臺灣博碩士論文加值系統

牙釉質表面酸蝕，改善了樹脂與牙釉質的黏著能力，近年來不論在實驗室或是臨床上均有很多利用雷射來進行牙釉質表面蝕刻的實驗，Nd:YAG照射後的牙釉質表面可以產生坑洞和融熔的表面。這種融熔和再結晶可以增加牙釉質表面粗糙度及抗酸性。照射Er:YAG雷射後的牙釉質表面會有牙釉質稜柱裸露，粗糙度增加，類似傳統磷酸酸蝕後之現象。多種因素會影響雷射的效果，如波長、能量大小，照射時間長短等。傳統上在裝置齒顎矯正托架前會先使用磷酸進行酸蝕，然而牙齒表面常會產生白斑去礦物質化的現象，此為矯正治療之最大缺點。本實驗的目的在於探討Nd:YAG雷射與Er:YAG雷射照射完整牙釉質表面時，其照射能量和作用效果間的關係。實驗選取牙冠部位完整，沒有蛀牙的牙齒，所有的牙齒均於解剖用顯微鏡下觀察，若表面不平整之牙齒則拋棄不用。第一部分實驗分別使用不同能量設定的Nd:YAG雷射及Er:YAG雷射進行照射， 然後於光學顯微鏡與電子顯微鏡下觀察比較，接著進行第二部分能量光譜分析。最後進行第三部分齒顎矯正托架黏著力測試。結果如下: (1) 雷射單位脈衝能量(mJ/pps)越高時，在Nd:YAG雷射照射組之牙釉質表面熔融狀態會隨著增劇，而在Er:YAG雷射照射組則會有牙釉質移除量的增加。(2)當Nd:YAG雷射能量設定在80mJ, 10pps,10sec時會造成牙釉質顯著熔融反應，而Er:YAG雷射能量設定在300mJ,10pps,10sec會使照射區域內所有牙釉質產生作用 (3) 經Nd:YAG雷射照射後產生坑洞和融熔處，其鈣磷比就會提高，而當熔融程度的程度越多時(例如產生氣泡)，鈣磷比例將會隨之提高。(4)鍵結力測試結果指出，磷酸組、Er:YAG雷射、Nd:YAG雷射三組間並無顯著差異。(5)電子顯微鏡下觀察經Nd:YAG雷射照射過後在牙釉質表面出現之微裂隙，在經過樹脂覆蓋並拆除之後，其寬度將會比未覆蓋樹脂的試樣為小，或是數目減少之現象。

Etching is an important factor for the adhesion of composite resin to enamel. Recently, laser has been used for enamel etching. Enamel surface treated with laser also develop more resistance to acid permeability. Different laser settings result to various alterations. Orthodontic bracket bonding is widely used in today`s dentistry, however white plaque around bracket is still a unfavorable problem. The purpose of this study was to evaluate the morphological changes on intact human enamel surface by Nd:YAG laser irradiation, Er:YAG laser irradiation and phosphoric acid etching. In the first step of our study, intact human enamel was prepared either by laser or acid etching and divided into 5 experimental groups, before the irradiation of Nd:YAG laser, sample were coated with black ink as initiator. Different energy(per pulse), pps, and irradiation time were tested. At the end of each interval, the sample was thoroughly irrigated with water, and imaged under LM. Samples were then compared under SEM. Different etching patterns were found between acid and laser groups under SEM. Acid etching result to smaller microspaces, and Nd:YAG laser produce irregular surface with numerous microcavities, micropores and microfissures. In the Er:YAG group, surface alterations that resemble the acid etching were found. It is concluded that (1) the alteration of enamel morphology was different in the two laser system. (2) 80mJ,10pps and 10secomds(Nd:YAG laser), and 300mJ, 10pps, 10seconds(Er:YAG laser) irradiation produce the significant and precise effect on the modification of human enamel under SEM in our study. (3) Ca/P ratio increased as the energy per pulses elevated in the Nd:YAG laser group.(4) Bonding test indicated that no significant difference exist between laser and acid etching groups.(5) The amounts of microfissures were seldom found on the enamel surface after bonding test in the Nd:YAG laser irradiation group.

目錄
謝誌……………………………………………………………Ⅰ
目錄……………………………………………………………Ⅱ
表次……………………………………………………………Ⅲ
圖次……………………………………………………………Ⅳ
壹、中文摘要…………………………………………………1
貳、英文摘要…………………………………………………3
參、前言………………………………………………………5
肆、文獻回顧…………………………………………………8
伍、材料和方法………………………………………………25
陸、結果………………………………………………………36
柒、討論………………………………………………………45
捌、結論………………………………………………………60
參考文獻………………………………………………………61
圖次
圖 1 x-ray之光譜70
圖2 原子的貝殼理論70
圖3 不同之X-ray71
圖4. X光之細分。72
圖5. continuum X-rays72
圖6. Nd-YAG雷射機型73
圖7. Er:YAG laser機型74
圖8. Er:YAG laser手機機頭74
圖9 光學顯微鏡(Leica MZ8, Germany)75
圖10 .掃描式電子顯微鏡(0Topcon ABT-60, Japan)75
圖11. 實驗樣本76
圖12. 能量光譜分析儀76
圖 13. Instron 5566, England77
圖14. 鍵結力測試模型近觀78
圖15. 不同能量同時作用於同一顆牙齒78
圖16. 未接受雷射照射之牙釉質79
圖17. 40mJ×10pps×10seconds Nd:YAG laser照射。79
圖18. 在較高倍率(1000倍)下觀察(40mJ×10pps× 10seconds Nd:YAG laser)。80
圖19. 80mJ×10pps×10seconds之Nd:YAG laser80
圖20. 電子顯微鏡低倍下觀察80mJ×10pps×10seconds之Nd:YAG laser照射後牙釉質表面變化。81
圖21. 電子顯微鏡1000倍觀察發現了粗糙程度明顯增加(80mJ×10pps×10seconds之Nd:YAG laser照射)82
圖22. 1000倍下電子顯微鏡觀察：82
圖23. 80mJ×30pps×10seconds Nd:YAG laser照射83
圖24. 墨汁殘留83
圖25. 電子顯微鏡1000倍下觀察84
圖26. 80mJ, 10pps, 10seconds Nd:YAG laser照射84
圖27. 80mJ, 10pps, 10seconds Nd:YAG laser距離2mm的照射85
圖28. Er:YAG laser對牙釉質表面型態50倍下觀察85
圖29. 未經雷射照射區域86
圖30. 溶解區87
圖31. 熔融區88
圖32. 鍵結力量測試之結果89
圖33. 酸蝕組所斷裂之位置皆在bracket與樹脂間。90
圖34. Er:YAG雷射酸蝕後斷裂位置位於樹脂間。90
圖35. Nd:YAG雷射之斷裂位置位於牙齒與樹脂間。91
圖36. 微裂隙寬度與數量象。91
圖37. Nd:YAG雷射照射後之牙釉質縱切面之觀察。92
表次
表一 各組最大移除力量……………………………………………93
表二 各組平均值與標準差…………………………………………93

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周正中 酸蝕劑與雷射作用於牛牙釉質之機轉研究 國立臺灣大學臨床牙醫科學研究所碩士學位論文 民國八十七年
汪建明 X光微區分析 材料分析 中國材料科學學會
陳家全 李家維 楊瑞森 生物電子顯微鏡學 國科會精儀中心