現今的牙醫材料科學不斷的發展與進步。近年來，複合樹脂因為美觀的需求與考量，逐漸成為臨床填補的主要材料。由於在臨床上最常見之填補物重新填補置換原因為繼發性齲齒，而使其應用受到限制。因此理想的牙科修復填補材料，不僅可以修復牙齒硬組織，而且具有抗菌性。繼發性齲齒是由於材料邊緣微滲漏（micro-leakage）而引起之細菌存在於牙本質小管中，或複合樹脂材料與牙齒硬組織之黏附不良而導致，以上都有可能導致牙髓感染並且引起術後之其他併發症。因此，牙科修復填補材料之抗菌性質具有重要的臨床意義，並且可以使醫師在做牙齒修形時以較小侵入性的方式來復形治療。
本實驗目的為評估修復填補材系統之抵抗去礦化能力，使用了掃頻光源式光學同調斷層掃瞄(Swept-source OCT, SS-OCT)與微米級電腦斷層掃描造影系統(Micro-CT)，以非破壞性之方法來針對樣本牙釉質與牙根牙本質區域來作觀察。
本研究之樣本製備為：64塊於齒頸部的地方切出體積6mm × 6mm × 2mm之樣本。於樣本中央，齒頸部牙釉質/牙根牙本質交界之表面備製一直徑2mm、深2mm圓柱體之窩洞，填入兩種不同的複合樹脂材料，分別為 Beautifil II（含玻璃表面反應填料, S-PRG filler）和 Estelite，與兩種牙科黏著劑，分別為Single Bond Universal和FL Bond II（含含玻璃表面反應填料）。
本研究分為兩部分進行人工齲齒實驗模型：
第一部分：再礦化與去礦化之酸鹼循環（pH-cycling）實驗模型之建立。
第二部分：口腔生物膜環境模型（Oral Biofilm Reactor）之建立。
我們以定性以及定量下，以微米級電腦斷層掃描、掃頻光源式光學同調斷層掃瞄兩種方式，觀察樣本之牙釉質與牙根牙本質表面變化，除此之外更利用電腦軟體CT-An及Image J定量分析計算出去礦化體積百分比與平均病灶深度，以及做微硬度(Micro-hardness)測試與分析。
實驗結果顯示，含有玻璃表面反應填料之牙科修復填補材料，經過去礦化過程後，不論是牙釉質或是牙根牙本質區域，相較於不含玻璃表面反應填料之牙科修復填補材料，較有抵抗去礦化之能力，也就是具有更好的抗齲能力。並且我們比較了掃頻光源式光學同調斷層掃瞄與微米級電腦斷層掃描兩種影像分析系統，掃頻光源式光學同調斷層掃瞄對於觀察去礦化表面更方便簡單，結果顯示兩種方式具有高度相關性。
綜合以上結論，本研究證實掃頻光源式光學同調斷層掃瞄不論在研究或是臨床之運用是一個很實用的分析診斷工具。並且本實驗結果證實含有玻璃表面反應填料之牙科修復填補材料，較有抵抗去礦化之能力，也就是具有更好的抗齲能力，因此在臨床上的應用有助於預防繼發性齲齒之潛力。

In dentistry nowadays, constant development and improvement in material science has been noticed. The use of dental composite resin material is increasing dramatically in recent years due to the esthetic demand. The ideal restorative material would not only perfectly restore hard dental tissues, but also possess antibacterial properties, as the most common reason for the filling replacement is secondary caries. Secondary caries is caused by bacterial infection/accumulation due to micro-leakage, and further bacteria presence in dentinal tubules. The poor adhesion of composite material to hard dental tissues would aggravate the situation. All of the above may lead to pulp infection and cause postoperative complications. Antibacterial properties of restorative materials are of major clinical importance and would allow for less invasive preparation on hard dental tissue.
The object of this study was to evaluate the anti-demineralization/anti-caries ability of antibacterial composite filling systems on enamel and root dentin by using non-destructive methods: Swept-source OCT（SS-OCT）and micron-computerized tomography (Micro-CT).
This study was carried out in two parts for artificial caries models setting
Part I: pH-cycling model.
Part II :Oral Biofilm Reactor model.
In this study, Sixty-four specimens, 6mm x 6mm x 2mm enamel/root dentin block with a cylinder cavity for each, were divided into two groups (n = 32) : pH-cycling group and the OBR group. Cavities were filled with Beautifil II composite resin or Estelite composite resin. Dentin bonding agents used in this study were Single Bond Universal and FL Bond II.
We qualitatively and quantitatively examined the demineralization lesions of surrounding enamel and root dentin portion by Micro-CT and SS-OCT. We defined the lesion type based on the SS-OCT images. Micro-hardness test was tested to verify the changes of surrounding affected tissue.
With the limited results, we can conclude that S-PRG filler-containing composite resin can effectively resist demineralization process and has the potential to prevent caries in enamel and root dentin regions. S-PRG filler-containing composite resin has good potential for caries prevention. Moreover, SS-OCT is a convenient method for examining demineralization lesions, and well correlated to Micro-CT in both tooth substrates. 


目錄
中文摘要 I
Abstract III
圖目錄 VII
表目錄 X
第一章 緒論 1
1.1 前言 1
1.2 研究動機與目的 2
1.3 研究假說 3
1.4 論文架構 3
1.5 實驗流程圖 4
第二章 文獻回顧 5
2.1 齲齒 5
2.2 牙科用複合樹脂 8
2.3 牙科用黏著劑 8
2.4 抗齲齒成分之原理與應用 9
2.5 掃頻光源式光學同調斷層掃瞄(Swept-Source OCT)應用 15
2.6 微米級電腦斷層掃描造影系統(Micro CT) 應用 16
第三章 實驗材料與方法 18
3.1 建立人工齲齒模型 18
3.1.1 牙齒收集與樣本備製 18
3.1.2 材料填補與分組 18
3.1.3 再礦化與去礦化溶液備製（pH-cycling） 19
3.1.4 建立口腔生物膜環境（Oral Biofilm Reactor, OBR） 20
3.2 測量與分析方法 22
3.2.1 微米級電腦斷層掃描造影與分析 22
3.2.2 掃頻光源式光學同調斷層掃瞄分析 23
3.3 微硬度(Micro-hardness)測試 24
3.4 統計方法 24
第四章 實驗結果 26
4.1 再礦化與去礦化溶液備製與循環（pH-cycling）模型 26
4.1.1 掃頻光源式光學同調斷層掃瞄（SS-OCT）分析 26
4.1.2 微米級電腦斷層掃描造影系統（Micro-CT）分析 28
4.1.3 pH-cycling SS-OCT與Micro-CT 影像相關性分析 28
4.1.4 樣本周邊齒質表面微硬度變化測試 29
4.2 口腔生物膜環境模型 30
4.2.1 掃頻光源式光學同調斷層掃瞄（SS-OCT）分析 30
4.2.2 微米級電腦斷層掃描造影系統（Micro-CT）分析 32
4.2.3 OBR SS-OCT與Micro-CT 影像相關性分析 33
4.3 pH-cycling與OBR相關性分析 34
第五章 討論 35
5.1 含氟材料與齲齒進展之探討 35
5.1.1 再礦化與去礦化酸鹼循環實驗模型討論 35
5.1.2 口腔生物模環境模型 38
5.2 SS-OCT與Micro-CT 影像相關性分析討論 41
5.3 人工齲齒模型分析討論 41
5.4 臨床應用 42
第六章 結論 44
第七章 未來研究方向 46
第八章 參考文獻 47
圖附錄 58
表附錄 87

圖目錄
圖3-1 本實驗使用之慢速切割機 55
圖3-2 細菌預先培養過程 55
圖3-3 細菌培養過程 56
圖3-4 細菌懸浮液製備過程 56
圖3-5 口腔生物膜系統 57
圖3-6 口腔生物膜運作系統pH測定 57
圖3-7 本實驗所使用之微米級電腦斷層掃描 58
圖3-8本實驗所使用的SS-OCT 58
圖3-9 本實驗所使用的之微硬度計 59
圖3-10 pH-cycling前/後之微硬度測試位置 59
圖3-11 維克氏硬度的測試原理。 60
圖4-1 pH-cycling循環後，BEF/SBU之SS-OCT影像 61
圖4-2 pH-cycling循環後，EST/SBU病灶之分布情形 62
圖4-3 pH-cycling循環後，BEF/FL病灶之分布情形 63
圖4-4 pH-cycling循環後，EST/FL病灶之分布情形 64
圖4-5 pH-cycling循環，牙根牙本質區域去礦化的形態示意 65
圖4-6 pH-cycling循環後，SS-OCT影像分析下牙釉質區域Lesion深度 65
圖4-7 pH-cycling循環後，SS-OCT影像分析下牙根牙本質區域Lesion深度 66
圖4-8 pH-cycling，SS-OCT分析下牙釉質/牙根牙本質之平均病灶深 66
圖4-9 pH-cycling循環後，複合樹脂填補物影響齒質抵抗去礦化分析 67
圖4-10 pH-cycling循環後，黏著劑影響齒質抵抗去礦化分析 67
圖4-11 pH-cycling循環後，Micro-CT分析下牙釉質/牙根牙本質之平均病灶深 68
圖 4-12 牙釉質區域，經由pH-cycling去礦化，SS-OCT影像與Micro-CT影像相關性 68
圖4-13 牙根牙本質區域，經由pH-cycling去礦化SS-OCT影像與Micro-CT 影像相關性 69
圖4-14 八天去礦化/再礦化循環 69
圖4-15 pH-cycling循環後，牙釉質微硬度之結果 70
圖4-16 pH-cycling循環後，牙根牙本質微硬度之結果 70
圖4-17 pH-cycling循環後，微硬度改變量百分比圖 71
圖4-18 OBR循環後，BEF/SBU病灶之分布情形 72
圖4-19 OBR循環後，EST/SBU病灶之分布情形 73
圖4-20 OBR循環後，BEF/FL病灶之分布情形 74
圖4-21 OBR循環後，EST/FL病灶之分布情形 75
圖4-22 OBR作用，牙根牙本質區域去礦化的形態示意 76
圖4-23 OBR作用，SS-OCT影像分析下牙釉質區域Lesion深度 76
圖4-24 OBR作用，SS-OCT影像分析下牙根牙本質Lesion深度 77
圖4-25 OBR作用後，SS-OCT分析下牙釉質/牙根牙本質之平均病灶深度 77
圖4-26 OBR作用後，複合樹脂填補物影響齒質抵抗去礦化分析 78
圖4-27 OBR作用後，複合樹脂填補物影響齒質抵抗去礦化分析 78
圖4-28 Micro-CT 2D/3D去礦化之影像 79
圖4-29 OBR作用後，Micro-CT分析下牙釉質/牙根牙本質之平均病灶深 80
圖4-30 VOI 示意圖 80
圖4-31 OBR作用，Micro-CT分析牙釉質區域之去礦化體積百分比 81
圖 4-32 牙釉質區域，經由OBR去礦化SS-OCT影像與Micro-CT 影像相關性 81
圖 4-33 牙根牙本質區域，經由OBR去礦化SS-OCT影像與Micro-CT 影像相關性 82
圖4-34 在牙釉質區域，兩種去礦化模型相關性 82
圖4-35 在牙根牙本質區域，兩種去礦化模型相關性 83

表目錄
表 3-2 BEAUTIFIL之材料安全資料表 84
表 3-3 ESTELITE之材料安全資料表 85
表 3-4 黏著劑成分表 85
表 3-5 樣本分組 86
表 4-1 去礦化型態定義與分類 86
表 4-2 經過pH-cycling循環，牙根牙本質區域去礦化之分類表 87
表 4-3 經過pH-cycling循環，牙釉質與牙根牙本質微硬度之結果 87
表 4-4 經過OBR，牙根牙本質區域去礦化之分類表 88

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