含層列黏土填料牙科封閉劑之氟釋放動力學與抗齲機制之研究

Abstract

目的 探討以改質高嶺土填料溝隙封閉劑之氟釋放動力學模式與抗齲能力。包括以下幾個部份來進行：(一)長期釋氟之量測；(二)氟再補充之釋放情形；(三)材料之抑菌能力測試；(四) 材料人工致齲模式之檢測；(五) 材料溝隙封閉效果之檢測及(六) 牙齒窩溝隙構造分析。 材料與方法 測試材料主要為含改質高嶺土填料溝隙封閉劑（K-30）及市售兩種基質之溝隙封閉材料，包括ClinproTM Sealant（Clinpro）與ClinproTM XT Varnish（Clinpro-XT）。所使用的方法為體外試驗包括：(一)長期釋氟之量測，利用離子層析儀記錄三種材料於去離子水中182天的氟釋放情形，並尋求材料的相關方程式；(二)氟再補充之釋放情形，將三種材料經處理後以2%wt NaF溶液進行再補充處理，利用離子層析儀記錄在去離子水中56天的氟釋放情形，找尋方程式以分析材料的釋氟模式；(三)材料之抑菌能力測試，採用Broth medium method來檢測。選擇的菌種為Streptococcus mutans GS-5, serotype C與Lactobacillus acidophilus ATCC4356，觀察材料在釋氟前後抑菌之效果；(四) 材料人工致齲模式之檢測，用酸鹼循環法來製造人工齲齒，使用人類牙齒做測試材料充填，以Micro CT及軟體分析來比較脫礦的情形牙齒窩溝隙構造分析；(五) 材料溝隙封閉效果之檢測，在人類臼齒咬合面使用材料進行溝隙封填，在變溫循環處理後以染劑滲透方式來評估材料的微滲漏情況；(六) 利用Micro CT來分析臼齒咬合面窩溝隙之解剖型態。 結果 材料之氟釋放模式方面，經過182天的釋氟過程，三種材料利用軟體分析所得最適合的方程式相同（ ）。在氟補充釋放的過程中，所得到材料相關的方程式，K-30與Clinpro-XT為同一個（ ）。Clinpro之方程式為 。抗菌測試方面，對GS-5的抑菌效果為Clinpro-XT > K-30 > Clinpro。ATCC4356的抑菌效果為Clinpro-XT > Clinpro ≒ K-30。經7天去離子水處理後的材料，抑菌效果有下降的情形。。填補材料的牙齒經人工致齲過程後，材料周圍齒質脫礦比例的大小為Clinpro（75.2±3.5%） > K-30（55.2±3.2%） > Clinpro-XT（43.9±2.4%）。材料封閉性的檢測結果，Clinpro-XT有明顯的微滲漏及材料脫落的情形，而Clinpro與K-30兩者在預防微滲漏的效果相同。牙齒窩溝隙構造分析的結果顯示，在是否易清潔的比例與其他學者研究的結果相似，利用Micro CT來觀察可發現窩溝隙構造的複雜性 結論 改質高嶺土填料溝隙封閉劑材料的釋氟量較Clinpro-XT為低，但略高於以複合樹脂為基質之Clinpro。由長期釋氟觀察所得三種材料對應的方程式相同，顯示其釋氟模式可能相近。在氟再補充釋放的的觀察，以程式比較的結果顯示，K-30與Clinpro-XT可能具備氟再補充之能力。由抑菌測試、人工致齲檢測與微滲漏測試之結果顯示，K-30具備一定程度的抗齲能力。由試驗中可看出以玻璃離子體為基質之材料有易脫落的狀況，此種情形與一般臨床所見相似。實驗結果顯示K-30有潛力可成為良好的溝隙封閉材料。

Objective To investigate the fluoride release kinetics and the anti-caries ability of the modified-kaolinite-filler-containing pit and fissure sealant (K-30) through the following methods: (1) Long-term fluoride elution process (2) Fluoride recharge experiment (3) Antibacterial test (4) Anti-demineralization ability in an artificial caries model (5) Sealing ability test (6) Morphologic analyses of pits and fissures of human molars. Materials and Methods An in-vitro study of K-30, ClinproTM Sealant (Clinpro) and ClinproTM XT Varnish (Clinpro-XT) included: (1) Long-term fluoride elution: Use Ion Chromatography to measure the amounts of fluoride released from the tested materials for 182 days. Find the equations of fluoride release amount against time for the materials. (2) Fluoride recharge: Recharge the materials with 2%wt NaF and use Ion Chromatography to measure the amounts of fluoride released for 56 days. Find the equation of fluoride release amount against time. (3) Antibacterial test: Observe the antibacterial activity before and after fluoride release of the materials against Streptococcus mutans GS-5, serotype C and Lactobacillus acidophilus ATCC4356 by broth medium method. (4) Anti- demineralization ability in an artificial caries model: Fill the extracted human teeth by the materials, induce artificial caries by pH cycling model and analyze tooth demineralization by micro CT. (5) Sealing test: Perform pit and fissure sealant on extracted human teeth by the materials and analyze the severity of microleakage by dye penetration test after thermal cycling. (6) Morphologic analyses of pits and fissures: Analyze the anatomic structure of pit and fissures of molars by using Micro CT. Results The 3 materials matched the same fluoride release equation “ ” during the elution process of 182 days. During the fluoride recharge, K-30 and Clinpro-XT matched the same fluoride release equation “ ”. The fluoride release equation of Clinpro was “ ”. The anti-bacterial effects against GS-5 were Clinpro-XT > K-30 > Clinpro. The result for ATCC4356 was Clinpro-XT > K-30 ≒ Clinpro. After soaking in deionized water for 7 days, all materials showed decreased in antibacterial effect. In artificial caries model, tooth demineralization percentage around filling materials were Clinpro (75.2±3.5%) > K-30 (55.2±3.2%) > Clinpro-XT (43.9±2.4%.). About sealing effect, there were obvious microleakage and dislodgement of pit and fissure sealant by Clinpro-XT while Clinpro and K-30 showed the same effect of preventing microleakage. Morphologic analysis of pits and fissures showed familiar result compared to other researches. The morphology of pit and fissure structure was so complicated. Conclusion The amount of fluoride release of the tested materials showed Clinpro-XT > K-30 > Clinpro. The equations of long term fluoride release of the materials were the same which indicated that the fluoride release model of the materials may be familiar. K-30 and Clinpro-XT may own the ability of fluoride recharge. K-30 showed good anti-caries effect compared with Clinpro. Consistent with clinical findings, glass-ionomer-based sealant were likely to be dislodged. The result showed that K-30 got the potential as an ideal sealant material.