臺灣博碩士論文加值系統

由於鈦金屬人工牙根植體在人體中的高成功率，使得人工植牙已經變成患者因疾病缺牙後的一種有效而且可靠的替代治療方式。但隨著人工植牙治療的盛行，細菌在人工植牙周圍軟硬組織中的積累，所造成的疾病發生率也隨之提高。過去學者們已經致力於研究，如何減少或消除鈦金屬人工植體上的細菌黏附和生物膜，以減低致病菌對人工牙根健康的影響。在人工牙根植體周圍炎的治療中，雷射領域的應用已被公認是有效的新治療方式。然而，在雷射治療中，光抗菌化學療法 (PACT)中常用的亞甲藍(MB)光敏劑因為在鈦金屬植體表面的滯留性不好，而對細菌產生的效果有限。本研究的目的是在體外實驗中，使用水溶性四級銨幾丁聚醣(QTS)，來增強亞甲藍光敏劑的滯留性與抗菌性，以及針對被生物膜汙染的大顆粒噴砂及酸蝕(SLA)表面處理的鈦合金上的所產生的效用做出評估。我們比較了使用不同濃度的QTS+MB來做PACT治療，在消滅革蘭氏陰性放線菌或革蘭氏陽性變形鏈球菌上的有效性。我們檢查細菌計數和脂多醣(LPS)檢測，以及評估人類成骨細胞樣MG63細胞的生長。結果表明，具有滯留能力的QTS+MB協同治療，顯著降低了鈦合金表面生物膜的堆積。更重要的是，在以QTS+MB-PACT治療處理過後的鈦金屬試片上，MG63細胞的成骨活性結果表現不輸給無菌的鈦金屬試片對照組。得出的結論是，在提高留滯能力、有效根除細菌和促進細胞生長方面，使用1% QTS包覆100 μg/mL MB的PACT協同治療是治療人工牙根植體周圍炎的一種有希望的治療方式。

Intensive efforts have been made to eliminate or substantial reduce bacterial adhesion and biofilm formation on titanium implants. However, in the management of peri-implantitis, the methylene blue (MB) photosensitizer commonly used in photoantimicrobial chemotherapy (PACT) is limited to a low retention on the implant surface. The purpose of this study was to assess enhancive effect of water-soluble quaternary ammonium chitosan (QTS) on MB retention on biofilm-infected SLA (sandblasted, large grid, and acid-etched) Ti alloy surfaces in vitro. The effectiveness of QTS + MB with different concentrations in eliminating Gram-negative A. actinomycetemcomitans or Gram-positive S. mutans bacteria was compared before and after PACT. Bacterial counting and lipopolysaccharide (LPS) detection were examined, and then the growth of human osteoblast-like MG63 cells was evaluated. The results indicated that the synergistic QTS + MB with retention ability significantly decreased the biofilm accumulation on the Ti alloy surface, which was better than the same concentration of 1 wt% methyl cellulose (MC). More importantly, the osteogenic activity of MG63 cells on the disinfected sample treated by QTS + MB-PACT modality was comparable to that of sterile Ti control, significantly higher than that by MC + MB-PACT modality. It is concluded that, in terms of improved retention efficacy, effective bacteria eradication, and enhanced cell growth, synergistically, PACT using the 100 μg/mL MB-encapsulated 1% QTS was a promising modality for the treatment of peri-implantitis.

致謝........................................................................I
中文摘要....................................................................II
Abstract..................................................................III
Content....................................................................IV
Figure list...............................................................VII
Table list.................................................................IX
Chapter 1 Introduction......................................................1
1.1 Dental implants.....................................................1
1.2 Osseointergration and dental implant surface treatment..............1
1.3 Biofilm.............................................................2
1.4 Streptococcus mutans................................................2
1.5 Aggregatibacter actinomycetemcomitan................................3
1.6 LPS.................................................................3
1.7 Peri-implant diseases...............................................3
1.8 Treatment methods for peri-implantitis..............................4
1.9 Nonsurgical treatments..............................................5
1.10 Mechanical debridement..............................................6
1.11 Air-polishing with glycine powder...................................6
1.12 Chemical debridement................................................7
1.13 HOCL chemical agent.................................................7
1.14 Laser treatment.....................................................8
1.15 aPDT treatment......................................................8
1.16 Photosensitizer.....................................................9
1.17 Bioadhesion of photosensitizer.....................................10
Chapter 2 Materials and methods............................................11
2.1 Preparation of QTS.................................................11
2.2 Preparation of solution............................................11
2.3 L929 cytotoxicity..................................................12
2.4 Viscosity..........................................................12
2.5 Preparation of titanium alloy......................................12
2.6 Solution flowability...............................................13
2.7 Bacteria seeding...................................................13
2.8 Photodynamic treatment.............................................13
2.9 Antibacterial efficacy.............................................14
2.9.1 Bacterial counting.................................................14
2.9.2 Bacterial colony observation.......................................14
2.9.3 LPS detection......................................................14
2.10 MG63 cell culture..................................................15
2.10.1 Cell attachment....................................................15
2.10.2 Cell proliferation.................................................15
2.10.3 Alkaline phosphatase activity......................................15
2.10.4 Calcium deposit quantification.....................................15
2.11 Statistical analysis...............................................16
Chapter 3 Results..........................................................17
3.1 L929 cell Cytotoxicity.............................................17
3.2 Viscosity of photosensitizer solutions.............................18
3.3 Retention efficacy of photosensitizer solutions....................19
3.4 Bacteriostatic ratio of different treatments.......................20
3.5 Bacterial colonies of different treatments.........................21
3.6 Residual LPS amount................................................22
3.7 MG63 Cell morphology of different treatments.......................23
3.8 MG63 Cell proliferation of different treatments....................24
3.9 Alkaline phosphatase (ALP) activity of different treatments........25
3.10 Mineralization of different treatments.............................26
Chapter 4 Discussion.......................................................28
Chapter 5 Conclusions......................................................34
References.................................................................35

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