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研究生:陳俊志
研究生(外文):Chun-Chih Chen
論文名稱:齲齒病灶區經雷射處理後其抗酸性之評估
論文名稱(外文):Evaluation of Acid Resistance of Lased Carious Lesions
指導教授:黃純德黃純德引用關係
指導教授(外文):Prof. Shun-Te Huang, Ph.D.
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱: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:2000
畢業學年度:88
語文別:中文
論文頁數:181
中文關鍵詞:齲齒病灶區雷射抗酸性
外文關鍵詞:Carious LesionLaserAcid Resistance
相關次數:
  • 被引用被引用:4
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
已有許多研究指出,使用雷射處理健康的牙釉質表面,會使其產生物理及化學上的變化,包括釉質稜柱的熔融再結晶和內部成分的改變,並導致抗酸性的增強。而面對臨床上常見的初期齲齒病灶區及窩洞齲齒病灶區,為了要達到健康齒質的最大量程度保留,我們以Nd:YAG雷射和CO2雷射來取代傳統的窩洞處理,希望能藉由初期齲齒病灶區及窩洞齲齒病灶區結構的改變,增加此區域的抗酸性。
選擇恆牙小臼齒80顆,從每顆牙的唇 (頰) 側面切割出3塊牙釉質試片,總共有240個樣本。隨機分成8組, 4組進行乳酸溶液侵蝕,另4組進行酸鹼循環溶液侵蝕。乳酸溶液侵蝕組中,再依浸泡時間分成4組,依次為浸泡1天、2天、5天、9天。酸鹼循環溶液侵蝕組也做相同的分組,以進行齲齒病灶區的形成。齲齒病灶區形成後,各組內樣本再隨機分成3小組。一為不做任何雷射處理的對照組;二為Nd:YAG雷射處理組;三為CO2 雷射處理組。Nd:YAG雷射與CO2 雷射的能量密度皆設定為83.33 J/cm2。雷射處理完成後,各小組樣本再依之前形成齲齒病灶區的條件置於侵蝕液中1天、2天、5天、9天。侵蝕完成取出後,利用離子分析儀分析侵蝕液中由牙齒表面溶出的鈣離子濃度,並以電子顯微鏡觀察各樣本表面型態的變化。
在電子顯微鏡下的觀察,乳酸溶液侵蝕組中不做雷射處理者,表面的破壞程度隨著浸泡時間加長而愈益嚴重,尤其在浸泡9天的組別中,可見明顯的第一型與第二型之酸蝕型態與裸露之牙釉質稜柱。Nd:YAG雷射處理組在熔融與再結晶後,出現了直徑大小不一的火山口狀坑洞與龜裂痕跡。而CO2 雷射處理組則不僅產生熔融與再結晶的現象,經再次乳酸侵蝕後也出現了第一型與第二型之酸蝕型態。浸泡九天者,因為破壞情形較為嚴重,因此在Nd:YAG雷射處理組與CO2 雷射處理組中,皆顯示了高溫產生的熔融表面層出現在不同的平面上。酸鹼循環溶液侵蝕組中不做雷射處理者,表面皆無明顯的破壞現象,且可見些許結晶顆粒附著在表面。Nd:YAG雷射處理組與乳酸溶液侵蝕組類似,出現了直徑大小不一的火山口坑洞,並有龜裂穿越坑洞的底部。CO2 雷射處理組出現了整片熔融再結晶的現象並有龜裂的痕跡,在表面也可見結晶附著其上。
在鈣離子濃度分析中,無論是乳酸溶液侵蝕組或是酸鹼循環溶液侵蝕組,經由雷射處理的樣本其所溶出的鈣離子濃度皆比未經雷射處理者低,經One-way ANOVA的檢定後在統計學上呈現出顯著的差異性 ( P < 0.05 ),不過Nd:YAG雷射處理組與CO2 雷射處理組間則沒有顯著的差異 ( P > 0.05 )。另外,取乳酸溶液侵蝕組各組的第一天鈣離子溶出濃度來比較,可知無論是Nd:YAG雷射處理組或是CO2 雷射處理組,浸泡乳酸一天以形成齲齒者,溶出的鈣離子濃度低於浸泡2天、5天、9天形成齲齒者,且在統計上具顯著的差異性 ( P < 0.05 ) 。同樣地,取酸鹼循環溶液侵蝕各組的第一天鈣離子溶出濃度來比較,無論是Nd:YAG雷射處理組或是CO2 雷射處理組,浸泡酸鹼循環溶液1天、2天、5天、9天以形成齲齒者彼此間沒有顯著的差異性 ( P > 0.05 )。
從以上的實驗結果我們可以得到結論,使用Nd:YAG雷射與CO2 雷射,能量密度設定在83.33 J/cm2,作用在已脫鈣的牙釉質表面時,可以增加其抗酸性,尤其當齲齒形成仍在初期齲齒病灶區時,效果較已形成窩洞齲齒病灶區時為佳,不過Nd:YAG雷射與CO2 雷射間並沒有差異。同時在電子顯微鏡下依然可以見到熔融與再結晶的現象,並有火山口狀的坑洞與龜裂的形成。
A large number of studies have shown that using laser to treat a sound enamel surface will produce its physical and chemical changes, including melting and re-crystallization of the enamel surface and alternation of the enamel composition, and thus, will improve its acid resistance.
This thesis intended to explore the use of laser to deal with initial caries and cavity caries. In order to preserve the most part of the tooth structure, Nd:YAG laser and CO2 laser are employed in the experiment instead of traditional cavity preparation in hope that by changing the lesion structure, we can increase their acid resistance.
The experiment was conducted as follows. We collected eighty permanent premolars, and each labial surface was cut into three parts, therefor provided two hundred and forty samples in total. All samples were divided into eight groups randomly for carious lesion formation. Fore groups were individually immersed in lactic acid for different duration of time, which were one, two, five, and nine days. The other four groups were also individually immersed in pH-cycling solution for the same periods of time. As caries were formed, each of the eight groups is divided into three sub-groups randomly. The first one is control sub-group; the second one is Nd:YAG laser-treated sub-group and the third one is CO2 laser-treated sub-group. After laser treatment, all sub-groups are re-immersed in the lactic acid or pH-cycling solution according to their previous division for the exact length of time. Finally, we use ISE-trol to analyze the Ca2+ concentration dissolving from the enamel surface and use SEM to show the morphological changes of enamel surfaces.
From the view of SEM, the groups in the lactic acid indicated that among the four control sub-groups the longer time it was in the solution, the more severe the destruction showed. That is, the 9-day group produced the most obvious destruction. In addition, the pattern I and II of etched enamel could also be found accompanied with the exposed enamel rods, especially in the 9-day group. In the Nd:YAG and CO2 laser-treated sub-groups, we could see the melting and re-crystallization of the enamel surface, and the melting surfaces appeared in different levels due to the severe destruction in the 9-day group. However, the pattern I and II of etched enamel were seen in the CO2 laser-treated sub-group and the crater-like holes of various diameters were seen in the Nd:YAG laser-treated sub-group only.
In the pH-cycling groups, there was no evident destruction on the enamel surface except for some crystal grains in the control sub-groups. In contrasr, in the Nd:YAG laser-treated sub-groups, there were crater-like holes of various diameters with cracks across the holes on the enamel surface. In the CO2 laser-treated sub-groups, we found not only the melting and re-crystallization surface but also the crystal grains depositing along the crack lines appeared.
In the aspect of analyzing Ca2+ concentration, the Ca2+ concentration dissolving from the lased enamel was lower than that of un-lased enamel in both lactic acid groups and pH-cycling groups, and it had a significant difference in statistics ( P < 0.05 ). On the other hand, there is no sustantial statistic difference between Nd:YAG and CO2 laser-treated sub-groups ( P > 0.05 ).
Furthermore, in lactic acid groups, as we compared the value of Ca2+ concentration tested on the first day all of the eught sub-groups, including Nd:YAG and CO2 laser-treated sub-groups, we discovered the value of 1-day group is lower than that of 2, 5, and 9-day groups, which reached a statistic significance ( P < 0.05 ). In comparison with the pH-cycling groups, the data on Ca2+ concentration tested on the first day appeared no statistic significance ( P > 0.05 ) among 1, 2, 5 and 9-day groups.
Based on the finding mentioned above, we concluded that using Nd:YAG and CO2 lasers with energy density of 83.33 J/cm2 on the decalcified enamel surface would increase its acid resistance, and the effect for initial caries was better than cavity caries. As far as effectness was concerned, both Nd:YAG and CO2 lasers proved the similar performance. Meanwhile, another contribution stemed from this particular experiment was that we could also find the melting and re-crystallization surfaces and the crater-like holes with cracks formation on the caries lesions as a result of laser treatment.
中文摘要
英文摘要
前言
文獻回顧
一.綜論
二.Nd:YAG雷射的作用
1.Nd:YAG雷射的物理性質
2.溫度效應對於牙髓的影響
3.硬組織上的臨床應用
(1)牙釉質表面的作用
(2)齲齒的預防
(3)雷射的刻蝕與鍵結效果
三.CO2雷射
1.CO2雷射的物理性質
2.溫度效應對於牙髓的影響
3.硬組織上的臨床應用
(1)牙釉質表面的作用
(2)齲齒的預防
(3)雷射的刻蝕與鍵結效果
材料與方法
一.齲齒之形成
1.牙釉質試片之準備
2.酸侵蝕液之準備
(1)乳酸溶液
(2)酸鹼循環溶液
3.酸侵蝕面積之固定
4.齲齒的形成
二.實驗分組
三.雷射處理
1.Nd:YAG雷射
2.CO2雷射
四.抗酸性之評估
1.鈣離子濃度之測定
2.掃瞄式電子顯微鏡之觀察
五.統計分析
實驗結果
一.鈣離子濃度之測定
二.掃瞄式電子顯微鏡之觀察
討論
一.就實驗方法方面
二.就實驗結果方面
結論
參考文獻
附錄
一.表 (Table)
二.圖 (Figure)
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