【摘要】：微創(chuàng)牙體粘結(jié)修復(fù)即牙體缺損的直接粘結(jié)修復(fù)技術(shù)是目前國內(nèi)外廣泛應(yīng)用的治療方法。牙本質(zhì)由于其自身的特殊結(jié)構(gòu)，在粘結(jié)治療中仍然存在一定的難度。應(yīng)用傳統(tǒng)的水濕粘結(jié)技術(shù)可以保持脫礦牙本質(zhì)中膠原纖維的蓬松，利于樹脂單體滲入，但是存在較高的臨床技術(shù)敏感性，單體析出，膠原纖維的降解均可導(dǎo)致粘結(jié)界面的質(zhì)量下降。牙本質(zhì)基質(zhì)中主體成分是I型膠原纖維，與樹脂單體通過微機(jī)械鎖結(jié)作用形成牙本質(zhì)粘結(jié)界面混合層（dentin hybrid layer,DHL）,混合層的質(zhì)量直接影響著粘結(jié)效果的好壞，決定粘結(jié)強度的高低。牙本質(zhì)基質(zhì)中存在著內(nèi)源性蛋白水解酶，稱基質(zhì)金屬蛋白酶（matrix metalloproteinases，MMPs），能降解混合層內(nèi)暴露的膠原纖維，導(dǎo)致粘結(jié)界面老化，粘結(jié)效果降低。近年來國內(nèi)外研究報道多種MMPs抑制劑應(yīng)用于牙本質(zhì)樹脂粘結(jié)界面可以有效延緩混合層的老化，提高粘結(jié)強度和耐久性。 目的： 本實驗在全酸蝕水濕粘結(jié)技術(shù)的基礎(chǔ)上，使用Adper Single Bond2體系，應(yīng)用氯己定(Chlorhexidine,CHX)和米諾環(huán)素（Minocycline，MI)作為MMPs抑制劑預(yù)處理牙本質(zhì)粘結(jié)界面，通過微拉伸強度測試（Microtensile Bonding Strength，MTBS）和場發(fā)射掃描電鏡（Field emission in-lens scanning electron microscope，F(xiàn)EISEM）觀察斷面類型及微觀形態(tài)，結(jié)合10%次氯酸鈉溶液（Sodiumhypochlorite，NaOCl）模擬體外粘結(jié)界面老化實驗，分析不同MMPs抑制劑對牙本質(zhì)樹脂粘結(jié)混合層強度及耐久性的影響，為形態(tài)學(xué)研究及臨床提供數(shù)據(jù)支持，完善效果評價。 材料和方法： 收集2周內(nèi)拔除的無齲人磨牙45顆，根據(jù)牙本質(zhì)粘結(jié)界面涂布抑制劑的方案不同分為三大組——酸蝕組、CHX組、MI組。各組磨牙去除冠部釉質(zhì)，暴露牙本質(zhì)淺層，酸蝕后，預(yù)處理牙本質(zhì)粘結(jié)界面，樹脂修復(fù)，沿粘結(jié)面的垂直方向切割成約1×1mm2長條形拉伸測試件，每大組在體視顯微鏡下選擇無缺損無微裂紋試件45個，根據(jù)應(yīng)用10%NaOCl模擬界面老化時間的不同隨機(jī)分為3個亞組——未老化組、老化5min組、老化10min組，每亞組各15個試件。試件制備完成后進(jìn)行微拉伸強度測試，統(tǒng)計學(xué)進(jìn)行數(shù)據(jù)分析，場發(fā)射掃描電鏡觀察斷面類型及斷裂面微觀形態(tài)。 結(jié)果： 采用SPSS20.0統(tǒng)計學(xué)軟件分析數(shù)據(jù)，在未老化、老化5min、老化10min時，CHX組粘結(jié)強度的差異均有統(tǒng)計學(xué)意義，均高于對照組（P0.05）；MI組中未老化，老化5min，老化10min時粘結(jié)強度均略高于對照組，但是差異均無統(tǒng)計學(xué)意義(P0.05)。 結(jié)論： 1.氯己定作為MMPs抑制劑預(yù)處理牙本質(zhì)粘結(jié)界面，可顯著提高各時間點牙本質(zhì)樹脂粘結(jié)強度，形成的混合層更均勻，樹脂滲透更充分，樹脂突更粗更長，與牙本質(zhì)小管結(jié)合更為緊密。 2.氯己定對10%NaOCl模擬老化下的粘結(jié)混合層存在保護(hù)作用，隨著老化時間的延長，混合層降解程度較小，減緩MMPs降解膠原纖維，控制粘結(jié)界面的老化進(jìn)展，改善粘結(jié)耐久性。 3.米諾環(huán)素作為MMPs抑制劑預(yù)處理牙本質(zhì)粘結(jié)界面，，對即刻和老化后的牙本質(zhì)樹脂粘結(jié)強度有所提高，但無顯著性差異。 4.米諾環(huán)素對10%NaOCl模擬老化下的粘結(jié)混合層保護(hù)作用不明顯，隨著老化時間的延長，混合層退化及膠原纖維降解情況未得到明顯改善。因此，米諾環(huán)素作為牙本質(zhì)粘結(jié)界面混合層中MMPs抑制劑的研究仍需進(jìn)一步探討。
[Abstract]:The technique of direct bonding repair of dental defect with minimally invasive dental prosthesis is a widely used treatment method at home and abroad. Because of its special structure, the dentin still has some difficulty in the bonding treatment. The application of traditional water wet bonding technique can maintain the fluffy of collagen fiber in the dentin of the demineralized tooth and be beneficial to the resin single. The body infiltrates, but there is a high clinical sensitivity. The degradation of the collagen fibers can lead to the degradation of the bonding interface. The main component of the dentin matrix is I collagen fiber, and the dentin bonding interface (dentin hybrid layer, DHL) and the mass of the mixed layer are formed by the micromechanical locking of the resin monomers. There is an endogenous protein hydrolase in dentin matrix, called matrix metalloproteinase (matrix metalloproteinases, MMPs), which can degrade the collagen fibers exposed in the mixed layer, which leads to the aging of the bonding interface and the decrease of bond effect. In recent years, many kinds of MM have been reported at home and abroad. The application of Ps inhibitors to dentin resin bonding interface can effectively delay the aging of the mixed layer, improve the bond strength and durability.
Objective:
On the basis of all acid etching water wet bonding technology, this experiment uses Adper Single Bond2 system, uses chlorhexidine (Chlorhexidine, CHX) and minocycline (Minocycline, MI) as the MMPs inhibitor to pretreat dentin bonding interface, and through the micro tensile strength test (Microtensile Bonding Strength, MTBS) and field emission scanning electron microscope (field emission scanning electron microscopy) N in-lens scanning electron microscope, FEISEM) observation section type and microscopic morphology, combined with 10% sodium hypochlorite solution (Sodiumhypochlorite, NaOCl) simulation in vitro bonding interface aging test, analyze the effect of different MMPs inhibitors on the bond strength and durability of dentin resin bond, and provide data support for morphological study and clinical study. Hold, improve the effect evaluation.
Materials and methods:
A total of 45 dental caries free molars were extracted for 2 weeks. According to the different coating inhibitors of dentin bonding interface, they were divided into three groups: acid corrosion group, CHX group and MI group. The teeth were removed from the crown enamel and exposed to the shallow layer of dentin. After acid etching, the dentin bonding interface was pretreated, the tree fat was repaired and the 1 x 1mm2 was cut along the vertical direction of the adhesive surface. Under the stereoscopic microscope, 45 specimens with no defect and no micro crack were selected under the stereoscopic microscope. According to the different aging time of the 10%NaOCl simulation interface, the specimens were randomly divided into 3 subgroups: the aging group, the aging 5min group, the aging 10min group, and each subgroup of 15 specimens. The microtensile strength test was performed after the preparation was completed, statistics and statistics. Data analysis and field emission scanning electron microscope (SEM) were carried out to observe the type of section and the microstructure of fracture surface.
Result:
SPSS20.0 statistical software was used to analyze the data. The difference of bond strength in group CHX was statistically significant when it was not aging, aging, 5min and aging 10min, all of which were higher than that of the control group (P0.05), and the bond strength of aging 10min in MI group was slightly higher than that in the control group, but the difference was not statistically significant (P0.05).
Conclusion:
1. chlorhexidine, as MMPs inhibitor pretreated dentin bonding interface, can significantly improve the bonding strength of dentin resin at all time points, the mixed layer is more uniform, the resin permeation is more fully, the resin process is thicker and longer, and it is closer to the dentinal tubule.
2. chlorhexidine has protective effect on the bonding layer of 10%NaOCl under simulated aging. With the prolongation of aging time, the degradation degree of the mixed layer is small, and the degradation of collagen fibers by MMPs is slowed down, and the aging progress of the bonding interface is controlled and the adhesion durability is improved.
3. minocycline, as an inhibitor of MMPs, pretreated dentin bond interface, which improved the bonding strength of dentin resin immediately and after aging, but there was no significant difference.
The protective effect of 4. minocycline on the bonding layer of 10%NaOCl under simulated aging is not obvious. As the aging time prolongs, the degradation of mixed layer and the degradation of collagen fiber have not been obviously improved. Therefore, the study of minocycline as a MMPs inhibitor in the mixed layer of dentin bonding interface still needs to be further explored.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.3

【共引文獻(xiàn)】

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