臺灣博碩士論文加值系統

根管治療後牙本質會產生不可逆的水分喪失，造成牙本質的抗張強度與韌性會減少14%，通常牙醫師會建議患者做補綴物，但對於窩洞不大、牙齒結構破壞不大、咬合力量不大的牙齒如前牙、因為某些因素考量需要較長的觀察期，不能即時給予補綴物、患者本身經濟上的考量，或身心障礙患者需全身麻醉下治療等情形，牙醫師利用複合樹脂復形愈見普遍，但水對牙本質鍵結有密不可分的關聯，因此牙本質的水分喪失是否會影響到複合樹脂與牙本質間鍵結強度是值得評估的問題。
本實驗針對以上目的選擇125顆完整無齲蛀的人類恆小臼齒進行二階段的實驗：PartⅠ：牙本質脫水，在溫度20℃，相對溼度50%下進行牙本質脫水，依水分喪失程度分為對照組、10%、20%、30%。並隨機選擇10個樣本觀察牙本質水分喪失的經時變化。PartⅡ：測量水分喪失後牙本質與複合樹脂黏結後的抗剪強度，依照水分喪失程度(對照組、10%、20%、30%)與牙本質黏著劑(Single Bond、Prime & Bond NT、Prompt L-Pop)分組，測試抗剪強度。測試結果以two-way ANOVA test進行統計分析。
PartⅠ：牙本質脫水
(1)在溫度20℃，相對溼度50 %下進行牙本質脫水的特徵是初期的重量喪失是快速的。
(2)牙本質樣本脫水達到喪失總重的50 %約需時3 ~ 5分鐘。
(3)牙本質重量喪失的速度在10 ~ 30分鐘間減緩，且在30分鐘內樣本重量喪失達到喪失總重的85 %。
(4)牙本質脫水在第7天達到重量減少3.33%，相當於水分喪失約30 %。
(5)牙本質脫水10 %約需2分鐘，20 %約需10分鐘，30 %約需7天。
PartⅡ：測量水分喪失後牙本質與複合樹脂黏結後的抗剪強度
一、牙本質黏著劑與水分喪失程度的影響
本實驗有二個主要因素：牙本質黏著劑與水分喪失程度，以two-way ANOVA統計分析牙本質黏著劑與水分喪失及其交互作用的影響可知在牙本質黏著劑與水分喪失程度間有顯著性之交互作用（F6,239＝3.58；P＝0.0021）。而檢視二個因素可知，在牙本質黏著劑各組間有顯著性差異存在 (P＜0.0001)，但水分喪失程度各組間沒有顯著性差異存在（P＝0.3559），因此在相同水分喪失程度下，牙本質的抗剪強度會因選擇的牙本質黏著劑的不同而受影響。
二、牙本質黏著劑的影響（承續結果一）
Single Bond組24.33（±5.03）MPa；Prime & Bond NT組23.09（±3.73）MPa；Prompt L-Pop組32.49（±4.88）MPa。以two-way ANOVA統計分析的事後比較可知各組間有顯著性差異存在 (P＜0.0001)，故再經由Tukey’s pairwise comparison得知Single Bond組與Prime & Bond NT組間有顯著性差異，Single Bond組與Prompt L-Pop組間有顯著性差異，Prime & Bond NT組與Prompt L-Pop組間有顯著性差異，且抗剪強度Prompt L-Pop組大於Single Bond組大於Prime & Bond NT組。
三、水分喪失程度的影響（承續結果一）
10%組26.70（±6.39）MPa，20%組27.58（±6.78）MPa，30%組26.28
（±6.41）MPa，對照組25.98（±5.08）MPa。以two-way ANOVA統計分析的事後比較可知各組間沒有顯著性差異存在 (P＝0.3559)。
四、Single Bond組中水分喪失的影響
10%SB組24.55（±5.61）MPa，20%SB組25.51（±5.46）MPa，30%SB組25.15（±4.68）MPa，對照組22.13（±3.84）MPa。以one-way ANOVA統計分析可知各組間沒有顯著性差異存在 (P＝0.1375)。
五、Prime & Bond NT組中水分喪失的影響
10%PB組22.47（±3.72）MPa，20%PB組21.81（±3.92）MPa，30%PB
組20.17（±3.69）MPa，對照組24.89（±2.73）MPa。以one-way ANOVA統計分析可知各組間有顯著性差異存在 (P＝0.0134)。故再經由Tukey’s pairwise comparison得知30%PB組與對照組間有顯著性之差異。
六、Prompt L-Pop組中水分喪失的影響
10%PL組32.08（±5.94）MPa，20%PL組34.41（±4.45）MPa，30%PL組32.53（±4.70）MPa，對照組30.93（±3.91）MPa。以one-way ANOVA統計分析可知各組間沒有顯著性差異 (P＝0.1507)。
電子顯微鏡觀察
Single Bond、Prime & Bond NT組與Prompt L-Pop組之斷裂型態大多為黏著性斷裂(adhesive failure)。
經由以上結果可得到結論：牙本質水分喪失不會影響牙本質抗剪強度，但牙本質黏著劑的選擇確實會影響牙本質抗剪強度。此外，含水性牙本質黏著劑（Single Bond及Prompt L-Pop）較不受牙本質的水分喪失影響；
不含水性牙本質黏著劑（Prime & Bond NT）在脫水30%情況下牙本質的抗
剪強度會減弱。因此，臨床上牙本質在根管治療後水分喪失9%對其鍵結強度及牙本質黏著劑的選擇是沒有影響的。

＜目次＞
中文摘要………………………………………………………1
英文摘要………………………………………………………4
壹、前言………………………………………………………8
貳、文獻回顧
一、牙本質的組成………………………………………10
二、根管治療後牙本質的變化…………………………10
三、牙本質的脫水方法…………………………………12
四、牙本質黏著系統的演變……………………………14
參、實驗目的……………………………………………….19
肆、材料與方法
一、牙本質樣本準備……………………………………20
二、牙本質的脫水………………………………………21
三、剪力測試樣本之製備………………………………22
四、抗剪強度之測試……………………………………25
五、掃瞄式電子顯微鏡（SEM）觀察………………….26
六、統計分析……………………………………………28
伍、實驗結果
一、牙本質脫水………………………………………29
二、抗剪強度 (MPa) 統計分析…………………….29
三、電子顯微鏡觀察…………………………………31
陸、討論
一、就材料方法方面……………………………………...37
（1）牙齒的選擇………………………………………37
（2）樣本之處理………………………………………37
（3）抗剪強度的樣本測試面積………………………37
（4）牙本質的脫水……………………………………38
（5）牙本質黏著劑的特性……………………………39
二、就實驗結果方面……………………………………….41
（1）牙本質脫水方面…………………………………41
（2）水對牙本質鍵結的影響…………………………44
（3）牙本質鍵結強度…………………………………47
（4）斷裂型態…………………………………………51
三、總論…………………………………………………….54
柒、結論…………………………………………………….55
參考文獻…………………………………………………….56
附錄
一、表……………………………………………………...63
二、圖……………………………………………………...72

1. Nakabayashi N.，Kojima K. and Masuhara E.：The promotion of adhesion by the infiltration of monomers into tooth states. J Biomed Mat Res 1982；16：265-73.
2. Gwinnett A.J.：Quantitative contribution of resin infiltration hybridization to dentin bonding. Am J Dent 1993；6(1)：7-9.
3. Grayson W.M.Jr，Sally J.M.，John H.K. and Mehdi B.：The dentin substrate：structure and properties related to bonding. J Dent 1997；25：441-58.
4. Pashley D.H. and Carvalho R.M.：Review：Dentin permeability and dentine adhesion. J Dent 1997；25：355-72.
5. Latta M.A. and Barkmeier W.W.：Dental adhesive in contemporary restorative dentistry. Dent Clin North Am 1998；42(4)：567-77.
6. Crater J.M.，Soreness S.E.，Johnson R.R.，Teitelbaum R.L. and Levine M.S.： Punch shear testing of extracted vital and endodontically treated teeth. J Biomech 1983；16：841-8.
7. Rivera E.，Yamauchi G.，Chandler G. and Bergenholtz G.：Dentin collagen cross-links of root-filled and normal teeth. J Endo 1988；14：195.
8. James LG.：The dentin-root complex：Anatomic and biologic considerations in restoring endodontically treated teeth. J Prosthet Dent 1992；67：458-67.
9. Helfer A.R.，Melnick S. and Schilder H.：Determination of moisture content of vital and pulpless teeth. Oral Surg Oral Med Oral Pathol 1972；34：661-70.
10. Marshall G.W.，Marshall S.J.，Kinney J.h.，Balooch M.：The dentin
substrate：structure and properties related to bonding. J Dent 1997；25：441-58
11. 張國威譯，Ten Cate A.R.著：牙本質-牙髓複合體。合記圖書出版社。口腔組織學發育、構造、功能 第二版：146-82。
12. Battistone G. and Burnett G.W.：Studies on the composition of teeth.Ⅲ.The amino acid composition of human dentinal protein. J Dent Res 1956；35：255-9.
13. Reeh E.S.，Messer H.H. and Douglas W.H.：Reduction in tooth stiffness as a
result of endodontic and restorative procedures. J Endo 1989 ；15：512-6.
14. Jameson M.W.，Hood J.A.A. and Tidmarsh B.G.：Effect of storage media on subsequent water loss and regain by human and bovine dentine and on mechanical properties of human dentine in vitro. Arch Oral Biol 1994；39：759-67.
15. LeFevre ML. and Manly RS.：Moisture，inorganic and organic contents of enamel and dentin from carious teeth. J Amer Dent Assoc 1938；25：233-42.
16. Burnett G. and Zenewitz J.：Studies of the composition of teeth. Ⅶ. The moisture content of calcified tooth tissues. J Dent Res 1958；37：581-89.
17. Brauer G.M.，Termini D.J.and Burns C.L.：Characterization of components of dental materials and components of tooth structure by differential thermal analysis. J Dent Res 1970；49：100-10.
18. Lim J.J. and Liboff A.R.：Thermogravimetric analysis of dentin. J Dent Res
1972；51：509-14.
19. Holager J.：Thermogravimetric examination on tooth carbonates. J Dent Res
1972；51：102-06.
20. Komrska J.：Derivatographic analysis of dentin. J Dent Res 1972；51：148-50.
21. Dibdin G.H. and Poole D.F.G.：Surface area and pore size analysis for human enamel and dentine by water vapour sorption. Arch oral Biol 1982；27：235-41.
22. van der Graaf E.R. and Ten Bosch J.J.：The uptake of water by freeze-dried human dentine sections. Arch Oral Biol 1990；35：731-739.
23. Tzyy-Jou G. Huang，Herbert Schilder and Dan Nathanson.：Effects of moisture content and endodontic treatment on some mechanical properties of human dentin. J Endo 1992；18：209-15.
24. van der Graaf E.R. and Ten Bosch J.J.：Changes in dimensions and weight of human dentine after different drying procedures and during subsequent rehydration. Arch Oral Biol 1993；38：97-99.
25. Jameson M.W.，Hood J.A.A. and Tidmarsh B.G.：The effects of dehydration and rehydration on some mechanical properties of human dentine. J Biomech 1993；26：1055-65.
26. Buonocore M.G.：A simple method of increasing the adhesive of acrylic filling materials to enamel surfaces. J Dent Res 1955；34：849-53.
27. Bowen R.L.：Adhesive bonding of various materials to hard tooth tissues II.
Bonding to dentin promoted by a surface-active comonomer. J Dent Res 1965；44：895-902.
28. Burke F.J.T. and McCaughey A.D.：The four generations of dentin bonding.
Am J Dent 1995；8：88-98.
29. Kugel G. and Ferrari M.：The science of bonding：from first to sixth generation. J Am Dent Assoc 2000；131：20S-25S.
30. Keate K.C. and Woolsey G.D.：The dentin-resin bond：a report on the “classical” and “new” generation adhesives. Tex Dent J 1988；105：6-11.
31. Pahley D.H.，Horner J.A. and Brewer P.D.：Interactions of conditioners on the dentin surface. Oper Dent 1992；5（suppl）：137-50.
32. Fusayama T.，Nakamura M.，Kurosaki N. and Iwaku M.：Non-pressure adhesion of a new adhesive restorative resin. J Dent Res 1979；58：1364-72.
33. Kanca J.：A method for bonding to tooth enamel conditioner. Quintessence Int 1991；22：285-90.
34. Mason P.N.，Calabrese M. and Graif L.：Modified extrusion shear bond strength of the 3M adhesive (abstract 256). J Dent Res 1998；77：1239.
35. Watanabe I. and Nakabayashi N.：Bonding durability of photocured Phenyl-P in TEGDMA to smear layer-retained bovine dentin. Quintessence Int 1993；24：335-42.
36. Miyazaki M.，Iwasaki K. and Onose H.：Adhesion of single application bonding systems to bovine enamel and dentin. Oper Dent 2002；27：88-94.
37. Tay F.R. and Pashley D.H.：Aggressiveness of contemporary self-etching
systems. I：Depth of penetration beyond dentin smear layers. Dent Mater 2001；296-308.
38. Prati C. and Pashley D.H.：Dentin wetness，permeability，thickness and bond
strength of adhesive systems. Am J Dent 1992；5：33-8.
39. Tagami J，Tao L. and Pahley D.H.：Correlation among dentin depth，permeability and bond strength of adhesive resins. Dent Mater 1990；6：45-50.
40. Technical report：Dental materials — Guidance on testing of adhesion to tooth structure. ISO TR 11405 ，1994.
41. Erickson R.L.，Glasspoole E.A. and Retief D.G.：Influence of test parameters on dentin bond strength measurements. J Dent Res 1989；68：374, Abstr. No. 1543.
42. Söderholm K-J.M.：Correlation of in vivo performance of adhesive restorative materials:A report of the ASC MD156 Task Group on Test Methods for the Adhesion of Restorative Materials. Dent Mater 1991；7：74-83.
43. Van Meerbeek B.，Vargas M.，Inous S.，Yoshida Y.，Peumans M.，Lambrechts P. and Vanherle G.：Adhesives and cements to promote preservation dentistry. Oper Dent 2001；6（suppl）：119-44.
44. Moll K. and Haller B.：Effect of intrinsic and extrinsic moisture on bond
strength to dentine. J Oral Rehabil 2000；27：149-64.
45. Haller B.：Recent developments in dentin bonding. Am J Dent 2000；13：44-50.
46. Pashley D.H. and Carvalho R.M.：Dentine permeability and dentine adhesion. J Dent 1997；25：355-72.
47. Tay F.R.，Gwinnett A.J.，and Wei S.H.Y.：Micromorphological spectrum from overdrying to overwetting acid-conditioned dentin in water-free, acetoned-based, single-bottle primer/adhesives. Dent Mater 1996；12：236-44.
48. Van Meerbeek B，Yoshida Y.，Lambreshts P.，Vanherle G.，Duke E.S.，Eick J.D. and Robison S.J.：A TEM study of two-water based adhesive systems bonded to dry and wet dentin. J Dent Res 1998；77：50-9.
49. Renson C.E.，Boyde A. and Jones S.J.：Scanning electron microscopy of human dentine specimensfractured in bend and torsion tests. Arch Oral Biol 1974；19：447-54.
50. Tay F.R.，Gwinnett J.A. and Wei S.H.Y.：Relation between water content in acetone/alcohol-based primer ans interfacial ultrastructure. J Dent 1998；26：147-56.
51. Kanca J.：Resin bonding to wet substrates I. Bonding to dentin. Quintessence Int 1992；5：318-20.
52. Xie J.，Powers J.M. and McGuckin R.：Invitro bond strength of two adhesives to enamel and dentin. Dent Mater 1993；9：295-9.
53. Pashley D.H.，Sano H.，Ciucchi B.，Carvalho R.M. and Russell C.M.：Bond strength versus dentin structures：a modeling approach. Arch Oral Biol 1995；40：1109-18.
54. Ferrari M.，Mannocci F.，Kugel G. and Garciá-Godoy F.：Standardized
microscopic evaluation of the bonding mechanism of NRC/Prime & Bond NT. Am J Dent 1999；12：77-83.
55. Iwaku M.，Inokoshi S.，Hosoda H. and Fusayama T.：Conservative dentistry with a caries detector and a chemically adhesive composite. A longitudinal study of a new system. Br Dent J 1983；155：19-22.
56. Söderholm K.J.M.：Does resin based dentin work？ Inter Dent J 1995；45：371-81.
57. Inagaki A.，Chigira H.，Itoh K. and Wakumoto S.：Effects of self-etching primers on dentin. Dent Mater 1989；5：403-7.
58. Tanumiharja M.，Burrow M.F.，Tyas M.J. and Carpenter J.：Field-emission scanning electron microscopy of resin-dentin interface morphology of seven dentin adhesive systems. J Adhesive Dent 2000；2：259-69.
59. Leonard J.E.，Gutmann J.L. and Guo I.Y.：Apical and coronal seal of roots
obturated with a dentine bonding agent and resin. Int Endo J 1996；29：76-83.
60. Ray H.A. and Trope M.：Periapical status of endodontically treated teeth in relation to the technical quality of the root filling and the coronal restoration. Int Endo J 1995；28：12-8.
61. Klevant F.J.H. and Eggink C.O.：The effect of canal preparation on periapical disease. Int Endo J 1983；16：68-75.