臺灣博碩士論文加值系統

使用玻璃離子體 (glass ionomer cement, GIC）做為溝隙封劑 (pit and fissure sealant) 來預防齲齒的優點是，它可與牙釉質直接以化學鍵結合，並釋放氟離子保護牙齒；在偏遠地區使用玻璃離子體，可以省去繁複的牙齒表面處理。但在偏遠地區設備不足的情況，牙齒容易遭致唾液之污染。本研究目的是在臨床上，驗證我們過去所作的體外實驗(in vitro study)的結果；在不沖洗齒面之條件下，僅將唾液污染的牙齒表面吹乾後，使用玻璃離子體做為窩隙防齲封劑，是否可恢復玻璃離子體與牙釉質之黏著力，保持玻璃離子體於牙齒之咬合面等溝隙系統 (sealant retention)。
本實驗選取220位，年齡介於6至8歲之國小學童，其恆牙第一大臼齒已萌出兩顆以上（上顎或下顎）且無齲齒者。採用玻璃離子體 (glass ionomer cement, 簡稱GIC, Fuji IX GP）為溝隙封劑材料；以口腔分隔法 (split mouth) 的方式，隨機分配一邊為控制側，另一邊則為實驗側。控制側按廠商指示的步驟完成玻璃離子體塗佈，而污染實驗側則按本實驗室過去所得之結果，僅將受唾液污染的牙齒，以「吹氣乾燥」的方式處理牙齒表面後，塗佈玻璃離子體於臼齒之溝隙上。每隔3個月檢查一次，評估玻璃離子體是否仍黏著於牙齒表面上，該牙是否有蛀牙等變化情形。將評估結果所得之數據，以McNemar’s test做分析比較。觀察封填劑固著（retention）的情形，是否符合我們先前體外研究（in vitro study）的結果：被唾液污染的齒面經吹氣乾燥後，與按標準程度處理的齒面，塗佈玻璃離子體後，兩者是否有相當的固著率。178學童完成全程18個月的觀察。結果顯示，至12個月為止，被唾液污染的實驗側牙齒，其玻璃離子體之固著率與控制側相當；而18個月後的觀察則顯示實驗側固著率有下降的趨勢。
塗佈封劑後18 個月後，實驗側玻璃離子體完全固著率為 17.89%、部份固著率為35.27%、完全脫落比率為45.26%、 齲齒發生率為1.58%；控制側的結果依序為22.63%、42.10%、33.68% 及 1.58%。以齲齒發生率而言，實驗側和控制側並無差異，但是下顎比率高於上顎。根據目前的結果顯示，唾液污染齒面的玻璃離子體窩隙封劑之固著率在18個月之後明顯下降，因此建議在進行玻璃離子體窩隙封劑塗佈時，仍需做好潮濕控制，以提升其固著率。玻璃離子體窩隙封劑脫落後是否仍具有預防齲齒的功效，則需更長的觀察時間來驗證。

英文摘要
Objective: To evaluate the retention and efficacy of the GIC sealants on the saliva contaminated enamel surface after air-dry procedure in clinical situation. Method: The initial population consisted of 220 schoolchildren, ages 6-8 years, whose permanent molars were sound sealed. A GIC (Fuji IX) was used as sealant material. All sealants were placed in a school setting by the same dentist. The teeth were randomly assigned to control side on which the treatment procedures were followed with manufacture’s instruction. The contralateral tooth surface was intentionally contaminated with saliva then air-dried without rinse before sealant placement. Evaluations were done with a dental probe with light pressure. Double-blind recall examinations for sealant retention were done at 3 months intervals until 18 months. 178 subjects returned for evaluation after 18 months. Results: After 18 months, 17.9% of the sealed teeth showed complete present, 35.3% partial present without caries, 45.3% complete loss without caries, and 1.5% caries or filled on occlusal surface of the contaminated side. In control side, the corresponding figures were 22.6%, 42.1%, 33.7% and 1.6%, respectively. Statistical analysis (Chi square test) revealed that there were no significant difference between the retention rate of the experimental side and the control side in the study periods. As to caries incidence, there was no significant difference (McNemar’s test) between experimental side and control side. Conclusion: Air drying to the saliva contaminated enamel without rinse prior to GIC placement seems to have comparable retention rate to teeth with regular procedure.

目 錄
中文摘要……………………………………………………...1
英文摘要…….…..........……………………………………...3
前言………………………………………………….………..5
文獻回顧 …………………………………………….………8
研究目的…………………………………………………….19
材料與方法………………………………………………….20
結 果..……………………………………………………..25
討 論…..…………………………….……………………...28
結 論..............................................................................37
參考文獻 ………….........................................................38
附 表………………………………………………………...43
附 圖………………………………………………………...54


表 次
Table 1. Code for indicate the area of the pit and fissure pattern covered ……………….…………………………………. 43
Table 2. Codes for diagnosis of Caries ……….……..…………….44
Table 3. Frequency distribution of defs at baseline for the study population …………..………………………………..…. 45
Table 4. Numbers and distribution of the subjects studied ………. 46
Table 5. Retention rate of GIC sealant of first molars over 18-month evaluation …………………………………………..…. 47
Table 6. Retention rate of Fuji IX sealant of maxilla first molar over 18-month evaluation …………….……….……. 48
Table 7. Retention rate of Fuji IX sealant of mandibular first molar over 18-month evaluation ………………………………. 49
Table 8. Failure rate of Fuji IX sealant over 18-month evaluation.. 50
Table 9. Numbers and percentage of caries +filled teeth over 18 months evaluation…………………………...…………....51
Table 10. Areas of fissure sealant loss from the various maxillary molar surface during18-monthaluation ………….……....52
Table 11. Areas of fissure sealant loss from the various mandibular molar surfaces during 18-month evaluation..………..…...53




圖 次

Figure 1. Split-mouth design methods for this sealant study.................................................................................54
Figure 2.1 Comparison of sealant retention between the control side and experimental side after 3 month......55
Figure 2.2 Comparison of sealant retention between the control side and experimental side after 6 months..............56
Figure 2.3 Comparison of sealant retention between the control side and experimental side after 9 months…………...............57
Figure 2.4 Comparison of sealant retention between the control side and experimental side after 12 months…....................58
Figure 2.5 Comparison of sealant retention between the control side and experimental side after 18 months……………….59
Figure 3.1 Retention rate of maxilla and mandible after 3 months...60
Figure 3.2 Retention rate of maxilla and mandible after 6 months...61
Figure 3.3 Retention rate of maxilla and mandible after 9 months...62
Figure 3.4 Retention rate of maxilla and mandible after 12 months.63
Figure 3.5 Retention rate of maxilla and mandible after 18 months.64
Figure 4. Retention rate of sealant retained and sealant loss……...65

1.Arrow P, Riordan PJ. Retention and caries preventive effect of a GIC and a resin-based fissure sealant. Community Dent Oral Epidemiol 1995;23:282-5
2.Beck JD. Risk revisited. Community Dent Oral Epidemiol 1998;26: 220-5
3.Berry EA, Ward M,. Bond strength of resin composite to air-braded enamel. Quintessence Int. 1995;26:559-62
4.Blackwood JA, Dilley DC, Roberts MW, Swift EJ. Evaluation of pumice, fissure enameloplasty and air abrasion on sealant microleakage. Pediatr Dentstr 2002;24:199-203
5.Boksman L, Gratton DR, McCutcheon E, Plotzke OB. Clinical evaluation of a glass-ionomer cement as a fissure sealant. Quintessence Int 1987;18:707-9.
6.Brockmann SL, Scott RL, Eick JD. A scanning electron microscopic study of the effect of air polishing on the enamel-sealant surface. Quintessence Int. 1990;21:201-6.
7.Brocklehurst PR, Joshi RI, Northeast SE. The effect of air-polishing occlusal surface on the penetration of fissures by a sealant. Int J Paediatr Dent. 1992;123:157-62.
8.Brown LJ, Kaste LM, Selwitz RH, Furman LJ: Dental caries and sealant usage in US children, 1988-91: selected findings from the third national health and nutrition examination survey. J Am Dent Asso 1996;127:335-43
9.Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J den Res 1955;34:849-53
10.Buonocore MG. Caries prevention in pit and fissures sealed with an adhesive resin polymerized by ultraviolet light: a two-year study of a single adhesive application. J Am dent 1971; 82: 1090-93.
11.Brunelle JA, Carols JP. Change in the prevalence of dental caries in US schoolchildren, 1961-1980. J Dent Res 1982;61(Spec Iss): 1346-51
12.Brinelle JA. Oral Health of United States children. The National Survey of dental caries in US schoolchildren: 1986-87. National and regional finding. NIH pub no 89-2247. Washington, DC: US Department of Health and Human Services, 1989.
13.Charbeneau GT, Dennison JB. Clinical success and potential failure after single application of a pit and fissure sealant: a four-year report. J Am Dent Assoc 1979;98:559-642.
14.Chen CN, Huang GF, Guo MK. An in vitrostudy on restoring bond strength of a GIC to saliva contaminated enamel under unrinse condition. J Dentist 2002;30:189-94.
15.Croll TP, Nicholson JW. Glass ionomer cements in pediatric dentistry: review of the literature. PediatnDent 2002;24:423-9.
16.Derry C, Fyffe HE. A proposed method for assessing the quality of sealants—the CCC Sealant Evaluation System. Comm Dent Oral Epidemeiol 2001;29:83-91.
17.Eidelman E, Fuks AB, Chosack A: The retention of fissure sealants: rubber dam or cotton rolls in a private practice. J Dent Child 1983;50:259-61
18.Feigal RJ, Hitt J, Spleith C. Retaining sealant on salivary contaminated enamel. J Am Dent Asso 1993;124:88-97
19.Forss H, Saarni U-M, Seppa L. Comparison of glass-ionomer and resin-based fissure sealants: a 2-year clinical trial. Comm Dent Oral Epidemeiol 1994;22:21-4
20.Forss H, Halme E. Retention of a glass ionomer and a resin-based fissure sealants and effect on caries outcome after 7 years. Comm Dent Oral Epidemeiol 1998;26:21-5
21.Forsten L, Fluoride release and uptake by glass ionomers. Scand J Dent Res 1991;99:241-5
22.Frencken JE, Makoni F. Atraumatic restorative treatment and glass-ionomer sealants in a school oral health programme in Zimbabwe: evaluation after 1 year. Caries Res 1998;32:119-26.
23.Geiger SB, Gulayev S, Weiss EI. Improving fissure sealant quality: mechanical preparation and filling level. J Dent 2000;28:407-12
24.Going RE, Haugh LD, Grainger DA, Conti AJ. Four-year clinical evaluation of a pit and fissure sealant. J Am Dent Assoc 1977;95: 972-81.
25.Gray GB. An evaluation of sealant restorations after 2 years. British Dental Journal 1999;186:569-75
26.Gillcrist JA, Vaughan MP, Plumlee GN, Jr, Wade G. Clinical sealant retention following two different tooth cleaning techniques. J Public Health Dent. 1998;58:254-6
27.Gwinnet AJ. Bonding of restorative resins to enamel. Int Dent J 1988;38:91-6.
28.Harris NO, Garcia-Godoy F. Primary preventive dentistry. Asimon and Schuster Company 1999; 5th edition: London
29.Hitt JC, Feigal RJ. The effect of moisture contamination on sealant technique. J Dent Res 1989:68(special issue)
30.Hitt JC, Feigal RJ: Use of a bonding to reduce sealant sensitivity to moist contamination: an in vitro study. Pediat Dent 1992;14:41-6
31.Hormati AA, Fuller JL. Denehy GE. Effects of contaminateon and mechanical disturbance on the quality of acid-etched enamel. JADA 1980:100;34-8
32.Ho TFT, Samales RJ, Fang DTS. A 2-year clinical study of two glass ionomer cements used in the atraumatic restorative treatment (ART) technique. Comm Dent Oral Epidemeiol 1999;27:195-201.
33.IADR sealant symposium. J Dent Res 1991;70(special issue): 266
34.Katsuyama S, Ishikawa, Fujii B. Glass ionomer dental cement-The materiall and their clinical use-1st edition,1993, IEA(English edition)


35.Kanellis MJ, Warren JJ, Levy SM. A comparison of sealant placement techniques and 12- month retention rates. J public Health Dent. 2000;60:53-6
36.Karlzen-Reuterving G, van Dijken JW. A three-year follow-up of glass ionomer cement and resin fissure sealant. ASDC J Dent Child 1995; 62:108-10
37.Komatu H, Shimokobe H, Kawakami S. Caries-preventive effect of glass ionomer sealant reapplication study: study presents 3-year results. J Assoc Dent Am 1994:125;543-9
38.Li SH, Kingman A, Forthofer R, Swango P. Comparison of tooth surface-specific dental caries attack patterns in US children from two national surveys. J Dent Res 1993;72:1398-1405
39.Lygidakis NA, Oulis KI, Christodoulidis A. Evaluation of fissure sealants retention following four different isolation and surface preparation techniques: four years clinical trial. J Clin Pediatr Dent. 1994;19:23-5
40.Lussi A. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries. Careis Res 1999:33;261-6
41.McKnight-Hanes C, Whitford GM. Fluoride release from three glass ionomer materials and the effects of varnishing with or without finishing. Caries Res 1992;26:345-350.
42.Mejare I, Mjor I. Glass ionomer and resin-based fissure sealants: a clinical study. Scand J Dent Res 1990;98:345-50
43.Mount GJ. Glass Ionomers：A review of their current status. Operative Dentistry 1994;24:115-124
44.Pardi V, Pereira AC. A 5-year evaluation of two glass-ionomer cements used as fissure sealants. Comm Dent Oral Epidemeiol 2003; 31:386-91.
45.Pardi V, Pereira AC, Mialhe FL, Meneghim MdeC, Ambrosano GM. Six-year clinical evaluation of polyacid-modified composite resin used as fissure sealant. J Clin Pediatr Dent 2004;28:257-60
46.Petersson G.., Twetman S., Bratthall D. Evaluation of a computer program for caries risk assessment in schoolchildren. Caries Res 2002; 36: 327-340
47.Pereira AC, Pardi V. Clinical evaluation of glass-ionomers used as fissure sealants: twenty-four-month results. ASDC J Dent Child 2001; 58:168-74.
48.Poulsen S, Beiruti N, Sadat N. A comparison of retention and the effect on caries of fissure sealing with a glass-ionomer and a resin based sealant. Comm Dent Oral Epidemeiol 2001;29:298-301.
49.Raadal M, Laegreid O, Laegreid KV, Hveem H, Korsgaard EK, Wangen K. Fissure sealing of permanent first molars in children receiving a high standard of prophylactic care. Comm Dent Oral Epidemeiol 1984;12:65-8.
50.Ripa LW. The current status of pit and fissures sealants. A review. J Can Dent Assoc 1985;5:367-38

51.Ripa LW, Leske GS, Varma AO. Longitudinal study of the caries susceptibility of occlusal and proximal surfaces of the first permanent molars. J Pub Health Dent 1988;48:8-13
52.Ripa LW. Has the decline in caries prevalence reduced the need for fissure sealants in the UK? A review. J Paediatr Dent 1990;6:79-84.
53.Rock Wp, Foulkes EE, Perry H, Smith AJ. A compareative study of fluoride-releasing resin ans glass ionomer materials used as fissure sealants. J Dent 1996;24:275-80
54.Roydhouse RH: Prevention of occlusal fissure caries by use of a sealant. J Dent Child 1968;35:253-62
55.Seppa L, Forss H: Resistance of occlusal fissures to demineralization after loss of glass ionomer sealants in vitro. Pediatr Dent 1991;13:39-42
56.Shi XQ, Welander U, Angmar-Mansson B: Occlusal caries detection with Kavo DIAGNOdent: an in vitro comparison. Caries Res 2000;34: 151-8
57.Siegal MD.Workshop on guidelines for sealant use. J Publ Health Dent. 1995;55(special issue):263-73
58.Silverstone LM: State of the art on sealant research and priorities for further research. J Dent Edu 1984;48:107-18
59.Silverstone LM, Hicks MJ, Featherstone MJ. Oral fluid contamination of etched enamel surface: an SEM study. J Am Dent Assoc 1985;110: 329-32
60.Simenson RJ. The clinical effectivence of a colored pit ans fissure sealant at 36 months. JADA 1981;102:323-7
61.Simenson RJ Retention and effectiveness of dental sealant after 15 years. J Am Dent Assoc 1991;122:34-42
62.Simenson RJ. Pit and fissure sealant: review of the literature. Pediatr Dent 2002;24:393-414
63.Songpasisan Y, Bratthall D, Phantumvanit P. Effects of glass ionomer cements, resin-based pit and fissure and HF application on occlusal surface in a developing country field trial. Comm Dent Oral Epidemeiol 1995;23:25-9
64.Straffon LH, Dennison JB, More FG: Three-year evaluation of sealant: effect of isolation on efficacy. J Am Dent Assoc1985;110:714-7
65.Walker J, Floyd K, Jacobsen J, Pinkham JR. The effectiveness of preventive resin restoration in pediatric patients. ASDC J Dent Child 1996;63:338-40
66.Weerheijm KL, Soet JJ de, Amerongen WE van. The effect of glass-ionomer cement on carious dentine: An in vivo study. Caries Res 1993;27:417-23.
67.Welbury R, Raadal M, Lygidakis N. Guidelines on the use of the pit and fissure sealants in Paediatric dentistry: an EAPD policy document .2004
68.Wendt LK, Koch G, Birkhed D. The retention and effectiveness of fissure sealant in permanent molars after 15-20 years. Comm Dent Oral Epidemeiol 2001a;29:302-7

69.WHO Oral Health Surveys, Basic methods, 4th ed. Geneva,1997
70.Wilson JP. Preventive dentistry. Dent Digest 1895;1:70-2
71.Zervou C, Kugel G, Leone C, Zavras A, Doherty EH, White GE. Enameloplasty effects on microleakage of pit and fissure sealants under load: an in vitro study. J Clin Pediatr Dent. 2000;244:279-85.