玻璃离子修复材料对人工脱矿牙本质龋再矿化的研究
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摘要
继发龋是牙齿龋病治疗修复失败的主要原因之一，在手术牙科的治疗中，为防止继发龋的发生，需要彻底去除龋坏组织。事实上，在牙本质龋的病理过程中，最前沿的龋坏组织仅有牙本质的脱矿，而没有细菌的侵入，这层牙本质在适当的矿物质浓度下可以再矿化，恢复牙本质小管的结构或封闭牙本质小管口，因此应保留以增加牙体的抗力强度。玻璃离子水门汀在牙釉质龋的研究中已经被证明可以促进脱矿牙釉质再矿化及防止牙釉质继发龋的发生，牙本质和牙釉质主要的晶体结构都是羟基磷灰石，只是牙本质的有机物含量比牙釉质高。本研究的目的是利用建立的离体牙人工牙本质龋的模型，评价玻璃离子水门汀和树脂玻璃离子复合体对脱矿牙本质是否有促进再矿化的作用，为临床龋病治疗、防止继发龋的发生和在深龋的治疗中少去除牙体组织以保护牙髓组织活力提供理论依据。
方法：1 建立人工牙本质龋的离体牙模型：选择56颗因正畸需要而拔除的成人双尖牙，在每颗牙齿的近远中面各制备一个大小相同的窝洞，除窝洞各壁，牙面涂指甲油两层，自然干燥后，分别浸入20ml的酸性缓冲液，至人工龋坏形成后取出，自然干燥。2 建立对照组和实验组样本：每个牙齿的其中一个面窝洞各壁及牙体表面涂抗酸指甲油，做为对照组。然后，随机分成4组，每组样本未涂指甲油的窝洞分别充填玻璃离子水门汀、树脂玻璃离子复合体、汞合金和用氧化锌水门汀垫底汞合金充填。所有牙齿每天浸入人工唾液20小时，酸性缓冲液2小时，循环28天。3 电镜扫描观察：沿釉牙骨质界与牙长轴垂直用硬组织切片机切开，对每个样本的两个剖面进行观察，先用低倍镜(×100)观察各修复材料与牙本质的邻接关系，再用高倍镜(×5000)观察牙本质小管的形态，并对每个样本的两
郑州大学2003年硕士学位毕业论文
玻璃离子修复材料对人工脱矿牙本质龋再矿化的研究
个剖面用电子能谱仪进行钙、磷、氟含量测定，计算均值并进行再矿化分析。
结果:1低倍镜下，玻璃离子水门汀和树脂玻璃离子复合体与牙本质之间无
裂隙发生，而汞合金和氧化锌水门汀与牙本质之间有明显的微缝隙发生。2高倍
镜下，玻璃离子水门汀和树脂玻璃离子复合体充填的牙齿，脱矿的牙本质小管的
管周牙本质的结构又重新恢复或管腔形态闭锁。而汞合金和氧化锌水门汀充填
组，脱矿的牙本质小管结构松散，与管间牙本质无明显的界限。3钙、磷、氟原
子含量的变化比较明显:玻璃离子水门汀和树脂玻璃离子复合体充填的牙齿钙、
磷、氟原子量明显高于对照组、汞合金充填组及氧化锌水门汀垫底的充填组
(p<0.01)。其余各组之间的钙、磷、氟含量分析无统计学意义(p>0.05)。
结论:
1酸蚀缓冲液制造的人工牙本质龋可以模拟活体牙的牙本质龋的脱矿区，可
以有再矿化的发生。
2玻璃离子水门汀和树脂玻璃离子复合体可以促进脱矿的牙本质再矿化，并
可以和牙本质形成紧密的邻接关系，防止微渗漏的发生。
3汞合金，氧化锌水门汀没有促进脱矿化牙本质再矿化作用，而且和牙本质
之间有微裂隙发生。
Recurrent caries is one of the most important reasons for the failure of the caries therapeutic restoration for the modern operative dentistry. Removal of all caries tissue is key .In pathology, the top of dentine caries is only demineralized and no bacterium, it shall be left because it can be remineralized in satiating mineral content solution and .In the study of enamel caries, The glass ionomer cement have been tested that it can promot remineralized and inhibited demineralized enamel.The main structure of dentine and enamal is alike. The content of organic substance of dentine was more than of enamals. The purpose of this study is to establish the artificial dentine carise model in vitro and to estimat the ability of glass ionomer cement and resin -modified glass ionomer about promoting remineralized and inhibited demineralized dentine caries .The study can also supply theoretic evidence for avoiding recurrent caries in clinical practice and protecting live pulp in treatmeant of heavy dentine caries .
Methods IThe establishment of an artificially dentine caries model
in vitro: Fifty-six human permanent lower premolars extracted for orthodontic reasons were selected for the study .Two same class V cavities were cut on the mesial and distal sides of each teeth respectively. The teeth were then immersed in a standard buffer solution to obtain caries -like wall lesions. Each tooth was dry at room temperature.2To set up the comparison group and the test group :One of the two cavities of each tooth was covered with the acid -resistant nail varnish and as the control groups, then the specimen were assigned randomly into four groups .Each groups (n=14),another cavities of each tooth were restored with the glass ionomer cement, the resin-modified glass ionomer, amalgam and ZOE.Each teeth was immersing in 20ml artificial saliva for 20h, then in acid buffer solution for 4h.The cyclic program was carried out for 28 days.3Scanning electron microphotography: Each tooth was sectioned perpendicular to the long axis of teeth alone the enamel-cemental junctions using a hardness tissue slicing machine. Observing the two sectioned side with 100 magnification for the junction of the dentine and the restoration. Then observing the morphology of dentinal tubule with 5000 magnification. Measured the content of calcium, phosphorus and fluoride using electron spectroscopy .The values of all the specimens were statistical analysis according to averaged parameter.
Result lunder 100 magnification.The junction of the glass ionomer cement and dentine, the resin -modified glass ionomer and dentine have no microleakage, but the junctions of the amalgam and dentine , ZOE
cement and dentine ,ZOE cement and the amalgam have clear microleakage (p<0.01)2 under 5000 magnification. The resin-modified glass ionomer, which demineralized peritubular dentine was covered with mineral substance ,but another test groups .the demineralized peritubular dentin were not changed.SThe change of the content of calicium, phosphorus, fluoride. The content of calicium, phosphorus, fluoride of the glass ionomer cement and resin-modified glass ionomer were more than the control group and anther two groups (p<0.01) . In another three groups ,the content of calicium, phosphorus, fluoride was not changed (p>0.05).
Conclusion IThe artificial dentine caries which was made in the acid buffer solution was similar to the demineralized dentine caries in situ, which can be remineralized 2Glass ionomer remineralization and inhibiting demineralization of dentine carries in Vitro. The two restorative material have chemical adhesion to the dentine 3Amalgam and ZOE cement do not promote remineralization of demineralized of dentine caries in vitro and have microleakage with dentine.
方法：1 建立人工牙本质龋的离体牙模型：选择56颗因正畸需要而拔除的成人双尖牙，在每颗牙齿的近远中面各制备一个大小相同的窝洞，除窝洞各壁，牙面涂指甲油两层，自然干燥后，分别浸入20ml的酸性缓冲液，至人工龋坏形成后取出，自然干燥。2 建立对照组和实验组样本：每个牙齿的其中一个面窝洞各壁及牙体表面涂抗酸指甲油，做为对照组。然后，随机分成4组，每组样本未涂指甲油的窝洞分别充填玻璃离子水门汀、树脂玻璃离子复合体、汞合金和用氧化锌水门汀垫底汞合金充填。所有牙齿每天浸入人工唾液20小时，酸性缓冲液2小时，循环28天。3 电镜扫描观察：沿釉牙骨质界与牙长轴垂直用硬组织切片机切开，对每个样本的两个剖面进行观察，先用低倍镜(×100)观察各修复材料与牙本质的邻接关系，再用高倍镜(×5000)观察牙本质小管的形态，并对每个样本的两
郑州大学2003年硕士学位毕业论文
玻璃离子修复材料对人工脱矿牙本质龋再矿化的研究
个剖面用电子能谱仪进行钙、磷、氟含量测定，计算均值并进行再矿化分析。
结果:1低倍镜下，玻璃离子水门汀和树脂玻璃离子复合体与牙本质之间无
裂隙发生，而汞合金和氧化锌水门汀与牙本质之间有明显的微缝隙发生。2高倍
镜下，玻璃离子水门汀和树脂玻璃离子复合体充填的牙齿，脱矿的牙本质小管的
管周牙本质的结构又重新恢复或管腔形态闭锁。而汞合金和氧化锌水门汀充填
组，脱矿的牙本质小管结构松散，与管间牙本质无明显的界限。3钙、磷、氟原
子含量的变化比较明显:玻璃离子水门汀和树脂玻璃离子复合体充填的牙齿钙、
磷、氟原子量明显高于对照组、汞合金充填组及氧化锌水门汀垫底的充填组
(p<0.01)。其余各组之间的钙、磷、氟含量分析无统计学意义(p>0.05)。
结论:
1酸蚀缓冲液制造的人工牙本质龋可以模拟活体牙的牙本质龋的脱矿区，可
以有再矿化的发生。
2玻璃离子水门汀和树脂玻璃离子复合体可以促进脱矿的牙本质再矿化，并
可以和牙本质形成紧密的邻接关系，防止微渗漏的发生。
3汞合金，氧化锌水门汀没有促进脱矿化牙本质再矿化作用，而且和牙本质
之间有微裂隙发生。
Recurrent caries is one of the most important reasons for the failure of the caries therapeutic restoration for the modern operative dentistry. Removal of all caries tissue is key .In pathology, the top of dentine caries is only demineralized and no bacterium, it shall be left because it can be remineralized in satiating mineral content solution and .In the study of enamel caries, The glass ionomer cement have been tested that it can promot remineralized and inhibited demineralized enamel.The main structure of dentine and enamal is alike. The content of organic substance of dentine was more than of enamals. The purpose of this study is to establish the artificial dentine carise model in vitro and to estimat the ability of glass ionomer cement and resin -modified glass ionomer about promoting remineralized and inhibited demineralized dentine caries .The study can also supply theoretic evidence for avoiding recurrent caries in clinical practice and protecting live pulp in treatmeant of heavy dentine caries .
Methods IThe establishment of an artificially dentine caries model
in vitro: Fifty-six human permanent lower premolars extracted for orthodontic reasons were selected for the study .Two same class V cavities were cut on the mesial and distal sides of each teeth respectively. The teeth were then immersed in a standard buffer solution to obtain caries -like wall lesions. Each tooth was dry at room temperature.2To set up the comparison group and the test group :One of the two cavities of each tooth was covered with the acid -resistant nail varnish and as the control groups, then the specimen were assigned randomly into four groups .Each groups (n=14),another cavities of each tooth were restored with the glass ionomer cement, the resin-modified glass ionomer, amalgam and ZOE.Each teeth was immersing in 20ml artificial saliva for 20h, then in acid buffer solution for 4h.The cyclic program was carried out for 28 days.3Scanning electron microphotography: Each tooth was sectioned perpendicular to the long axis of teeth alone the enamel-cemental junctions using a hardness tissue slicing machine. Observing the two sectioned side with 100 magnification for the junction of the dentine and the restoration. Then observing the morphology of dentinal tubule with 5000 magnification. Measured the content of calcium, phosphorus and fluoride using electron spectroscopy .The values of all the specimens were statistical analysis according to averaged parameter.
Result lunder 100 magnification.The junction of the glass ionomer cement and dentine, the resin -modified glass ionomer and dentine have no microleakage, but the junctions of the amalgam and dentine , ZOE
cement and dentine ,ZOE cement and the amalgam have clear microleakage (p<0.01)2 under 5000 magnification. The resin-modified glass ionomer, which demineralized peritubular dentine was covered with mineral substance ,but another test groups .the demineralized peritubular dentin were not changed.SThe change of the content of calicium, phosphorus, fluoride. The content of calicium, phosphorus, fluoride of the glass ionomer cement and resin-modified glass ionomer were more than the control group and anther two groups (p<0.01) . In another three groups ,the content of calicium, phosphorus, fluoride was not changed (p>0.05).
Conclusion IThe artificial dentine caries which was made in the acid buffer solution was similar to the demineralized dentine caries in situ, which can be remineralized 2Glass ionomer remineralization and inhibiting demineralization of dentine carries in Vitro. The two restorative material have chemical adhesion to the dentine 3Amalgam and ZOE cement do not promote remineralization of demineralized of dentine caries in vitro and have microleakage with dentine.
引文
1. Ki-Taeg Jang .Remineralizing effects of glass ionomer restirations on adjacent interproximal caries. J Dent FOR CHILDREN 2001,3:125-128.
2. S.L.Creanor, L.A.Awawadeh, W.ESaunders, el.at The effect of a resin-modified glass ionomer restorative material on artifially demineralised dentine caries in vitro.J Dent 1998,26 527-531
3．樊明文．牙体牙髓病学．第一版 北京：人民卫生出版社．2000，11．34-43．
4．陈钨，氢氧化钙个导体内牙本质桥形成的研究，实用口腔医学．1990，6：117．
5．张加理．童建忻．牙体性物电位的测量和研究．口腔材料器械杂志．1992，1：13-14．
6．腾山茂。The glass ionomer coments．东京GC齿科工业会社．1989，1：1
7 Koulourides T. Fluonde and the caries process. J Dent Res,1990, 69:558.
8. Dreessen FCM,Enamel caries transformation and remineralization In:Dressens FCM,Woltgen JHM,ed,Tooth development and Caries.VoI_2.Boca Roton, Florda,CRC Press InC,1986,25-63.
9．黄定明．玻璃离子水门汀氟释放的离体研究．牙体牙髓牙周病学杂志．1996 6．203-205．
10.Elmallakh BF, sarkarNK.Floride release from glass ionomer cements in deioniszed water and artificial saliva, Dent Marter,1990,98:173.
11.Lammers PC,Borggreven JMPM,Diessens Fcm et.al.Acid Susceptibility of lesions in bovine enamel after remineralization in the presence of fluoride and /or carbonate.Caries Res,1992,26:1.
12.Wgao.Demineralisation and remineralisation of dentine Caries,and the role of glass-ionomer cements.International Dental Journal 2000,50:52-53
13.Yip H K Beely J A.The specificity of caries detector dyes in cavity preparation. Br Dent J 1994,176:417-421.
14．黄定明．周学东．不同品牌玻璃离子水门汀氟释放比较．实验口腔医学．1999 15：169-171．
15 Mount,G.J Glass-ionomer cements:past,present and futre.Oper Dent. 1994,19:82-90.
16．候本祥，洪法廉，刘鲁川．玻璃离子水门汀与牙本质的剪切粘结强度．牙体牙髓牙周病学杂志．1992，2：13．
17． Um CM,OiloG, The effect of early water contact on glass-ionomer ccements[J.]. Quintessence Int 1992,36:209-214
18． Berta chini SM.Abate PF,Blank A,et.al.Solubility and flueride release in ionomers and compomers(J).Ouiutessence Int 1999,30:193-197．
19． Deniz cemalmaz, Effect of early water comtact on solubility of glass ionomer luting coment(J).J prosthet Dent 1998,80:474-478．
20． Rodrigues carcia RC.De Goes MF.Del Bel cury AA.Influence of protecting agents on the solubility of glass ionomers[J].Am J Dent 1995,8:294-296．
21． Creanor SL.Effect of extrinsic fluoride concentraion on the up take and release of fluonde from two glass ionomer cements. 1995,29:424．
22． B.J. Millar, E. Abidon, J.W. Nichoison, In Vitro caries Inhibition by polyacrylic-modified composite resins compomers, J. Dent, 1998,26:133-136．
23． Mitra SB.In vitro fluoride release from a light-cured glass ionomer liner /base ,J Dent Res, 1991;70:75．
24． 李晨军，LG1C和GIC与牙釉质抗剪粘结强度，牙体牙髓牙周病学杂志。 1994，4：154．
25． Pereira,PN,Yamada.T. Inonoshi.S.et.aLAdhesion of resinmodified galss ionomer cements using resin banding systems.J Dent. 1998,26:479-485．
26． Fried.K-H. Schmalz-G. Killer K-A et.al. Resin-Medified glass ionomer cements:Fluoride release and influence on Streptococus mutans growth.Eur J oral Sci.l997,105:81-85．
27． Bourhe FM ,walls AW ,MC cabet JF,Light actived glass polyalkenoate (ionomer)cements:the setting reaction.J Dent ,1992,20:115
28． M jor IA Glass ionomer cement restorations and secondary caries: a preliminary report. Ae to Odonotologica Scandinavica, 1997,55:58-68
2. S.L.Creanor, L.A.Awawadeh, W.ESaunders, el.at The effect of a resin-modified glass ionomer restorative material on artifially demineralised dentine caries in vitro.J Dent 1998,26 527-531
3．樊明文．牙体牙髓病学．第一版 北京：人民卫生出版社．2000，11．34-43．
4．陈钨，氢氧化钙个导体内牙本质桥形成的研究，实用口腔医学．1990，6：117．
5．张加理．童建忻．牙体性物电位的测量和研究．口腔材料器械杂志．1992，1：13-14．
6．腾山茂。The glass ionomer coments．东京GC齿科工业会社．1989，1：1
7 Koulourides T. Fluonde and the caries process. J Dent Res,1990, 69:558.
8. Dreessen FCM,Enamel caries transformation and remineralization In:Dressens FCM,Woltgen JHM,ed,Tooth development and Caries.VoI_2.Boca Roton, Florda,CRC Press InC,1986,25-63.
9．黄定明．玻璃离子水门汀氟释放的离体研究．牙体牙髓牙周病学杂志．1996 6．203-205．
10.Elmallakh BF, sarkarNK.Floride release from glass ionomer cements in deioniszed water and artificial saliva, Dent Marter,1990,98:173.
11.Lammers PC,Borggreven JMPM,Diessens Fcm et.al.Acid Susceptibility of lesions in bovine enamel after remineralization in the presence of fluoride and /or carbonate.Caries Res,1992,26:1.
12.Wgao.Demineralisation and remineralisation of dentine Caries,and the role of glass-ionomer cements.International Dental Journal 2000,50:52-53
13.Yip H K Beely J A.The specificity of caries detector dyes in cavity preparation. Br Dent J 1994,176:417-421.
14．黄定明．周学东．不同品牌玻璃离子水门汀氟释放比较．实验口腔医学．1999 15：169-171．
15 Mount,G.J Glass-ionomer cements:past,present and futre.Oper Dent. 1994,19:82-90.
16．候本祥，洪法廉，刘鲁川．玻璃离子水门汀与牙本质的剪切粘结强度．牙体牙髓牙周病学杂志．1992，2：13．
17． Um CM,OiloG, The effect of early water contact on glass-ionomer ccements[J.]. Quintessence Int 1992,36:209-214
18． Berta chini SM.Abate PF,Blank A,et.al.Solubility and flueride release in ionomers and compomers(J).Ouiutessence Int 1999,30:193-197．
19． Deniz cemalmaz, Effect of early water comtact on solubility of glass ionomer luting coment(J).J prosthet Dent 1998,80:474-478．
20． Rodrigues carcia RC.De Goes MF.Del Bel cury AA.Influence of protecting agents on the solubility of glass ionomers[J].Am J Dent 1995,8:294-296．
21． Creanor SL.Effect of extrinsic fluoride concentraion on the up take and release of fluonde from two glass ionomer cements. 1995,29:424．
22． B.J. Millar, E. Abidon, J.W. Nichoison, In Vitro caries Inhibition by polyacrylic-modified composite resins compomers, J. Dent, 1998,26:133-136．
23． Mitra SB.In vitro fluoride release from a light-cured glass ionomer liner /base ,J Dent Res, 1991;70:75．
24． 李晨军，LG1C和GIC与牙釉质抗剪粘结强度，牙体牙髓牙周病学杂志。 1994，4：154．
25． Pereira,PN,Yamada.T. Inonoshi.S.et.aLAdhesion of resinmodified galss ionomer cements using resin banding systems.J Dent. 1998,26:479-485．
26． Fried.K-H. Schmalz-G. Killer K-A et.al. Resin-Medified glass ionomer cements:Fluoride release and influence on Streptococus mutans growth.Eur J oral Sci.l997,105:81-85．
27． Bourhe FM ,walls AW ,MC cabet JF,Light actived glass polyalkenoate (ionomer)cements:the setting reaction.J Dent ,1992,20:115
28． M jor IA Glass ionomer cement restorations and secondary caries: a preliminary report. Ae to Odonotologica Scandinavica, 1997,55:58-68