玻璃離子體窩隙封劑對唾液污染齒面黏著力之臨床研究

Abstract

使用玻璃離子體 (glass ionomer cement, GIC）做為溝隙封劑 (pit and fissure sealant) 來預防齲齒的優點是，它可與牙釉質直接以化學鍵結合，並釋放氟離子保護牙齒；在偏遠地區使用玻璃離子體，可以省去繁複的牙齒表面處理。但在偏遠地區設備不足的情況，牙齒容易遭致唾液之污染。本研究目的是在臨床上，驗證我們過去所作的體外實驗(in vitro study)的結果；在不沖洗齒面之條件下，僅將唾液污染的牙齒表面吹乾後，使用玻璃離子體做為窩隙防齲封劑，是否可恢復玻璃離子體與牙釉質之黏著力，保持玻璃離子體於牙齒之咬合面等溝隙系統 (sealant retention)。 本實驗選取220位，年齡介於6至8歲之國小學童，其恆牙第一大臼齒已萌出兩顆以上（上顎或下顎）且無齲齒者。採用玻璃離子體 (glass ionomer cement, 簡稱GIC, Fuji IX GP）為溝隙封劑材料；以口腔分隔法 (split mouth) 的方式，隨機分配一邊為控制側，另一邊則為實驗側。控制側按廠商指示的步驟完成玻璃離子體塗佈，而污染實驗側則按本實驗室過去所得之結果，僅將受唾液污染的牙齒，以「吹氣乾燥」的方式處理牙齒表面後，塗佈玻璃離子體於臼齒之溝隙上。每隔3個月檢查一次，評估玻璃離子體是否仍黏著於牙齒表面上，該牙是否有蛀牙等變化情形。將評估結果所得之數據，以McNemar’s test做分析比較。觀察封填劑固著（retention）的情形，是否符合我們先前體外研究（in vitro study）的結果：被唾液污染的齒面經吹氣乾燥後，與按標準程度處理的齒面，塗佈玻璃離子體後，兩者是否有相當的固著率。178學童完成全程18個月的觀察。結果顯示，至12個月為止，被唾液污染的實驗側牙齒，其玻璃離子體之固著率與控制側相當；而18個月後的觀察則顯示實驗側固著率有下降的趨勢。 塗佈封劑後18 個月後，實驗側玻璃離子體完全固著率為 17.89%、部份固著率為35.27%、完全脫落比率為45.26%、 齲齒發生率為1.58%；控制側的結果依序為22.63%、42.10%、33.68% 及 1.58%。以齲齒發生率而言，實驗側和控制側並無差異，但是下顎比率高於上顎。根據目前的結果顯示，唾液污染齒面的玻璃離子體窩隙封劑之固著率在18個月之後明顯下降，因此建議在進行玻璃離子體窩隙封劑塗佈時，仍需做好潮濕控制，以提升其固著率。玻璃離子體窩隙封劑脫落後是否仍具有預防齲齒的功效，則需更長的觀察時間來驗證。

英文摘要 Objective: To evaluate the retention and efficacy of the GIC sealants on the saliva contaminated enamel surface after air-dry procedure in clinical situation. Method: The initial population consisted of 220 schoolchildren, ages 6-8 years, whose permanent molars were sound sealed. A GIC (Fuji IX) was used as sealant material. All sealants were placed in a school setting by the same dentist. The teeth were randomly assigned to control side on which the treatment procedures were followed with manufacture’s instruction. The contralateral tooth surface was intentionally contaminated with saliva then air-dried without rinse before sealant placement. Evaluations were done with a dental probe with light pressure. Double-blind recall examinations for sealant retention were done at 3 months intervals until 18 months. 178 subjects returned for evaluation after 18 months. Results: After 18 months, 17.9% of the sealed teeth showed complete present, 35.3% partial present without caries, 45.3% complete loss without caries, and 1.5% caries or filled on occlusal surface of the contaminated side. In control side, the corresponding figures were 22.6%, 42.1%, 33.7% and 1.6%, respectively. Statistical analysis (Chi square test) revealed that there were no significant difference between the retention rate of the experimental side and the control side in the study periods. As to caries incidence, there was no significant difference (McNemar’s test) between experimental side and control side. Conclusion: Air drying to the saliva contaminated enamel without rinse prior to GIC placement seems to have comparable retention rate to teeth with regular procedure.