대학교 치의학전문대학원 소아치과학교실) ;
  • 김신 (부산대학교 치의학전문대학원 소아치과학교실)
  • Kim, In-Young (Department of Pediatric Dentistry, School of Dentistry, Pusan National University) ;
  • Jeong, Tae-Sung (Department of Pediatric Dentistry, School of Dentistry, Pusan National University) ;
  • Kim, Shin (Department of Pediatric Dentistry, School of Dentistry, Pusan National University)
  • 발행 : 2009.02.27
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초록

초기 법랑질 우식은 환자의 구강 위생 증진 및 국소적 불소 도포를 통해 재광화가 가능하나 이는 환자의 협조도에 전적으로 의존하게 되어 있어 임상적 효과를 확신하기 힘들다. 그 대안으로 병소 진행의 보다 초기 단계에 병소의 미세 다공구조를 광중합 레진으로 전색하는 시도가 행해져 오고 있다. 그러나 법랑질 초기 우식의 표층은 병소 본체에 비해 상대적으로 낮은 세공 용적으로 인하여 접착레진의 침투를 방해할 수 있다. 따라서 적절한 표면 처리를 통한 표층의 일부 혹은 전체의 제거가 접착레진의 침투에 중요하다. 그러나 아직까지 자연적인 법랑질 초기 우식 병소의 표면 처리에 관한 연구는 부족한 실정이다. 이에 본 연구에서는 평활면 법랑질 초기 우식에 대한 접착레진 적용 전 적절한 표면 처리 방법을 알아보고자 시행되었다. 인접면에 법랑질 초기 우식을 보이는 39개의 발거된 유구치를 각기 다른 방법의 표면처리를 시행한 바, 수세만 시행한 대조군인 1군, 15초간 15% 염산 처리한 2군, 15초간 35% 인산 처리한 3군, 30초간 35% 인산 처리한 4군, 0.5% 차아염소산나트륨으로 세척한 5군의 5개 군으로 이루어졌다. 각 군당 3개의 치아는 주사전자현미경으로 관찰하고, 나머지 24개에는 접착레진을 도포하고 그 절단 시편을 공초점 레이저 주사현미경으로 관찰하여 다음과 같은 결론을 얻었다. 1. 주사전자현미경 관찰 결과, 2군에서 가장 명백한 표층 제거가 관찰되었고, 3군과 4군에서는 일부 불규칙적인 표층 제거, 5군에서는 미약한 표층 제거가 나타났다. 2. 각 군의 평균 침투 깊이는 $6.85{\sim}23.09{\mu}m$로 측정되었으며, 침투 깊이의 군간 비교에서는 2군에서 가장 크게, 이어 4군, 3군, 5군, 1군의 순이었으며, 5군을 제외한 모든 실험군에서는 대조군에 비해 크게 나타났다. (p<0.01)

Early enamel caries is commonly remineralized by the patient‘s improved oral hygiene or fluoridation, however the result is clinically unreliable. As an alternative, we tried to seal the lesions with low-viscosity light-curing resin. The aim of the present study was to search the proper methods of the adequate pretreatment prior to applying adhesive resin on natural proximal caries lesions. Thirty nine extracted deciduous molar teeth showing proximal early caries lesion were used for this study. They were divided into 5 groups : Group 1; only carefully cleaned with water, group 2; etched with 15% HCl for 15s, group 3; etched with 35% phosphoric acid for 15s, group 4; etched with 35% phosphoric acid for 30s, and group 5; cleaned with 0.5% NaOCl. Following results were obtained by evaluating with SEM and CLSM after applied with adhesive resin. 1. As a result of SEM evaluation, group 2 showed clearly removed surface layer, group 3,4 showed partially removed surface layer irregularly, group 5 showed slightly removed surface layer. 2. Group 2 showed the deepest infiltration depth, followed by group 4, group 3, group 5, group 1 and besides group 5, other groups showed significantly deep infiltration depth. (p < 0.01) In conclusion, the best methods of the adequate pretreatment on natural proximal caries lesion for deep infiltration of adhesive resin was to etch with 15% HCl for 15s.

키워드

참고문헌

  1. Mejare I, Kallestal C, Stenlund H, et al. : Caries development from 11 to 22 years of age: A prospective radiographic study. Caries Res, 32:10-16, 1998. https://doi.org/10.1159/000016424
  2. Paris S, Meyer-Lueckel H, Kielbassa AM : Resin infiltration of natural caries lesions. J Dent Res, 86:662-666, 2007. https://doi.org/10.1177/154405910708600715
  3. Franklin GG, James BS, Kevin JD : Caries progression of white spot lesions sealed with an unfilled resin. J Clin Pediatr Dent, 21: 141-143, 1997.
  4. Featherstone JD : The continuum of dental cariesevidence for a dynamic disease process. J Dent Res, 83:39-42, 2004. https://doi.org/10.1177/154405910408301S08
  5. 임성수, 김용기 : Fluoride varnish 도포가 초기 법랑질 우식 병소의 재석회화에 미치는 영향에 관한 연구. 대한소아치과학회지, 20:131-144, 1993.
  6. Mejare I, Kallestal C, Stenlund H : Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: A prospective radiographic study. Caries Res, 33:93-100, 1999. https://doi.org/10.1159/000016502
  7. Robinson C, Brookes SJ, Kirkham J, et al. : In vitro studies of the penetration of adhesive resins artificial caries-like lesions. Caries Res, 35:136-141, 2001. https://doi.org/10.1159/000047445
  8. Kidd EA : How ‘clean’must a cavity be before restoration? Caries Res, 38:305-313, 2004. https://doi.org/10.1159/000077770
  9. Schmidlin PR, Besek MJ : Atraumatic tooth separation and proximal sealing: filling the gap between preventive and restorative dentistry. Pract Proced Aesthet Dent, 15:65-69, 2003.
  10. Gomez SS, Basili CP, Emilson CG : A 2-year clinical evaluation of sealed noncavitated approximal posterior carious lesions in adolescents. Clin Oral Investig, 9:239-243, 2005. https://doi.org/10.1007/s00784-005-0010-7
  11. 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, 40:382-388, 2006. https://doi.org/10.1159/000094282
  12. Mertz-Fairhurst EJ, Schuster GS, Willams JE, et al. : Clinical progress of sealed and unsealed caries. 1. Depth changes and bacterial counts. J Prosthet Dent, 42:521-526, 1979. https://doi.org/10.1016/0022-3913(79)90245-2
  13. Kielbassa AM, Gillmann L, Zantner C, et al. : Profilometric and microradiographic studies on the effects of toothpaste and acidic gel abrasivity on sound and demineralized bovine dental enamel. Caries Res, 39:380-386, 2005. https://doi.org/10.1159/000086844
  14. Gao XJ, Andreason P, Elliott JC : Scanning and contact microradiographic study of the effect of degree of saturation on the rae of enamel demineraization. J Dent Res, 70:1332-1337, 1991. https://doi.org/10.1177/00220345910700100401
  15. Meyer-Lueckel H, Paris S, Kielbassa AM : Surface layer erosion of natural caries lesions with phosphoric and hydrochloric acid gels in preparation for resin infiltration. Caries Res, 41:223-230, 2007. https://doi.org/10.1159/000099323
  16. Croll TP : Bonded resin sealant for smooth surface enamel defects: new concepts in ‘microrestorative' dentistry. Quintessence Int, 18:5-10, 1987.
  17. Silverstone LM : Remineralization phenomena. Caries Res, 11:59-84, 1977. https://doi.org/10.1159/000260296
  18. Ekstrand KR, Martignon S : Managing approximal carious lesions: A new non-operative approach. Abstract of papers presented at the 51st ORCA Congress. Caries Res, 38:357-412, 2004. https://doi.org/10.1159/000078182
  19. Paris S, Meyer-Lueckel H, Mueller J, et al. :Progression of sealed initial bovine enamel lesions under demineralizing conditions in vitro. Caries Res, 40:124-129, 2006. https://doi.org/10.1159/000091058
  20. Paris S, Meyer-Lueckel H, C¨olfen H, et al. : Penetration coefficients of commercially available and experimental composites intended to infiltrate enamel carious lesions. Dent Mater, 23:742-748, 2007. https://doi.org/10.1016/j.dental.2006.06.029
  21. Hicks MJ, Silverstone LM : Internal morphology of surface zones from acid-etched caries-like lesions: a scanning electron microscopic study. J Dent Res, 64:1296-1301, 1985. https://doi.org/10.1177/00220345850640110901
  22. Larsen MJ, Pearce EI : Some notes on the diffusion of acidic and alkaline agents into natural human caries lesion in vitro. Arch Oral Biol, 37:411-416, 1992. https://doi.org/10.1016/0003-9969(92)90025-4
  23. Gray GB, Shellis P : Infiltraion of resin into white spot caries-like lesions of enamel: an in vitro study. Eur J Prosthodont Restor Dent, 10:27-32, 2002.
  24. Simonsen RJ : Pit and fissure sealant: review of the literature. Pediatr Dent, 24:393-414, 2002.
  25. Aoba T, Yagi T : Crystallographic and structural alterations in the mineral phase of human enamel with caries attacks. J Oral Pathol, 11:201-209, 1982. https://doi.org/10.1111/j.1600-0714.1982.tb00157.x
  26. Charles QL, Zia S, Charles MC : Microscopic apperance of enamel white-spot lesions after acid etching. Quintessence Int, 26:279-284, 1995.
  27. 이애련, 김신 : 탈회 및 재광화 후 법랑질 결정의 변화에 관한 연구. 대한소아치과학회지, 21:67-85, 1994.
  28. Paris S, Meyer-Lueckel H, Mueller J, et al. : 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, 22:22-28, 2006. https://doi.org/10.1016/j.dental.2005.03.005
  29. Gomez SS, Onetto JE, Uribe SA, et al. : Therapeutic seal of approximal incipient noncavitated carious lesions: technique and case reports. Quintessence Int, 38:99-105, 2007.
  30. Mertz-Fairhurst EJ, Curtis JW Jr, Ergle JW, et al. : Ultraconservative and cariostatic sealed restorations: results at year 10. J Am Dent Assoc, 129:55-66, 1998.
  31. Inaba D, Duschner H, Jongebloed W, et al. : The effects of a sodium hypochlorite treatment on demineralised root dentine. Eur J Oral Sci, 103:368-374, 1995. https://doi.org/10.1111/j.1600-0722.1995.tb01859.x
  32. Robinson C, Hallsworth AS, Shore RC, et al. : Effect of surface zone deproteinisation on the access of mineral ions into subsurface carious lesions of human enamel. Caries Res, 24:226-230, 1990. https://doi.org/10.1159/000261272
  33. Bitter NC : A scanning electron microscopy study of the effect of bleaching agents on enamel: A preliminary report. J Prosthet Dent, 67: 852-855, 1992. https://doi.org/10.1016/0022-3913(92)90600-F
  34. Barbosa SV, Safavi KE, Spangberg LSW : Influence of sodium hypochlorite on the permeability and sructure of cervical human dentine. Int Endod J, 27:309-312, 1994. https://doi.org/10.1111/j.1365-2591.1994.tb00274.x
  35. Meyer-Lueckel H, Paris S : Progression of artificial enamel caries lesions after infiltration with experimental light curing resins. Caries Res, 42:117-124, Epub 2008 Feb 28, 2008. https://doi.org/10.1159/000118631
  36. Llodra JC, Bravo M, Delgado-Rodriguez M, et al. : Factors influencing the effectiveness of sealants-a meta-analysis. Community Dent Oral Epidemiol, 21:261-268, 1993. https://doi.org/10.1111/j.1600-0528.1993.tb00771.x
  37. 김신, 최외임, 하은숙 등 : Enamel microabrasion. 대한소아치과학회지, 19:376-381, 1992.
  38. Croll TP, Killian CM, Miller AS : Effect of enamel microabrasion compound on human gingiva: report of a case. Quintessence Int, 21:959-963, 1990.
  39. 박병철, 조영곤, 문주훈 : 공초점레이저주사현미경을 이용한 심미수복재와 상아질 접착계면에 관한 연구. 대한치과보존학회지, 25:313-320, 2000.