臺灣博碩士論文加值系統

　　本研究目的在評估加氟牙本質小管堵塞劑（包括A液與B液， A液含10 wt％ CaCl2　與 30 wt％ polyethylene glycol；B液含5 wt％ Na2 HPO4與0.3 wt％ NaF）治療牙本質過敏症之臨床效果；並以體外實驗探討其作用機序。
臨床治療實驗有32位患者共92顆牙齒接受本劑治療，以銳利探針定位出牙本質敏感區域，利用牙科治療椅噴槍的冷空氣刺激，記錄病人疼痛級數，（0為不痛，1為輕度疼痛，2為中度疼痛，3為極度疼痛無法忍受）。以本劑之A與B液分別塗抹磨擦患齒10秒，重複三次。治療效果依據術後與術前記錄之病人敘述疼痛級數相比較，得到90.2％立即治療有效之成功率。經2週，1個月，3個月，6個月追蹤，除了一位女病人在2週回診時描述牙本質敏感症有復發情形。其餘病例情況良好，無復發現象‧經過探尋而查知此病患是個習慣每天含一顆Vit C以預防感冒者。
體外實驗使用86顆拔除後無齲齒的人類單根牙，由CEJ往牙根方向移除3~4mm區域的牙骨質，並浸泡0.5M EDTA(PH7.4)1分鐘，繼之以加氟牙本質小管堵塞劑塗抹牙齒(步驟與臨床治療相同)。將86顆牙齒隨機分成Ａ至Ｅ組，Ａ組8顆牙齒塗抹後以掃描式電子顯微鏡(scanning electron microscope, SEM) 觀察牙齒表面情形。B組15顆牙齒劈開後，觀察縱切面。C組15顆牙齒刷牙5分鐘以後，劈開牙齒觀察縱切面。D組24顆牙齒刷牙5分鐘以後，浸泡蒸餾水一，二，三天觀察牙齒表面。E組24顆牙齒刷牙5分鐘以後，浸泡維他命C水溶液一，二，三天觀察牙齒表面。
以掃描式電子顯微鏡觀察牙齒表面可見到細小結晶顆粒堵塞住牙本質小管入口（主要組成是氟磷灰石），劈開牙齒後觀察縱切面發現緻密結晶沉澱堵塞牙本質小管達1.5-2.5μm，且刷牙能移除的只有牙本質小管外面即表面的結晶鹽沉澱，小管內結晶沉澱堵塞情形仍良好。然而，結晶沉澱無法抵抗維他命Ｃ水溶液的侵蝕，在37℃環境下，浸泡在飽和維他命Ｃ水溶液3天，以掃描式電子顯微鏡觀察結晶沉澱被酸蝕所造成的缺口很明顯。
本研究的結論為加氟牙本質小管阻塞劑治療牙本質過敏症有高達90.2％的立即治療有效成功率。體外實驗中以掃描式電子顯微鏡觀察，本劑作用所產生氟磷灰石結晶顆粒細小，易於堵塞進入牙本質小管，達到去敏感效果。酸性食物（例如維他命C）對阻塞劑之破壞而造成敏感症復發遠大於刷牙之機械性破壞。

　　The purpose of this study was to evaluate the clinical effectiveness of a fluoridated dentinal tubule-occluding agent on treating dentin sensitivity. The agent composed of “A” solution and “B” solution. There were 10％ CaCl2　, 30％ polyethylene glycol in “A” solution ，while 5％ Na2 HPO4 ，0.3％ NaF in “B” solution. Some related in vitro experiments were designed to investigate its mechanism.
Thirty-two subjects (ninety-two teeth) were selected in the study. The sensitive area was identified by mechanical stimulation using a sharp explorer. Cold air from a dental three-way syringe would elicit sharp pain. The pain scores patients described were recorded. (0:normal sensation, 1:mild discomfort, 2:moderate, 3:severe intolerable)
The application of ”A” solution 10 second followed by “B” solution repeated 3 times resulted in immediate relief from dentin sensitivity in 90.2％ of cases treated. After two weeks, one month, three months, six months observation period, no recurrence was found, except for a female patient.
As for the in vitro studies, the dentin surface of 86 human single root teeth were exposed and treated with 0.5M EDTA solution (PH7.4) for 1 min. The treatment procedure is similar to clinical sequence as previously described. The samples were classified into A-E group. Group A and B observed the surface texture and the depth of the agent occluding dentinal tubule by SEM; Group C was brushed for 5 min, and then observed the depth penetrated by the agent. Group D and E were soaked in distilled water and saturated vitamin C solution separately for 1,2,3 days.
SEM observation revealed that fine crystal deposition covered the treated dentin surface, and the depth of agents occluding dentinal tubule were 1.5-2.5μm. Brushing removed only the surface crystal deposition and those in the tubule were remained.
Crystal deposition was not dissolved by distilled water in 3 days. However, crystal deposition can be dissolved by saturated vitamin C solution in 3 days.
It is concluded that topical application of this fluoridated dentinal tubule-occluding agent resulted in immediate relief from dentin hypersensitivity in 90.2％ of cases treated. Crystal deposition was densely occluded dentinal tubule to 1.5-2.5μm. However acid dietary, taking vitamin C solution for example, could destroy crystal depositions more from the brushing action.

壹、 摘要 1
貳、 緒論 3
參、 研究目的 9
肆、 材料與方法 10
伍、 結果 15
陸、 討論 18
柒、 結論 24
捌、 參考文獻 25
玖、 附表與附圖 29
拾、 英文摘要 43

(1)Flynn J., Galloway R., Orchardson R.: The incidence of hypersensitivite teeth in the west of Scotland. J Dent Vol.13,No.3 : 230－236, 1985.
(2)Addy M.: Etiology and clinical implications of dentin hypersensitivity. Dent Clin North Am Vol.34,No.3 : 503－504, 1990.
(3)Liu H.C.,Lan W.H.,Hsieh C.C.: Prevalence and distribution of cervical dentin hypersensitivity in a population in Taipei, Taiwan. J Endod Vol.24,No. 1:45-7,1998.
(4)Addy M., Mostafa P., Newcombe R.G.: Dentin hypersensitivity :the distribution of recession, sensitivity and plaque. J Dent Vol.15：242－248, 1987.
(5)Trowbridge H., Silver D.: A review of current approaches to in-office management of tooth hypersensitivity. Dent Clin North Am Vol.34：561－581, 1990.
(6)Addy M., Absi E., Adams D.: Dentin hypersensitivity：the effects in vitro of acids and dietary substances on root planed and burred dentin. J Clin Periodontol Vol.14：274－279, 1987.
(7)Clark D., Woo G., Silver J.: The influence of frequent ingestion of acids in the diet on the treatment for dentin sensitivity. J Can Dent Assoc Vol.56,No.12：1101－1103, 1990.
(8)Spigest O.: Oral symptoms in bulimia nervosa. A survey of 34 cases. Acta odontol Scand Vol. 49：335－339, 1991.
(9)Uchida A., Wakano Y., Fukuyama U., Miki T., Iwayama Y., Okada H.: Controlled clinical evaluation of a 10 percent strontium chloride dentifrice in treatment of dentin hypersensitivity following periodontal surgery. J Periodontol Vol.51,No.10：578－581, 1980.
(10)Colbert B., Fischer C.: Dentin hypersensitivity：a review. Endod Dent Traumatol Vol. 7：145－152, 1991.
(11)Brashear A.D. :The innervation of the teeth . An analysis of nerve fiber composition of the pulp and periodontal tissue and their probable significance. J Comp Neural Vol.64:169-185, 1936.
(12)Brannstrom M., Astrom A.: A study on the mechanism of pain elicited from the dentin. J Dent Res Vol.43,No.4:619-25,1964.
(13)Lilja J., Nordenvall K.J., Brannstrom M.: Dent sensitivity, odontoblasts and nerves under desiccated or infected experimental cavities. Swed Dent J Vol. 6：93－103,1982.
(14)Brannstrom M., Linden A., Strom A.：The hydrodynamics of dentin and pulp fluid：Its significance in relation to dental pain. Caries Res Vol.1：310－317, 1967.
(15)Brannstrom M., Johnson G., Nordenvall K.J.: Transmission and control of dentinal pain： resin impregnation for the desensitization of dentin. J Am Dent Assoc Vol.99：612－8, 1979.
(16)Hirvonen T., Narhi M.: The excitability of dog pulp nerves in relation to the condition of the dentin surface. J Endod Vol.10:294-8,1984.
(17)Louis P., Gangarosa Sr.: Current strategies for dentist-applied treatment in management of hypersensitive dentin. Archs Oral Biol Vol.39, Suppl.: 101S-106S.1994.
(18)Holborow D.W.: A clinical trial of a potassium oxalate system in the treatment of sensitive root surfaces. Archs Oral Biol Vol.39, Suppl.: 134S, 1994.
(19)Calamia J., Cooper H., Styner D., Rattet A., Kaim J.: Effect of Amalgambond (a 4-META bonding agent) on cervical sensitivity. J Dent Res Vol.71,(special issue):132. Abstract, 1992.
(20)藍萬烘,劉興成，半導體雷射治療齒頸部牙本質過敏症之研究.中華牙誌 Vol.15,No.1：36-43, 1996.
(21)Imai Y., Akimoto T.: A new method of treatment for dentin hypersensitivity by precipitation of calcium phosphate in situ. Dental Materials Journal Vol.9, No.2 :167－172, 1990.
(22)Ikemura R.: Studies on new treatment agents for dentin hypersensitivity. 日齒保誌Vol.36 ,No. 6：1686－1689, 1993.
(23)Wichgers G., Emert L.: Dentin hypersensitivity. General Dentistry MAY-JUNE : 225-230, 1996.
(24)Bodie D., Darl M., John A.：Concepts and Models of inorganic chemistry.3rd Edition: 379-440.
(25)Grossman L.I.：The treatment of hypersensitive dentin. J Am Dent Assoc Vol. 21：2050-2053, 1934.
(26)Newman C.: Clinical Periodontology. 8th Edition: 796-798,1996.