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研究生:曾琬瑜
研究生(外文):Tseng Wan Yu
論文名稱:牙本質黏著劑對人體牙髓造纖維細胞的毒性
論文名稱(外文):Cytotoxicity of Dentin Bonding Agents on Human Pulp Fibroblasts
指導教授:陳瑞松陳瑞松引用關係鄭景暉鄭景暉引用關係劉靜誠
指導教授(外文):Chen Ruey SongJiiang JengLiu Ching-Cheng
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:臨床牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:1999
畢業學年度:87
語文別:中文
論文頁數:78
中文關鍵詞:牙本質黏著劑牙髓細胞毒性牙本質薄片照射強度造纖維細胞
外文關鍵詞:Dentin Bonding Agentpulpfibroblastcytotoxicitydentin barrierlight intensity
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美容牙科已經成為現代人的新需求,複合樹脂的沿革更是日新月異,牙本質黏著劑也在這個舞台扮演重要的角色。1955年Buonocore 以酸蝕處理牙齒表面,可得到更好的黏著效果,乃牙釉質黏著劑和牙本質黏著劑發展的起始;之後,牙本質黏著劑的研發更是漸漸受到重視。
最新的牙本質黏著劑使用順序是,除去齲齒組織後,以35%磷酸塗抹窩洞表面(total etching technique)約15秒後,以水沖洗並且徐徐吹之,以保留部分水分(稱為wet bonding te-chnique);之後塗上底劑(primer)和牙本質黏著劑(dentin bonding agent),以鹵素光照射聚合;最後加上複合樹脂(com-posite resin),再加以照射。伸入牙本質小管中的牙本質黏著劑(以下簡稱DBA)會和牙本質小管中的液體(dentinal fluid)接觸,部分尚未聚合的單體(monomer)或是寡體(oligomer)便會溶解在液體中,隨之進入牙髓組織並且對牙髓組織造成潛在的影響。
究竟DBA對牙髓組織是否會造成毒性反應呢?各家學者皆有不同的看法。根據不同的學者,應用不同的研究方法,所得結果也不一樣。本實驗採取體外實驗的方式,測試在不同的實驗情形下DBA的毒性。首先是分析不同聚合程度時,DBA的細胞毒性。可以發現光強度在300mcv之聚合程度時,毒性最小,細胞存活率是負對照組的74%,細胞形態和負對照組相似;在光強度100mcv時,存活率只有30.2﹪,細胞形態較圓,細胞突起縮短;而200mcv時,存活率為50.6﹪,細胞形態介於100 mcv和300 mcv之間。第二部分的實驗是測試新一代的單瓶DBA毒性。可以發現在1/1000(v/v)稀釋濃度下時,三種DBA:Sprint(SP),Single Bond(SB),和Prime & Bond 2.1(PB),都具有相當大的毒性,細胞存活率各為:18.7﹪,19.6﹪,15.7﹪。在1/2000(v/v)的濃度時,三者都具有毒性,但比1/1000時毒性小。在1/4000(v/v)時,SP,PB和負對照組沒有統計上的差異,但是SB仍然具有毒性,為負對照組的83.1﹪。最後是透過不同厚度之牙本質薄片(Dentin Barrier)時,比較其毒性大小。經由實驗結果可知,當牙本質厚度越小時,毒性就越大。
本實驗結果顯示,DBA的濃度越高,對牙髓造纖維細胞的毒性就越大。所以臨床操作時,DBA必須能夠充足的聚合;而且不同的DBA具有相似的潛在毒性,所以必須注意正確的操作。尤其在較深的齲齒,剩餘的牙本質很薄,更有可能對牙髓組織造成毒性;所以需注意保護牙髓和良好的邊緣完整性,以減少牙髓組織傷害與發炎,達到最好的治療效果。
Esthetic dentistry has become more and more important today. The advance of composite resin and dentin bonding technique is quickly, too. In 1955, Buonocore applied acid on the tooth surface to “render the tooth surface more receptive to composite resin adhesion.” His pioneering experimental works led to major changes in the practice of dentistry. Now we are in the age of adhesive dentistry.
The current clinical procedures of composite resin restoration are described as below. Briefly, following cavity preparation, the exposed dentin and enamel surfaces are etched with 35% phosphoric acid for 15 second, so called “ total etching”. Then primer and the DBA are sequentially applied, and a visible light is used to cure the DBA. The composite resin is packed into the prepared cavity and then cured by visible light. Finally, the restoration is finished and polished with rotary instruments.
Acid etching technique is used to remove smear layer, decalcify the dentin surface, and expose the collagen network. The DBA will penetrate into the collagen network, and directly contact with the dentinal fluid. Some monomers and oligomers that dissolved in the dentinal fluid will influence the biological functions of dental pulp.
It is still not concluded whether DBA will impair the biological functions of the pulp. Previous results are quite controversial possibly due to different research methods and materials applied. In the present study, the cytotoxicity of DBA were tested in different experimental conditions. At first, the influence of different curing intensity on DBA cytotoxicity was measured. In the curing intensity of 300 mcV, the cytotoxicity of DBA is less evident, and the cell numbers decreased by 26﹪following 5 days of exposure. In the 2nd experiment, cytotoxicity of 3 different concentrations of 3 DBA【Sprint(SP)、Single Bond(SB)and Prime&Bond 2.1(PB)】on the dental pulp were tested. The results showed that , when the DBA was diluted with culture medium at a ratio of 1:1000(v/v)and 1:2000 , all DBAs show significant cytotoxicity. In the 1/2000 group, the DBAs still have cytotoxicity, but less than that of 1/1000. In 1/4000 group, there is no significant difference between SP, PB and negative control. In the last experiment, we tested whether different thickness(100μm, 300μm , and 500μm) of dentin barrier will affect the DBA cytotoxicity. The thinner the dentin slices, the more cytotoxicity it showed. There is also strong direct linear relationship between the thickness of dentin barrier and cytotoxicity.
When the concentration of DBA was elevated, its cytotoxicity to pulp would become more evident. So we have to notice:
1. The light intensity must be enough.
2. Different DBAs exert cytotoxicity to dental pulp cells to a similar extent, so DBAs should be carefully manipulated in clinical operative dentistry.
3. When the dental caries is deep and the remaining dentin thickness is thin, potential harmful effect of DBA on the pulp became possible. Therefore, good marginal sealing and adequate lining are important.
第一章 中文摘要6
第二章 英文摘要9
第三章 簡介11
第四章 文獻回顧14
第一節 牙本質的結構14
第二節 牙本質黏著劑的沿革16
第三節 酸蝕後的牙本質結構變化23
第四節 牙本質黏著劑的毒性24
第五節 目的27
第五章 材料與方法29
第一節 牙髓細胞的培養29
第二節 不同照射強度對DBA毒性的影響30
第三節 不同DBA之毒性測試31
第四節 不同牙本質薄片厚度的毒性影響32
第五節 細胞毒性的評估方法32
第六節 統計方法33
第六章 結果34
第一節 不同聚合程度牙本質黏著劑的毒性34
第二節 不同品牌單瓶黏著劑的毒性36
第三節 黏著劑透過不同厚度牙本質薄片的毒性40
第七章 討論41
第一節 體外實驗的優點和缺點41
第二節 濾出(LEACHABLE)的單體和毒性之間的關係44
第三節 實驗MODEL之比較45
第四節 不同DBA的毒性比較47
第八章 結論49
第九章 表格50
第十章 圖片56
第十一章 文獻參考75
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