【摘要】：背景齲病是人類口腔中發(fā)病率較高的一種常見疾病。早期釉質(zhì)齲牙體外觀看似無齲壞,但釉質(zhì)內(nèi)部已出現(xiàn)脫礦,部分釉柱結(jié)構(gòu)已遭到破壞,從而出現(xiàn)孔隙,致齲微生物以這些孔隙為通道向釉牙本質(zhì)界方向滲入,加快釉質(zhì)的進(jìn)一步破壞,在牙表面出現(xiàn)點(diǎn)狀或者塊狀的顏色異常,稱為白堊斑,此區(qū)域的牙釉質(zhì)亮度及透明度均較正常牙釉質(zhì)低。在臨床上,白堊斑(vhite spot lesions)是釉質(zhì)早期齲的一種表現(xiàn),多見于正畸矯形的人群。現(xiàn)階段,口腔醫(yī)生針對早期非齲洞性釉質(zhì)齲(包括釉質(zhì)白堊斑)已提出兩個微創(chuàng)治療方案：一是在釉質(zhì)脫礦的基礎(chǔ)上,利用藥物使已溶解的有機(jī)物還原,即再礦化；二是用流動性大的樹脂材料沿著已破壞的釉柱孔隙滲入到齲損部位,充填其中,從而隔斷致齲微生物向釉質(zhì)深處進(jìn)展。在臨床上,常用的再礦化藥物為含氟制劑,對于氟能促進(jìn)早期齲再礦化的研究已碩果累累。然而,關(guān)于堵塞脫礦區(qū)孔隙的研究甚少,尚未得到口腔醫(yī)生的一致認(rèn)可,此區(qū)可謂空白。近年來,對于非齲洞性釉質(zhì)齲的治療,出現(xiàn)了一種微創(chuàng)新技術(shù)——滲透。樹脂滲透是一項(xiàng)阻斷齲進(jìn)展的微創(chuàng)技術(shù),滲透樹脂在治療非齲洞性釉質(zhì)齲過程中不需備洞,避開了傳統(tǒng)充填治療過程中對齲損周圍正常牙釉質(zhì)地切削。綜合國內(nèi)外的大量文獻(xiàn)發(fā)現(xiàn),國內(nèi)外關(guān)于滲透樹脂在早期釉質(zhì)齲方面的治療,報(bào)道很少。本研究借助國外學(xué)者的研究方法,創(chuàng)新性地開展?jié)B透樹脂在乳牙方面的研究,同時從滲透時間、酸蝕劑的選擇以及粘結(jié)劑的應(yīng)用三方面研究了滲透樹脂的滲透性,為滲透樹脂在臨床上更有效地應(yīng)用在一定程度上提供了參考依據(jù)。目的通過對滲透樹脂滲透時間、酸蝕劑的選擇以及粘結(jié)劑的應(yīng)用等滲透性的體外研究,為臨床正畸白堊斑以及早期釉質(zhì)齲提供理論依據(jù)和一種無痛微創(chuàng)的治療選擇。材料和方法1.滲透樹脂在不同滲透時間對早期人工釉質(zhì)齲滲透深度的影響：選擇正畸拔除的健康無齲的前磨牙制成釉質(zhì)塊,先制備人工釉質(zhì)齲模型,隨機(jī)分成5組,每組10個標(biāo)本,用滲透樹脂分別滲透1min,2min,2.5min,3min,4min,然后光固化60s。然后再切片打磨制成標(biāo)本,用倒置熒光顯微鏡觀察標(biāo)本,測量齲損深度LD和滲透深度PD,計(jì)算滲透百分?jǐn)?shù)PP(PP=PD/LD×100%),采用多樣本秩和檢驗(yàn)統(tǒng)計(jì)分析滲透深度和時間的關(guān)系。2.不同酸蝕劑作用于乳牙早期人工釉質(zhì)齲對滲透樹脂滲透深度的影響：選取60顆正常替換拔除的健康無齲的第一乳磨牙,先制備人工釉質(zhì)齲模型,隨機(jī)分成A、B兩組,每組30個標(biāo)本,在組內(nèi)又分為3組,分別用15%HCL和37%H3P04的酸蝕劑酸蝕60s,90s,120s,均涂布滲透樹脂滲透3min,光固化60s。再切片制成標(biāo)本,用倒置熒光顯微鏡觀察并測量齲損深度LD和滲透深度PD,計(jì)算滲透百分?jǐn)?shù)PP,采用SPSS13.0軟件統(tǒng)計(jì)分析不同酸蝕劑不同酸蝕時間對滲透深度的影響。3.粘結(jié)劑作用于早期人工釉質(zhì)齲對滲透樹脂滲透深度的影響：選擇正畸拔除的健康無齲無裂紋的第一前磨牙30顆,先制備人工釉質(zhì)齲模型,再用15%鹽酸酸蝕2min,羅丹明染色后,隨機(jī)分成3組,每組10個標(biāo)本,第一組涂布粘結(jié)劑和滲透樹脂,第二組只涂布粘結(jié)劑,第三組只涂布滲透樹脂3min,均光固化60s。然后再打磨成標(biāo)本,在倒置熒光顯微鏡下觀察并測量齲損深度LD和滲透深度PD,計(jì)算滲透百分?jǐn)?shù)PP,采用SPSS13.0統(tǒng)計(jì)分析粘結(jié)劑對滲透深度影響。結(jié)果1.滲透樹脂在1min的滲透深度明顯小于3min的滲透深度。滲透樹脂在2.5min時能夠達(dá)到最大脫礦深度的90%,在3min時能基本達(dá)到釉質(zhì)脫礦深度,再增加滲透時間對滲透深度不會產(chǎn)生明顯影響,差異無統(tǒng)計(jì)學(xué)意義。2.磷酸組的滲透深度明顯小于鹽酸組,滲透百分比也明顯低于鹽酸組,37%H3PO4酸蝕120s后滲透樹脂的滲透深度能達(dá)到乳牙釉質(zhì)脫礦深度的60%,而15%HCL酸蝕60s后滲透樹脂的滲透深度能達(dá)到乳牙釉質(zhì)脫礦深度的70%,在酸蝕90s和120s滲透樹脂基本能完全滲透,兩者之間的差異無統(tǒng)計(jì)學(xué)意義。3.粘結(jié)劑組的滲透深度明顯小于滲透樹脂組以及粘結(jié)劑和滲透樹脂結(jié)合組,滲透樹脂組的滲透深度稍小于粘結(jié)劑和滲透樹脂結(jié)合組,兩組之間無明顯統(tǒng)計(jì)學(xué)差異。粘結(jié)劑的滲透能達(dá)到釉質(zhì)齲脫礦深度的20%,滲透樹脂組以及粘結(jié)劑和滲透樹脂結(jié)合組均能達(dá)到最大的滲透深度。結(jié)論1.3min的滲透時間基本能達(dá)到早期釉質(zhì)齲的最大脫礦深度。2.用15%鹽酸酸蝕90s-120s可以有效去除乳牙早期釉質(zhì)齲表面的玷污層,使?jié)B透樹脂能基本達(dá)到最大的滲透。3.粘結(jié)劑的應(yīng)用沒有阻礙滲透樹脂的滲透,不會減小滲透樹脂的滲透深度。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R781.1

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