Noninvasive penetration resin materials repair early stage deciduous caries

doi:10.3969/j.issn.2095-4344.2013.25.025

Abstract

Abstract:

BACKGROUND: Due to the anatomical location of early deciduous caries, plaque is difficult to remove, and the effect of conventional remineralization therapy is poor.
OBJECTIVE: To observe the clinical effect of noninvasive penetration resin for the treatment of early deciduous caries.
METHODS: 120 teeth with early deciduous caries were collected and divided into penetration resin group and flowable resin group, 60 teeth in each group. The teeth were treated with penetration resin and flowable resin respectively. The tooth morphology of caries, enamel demineralization removing caused chalk stains and color stability, secondary caries and treatment success rate were evaluated at 1-year follow-up after treatment.
RESULTS AND CONCLUSION: The efficacy at 1 year after filling treatment showed that tooth morphology of caries, enamel demineralization removing caused chalk stains and color stability, and secondary caries in the penetration resin group were better than those in the flowable resin group. The treatment success rate in the penetration resin group (96.7%) was significantly higher than that in the flowable resin group (76.7%), and the difference was significant (P < 0.05). Noninvasive penetration resin material is the simple and efficient method to prevent the development caries.

Key words: biomaterials, biomaterial academic discussion, early deciduous caries, infiltration techniques, penetration resin, flowable resin, fluoride, chalk stains, secondary caries

CLC Number:

R318

Mao Qing-hua, Ge Qing-hua, Ning Jia, Jiang Hai-ying. Noninvasive penetration resin materials repair early stage deciduous caries [J]. Chinese Journal of Tissue Engineering Research, 2013, 17(25): 4739-4744.

Figures/Tables 2

2 无创渗透树脂材料的渗透性能无创渗透树脂的渗透性能体现在渗透深度和渗透速度2个方面。Meyer-Lueckel等[5]在15%盐酸酸蚀龋损表面使用黏结剂和渗透树脂进行实验，应用横断显微放射照相技术和激光共聚焦显微镜来观察两种材料的渗透深度，结果发现黏结剂材料在龋病区域的渗透表浅，大约在67 μm，而渗透树脂材料的渗透较深，大约在171 μm。Meyer-Lueckel等[11]在体外实验对比双酚A甲基丙烯酸缩水甘油酯、二甲基丙烯酸三甘醇酯、乙醇3种材料不同比例混合制备的12种渗透树脂材料与Excite黏结剂进行渗透能力的比较，发现渗透树脂材料比黏结剂更能深度进入龋坏组织中，含有二甲基丙烯酸三甘醇酯，不含有乙醇的混合渗透材料，在阻断龋病进展方面更具优势。在渗透速度研究方面，与黏结剂比较，渗透树脂的速度更快。Paris等[12-13]研究发现黏结剂在人工龋上的渗透速度均值在3.47 μm/s，渗透树脂材料在人工龋上的渗透速度大于30 μm/s。Meyer-Lueckel等[14]研究发现渗透树脂在自然龋上的渗透速度为3.33 μm/90 s，明显低于在人工龋上的渗透速度，可能由于自然龋表面的玷污层未处理完全的原因，影响材料的渗透速度。渗透树脂材料适合于邻面和光滑面非洞龋损，即位于釉质和牙本质浅层1/3的早期龋。而且可以去除与美观相关的光滑面釉质白垩色斑块，常在正畸固定矫治器被去除后釉质表面的脱矿。早期釉质龋中脱矿物质的机械稳定，保存健康的患牙和邻牙，永久性的堵塞表层的微孔和龋洞，可以阻止龋病的进展，降低再次龋坏的风险，推迟修复性治疗的时间，没有治疗后敏感和牙髓炎的风险，降低牙龈炎和牙周炎的风险，对于唇面脱矿的病损，如正畸后的白垩斑块，可以提高美观效果。患者容易接受，不需要多次复诊，不用麻醉和机械磨除。值得注意的是渗透树脂没有X射线阻射，治疗的效果可以通过将来的复查来追踪。"

3 影响无创渗透树脂材料性能的因素 3.1 材料的渗透系数 Paris等[15]利用物理Washburn方程式说明渗透材料的物理特性，d2是PC与rt的乘积，d为树脂渗透的渗透深度，PC为渗透材料的渗透系数，r为微孔的半径，t为材料的渗透时间。从公式中可见渗透材料的渗透系数与渗透深度相关性很强，渗透深度与渗透效果是紧密相关的。渗透系数越大，渗透速度越快。微孔的半径、体积和数量也影响渗透树脂材料的效果。渗透系数与树脂材料对空气的表面张力、树脂与釉质的接触角以及树脂动态黏度等相关。提高表面张力，降低黏度和减小接触角可增强树脂的渗透系数。 3.2 釉质表层处理早期龋齿发生后，表层下已严重脱矿，表层釉质相对完整，而表层的釉质会阻碍渗透树脂的渗透性。如何处理矿物含量较高的牙釉质表层使渗透性增强是学者们关注的焦点。处理方法有机械性磨除和酸蚀处理[16]。机械性磨除法由于磨除量难以控制，有可能会对邻面造成缺损，机械性磨除法只能使龋病区暴露，并不能增加微孔的半径和体积，而且在磨除过程中会在表面釉质产生玷污层，反而阻碍龋病区域的开放，从提高渗透系数方面考虑作用不大。目前釉质表层处理应用最多的是酸蚀技术，此技术可以使釉质表层发生脱矿，增加渗透的面积和体积。常用的酸蚀剂有磷酸、盐酸以及有机酸，而且酸蚀剂使用的种类、浓度、pH值以及酸蚀时间等都会对釉质表层处理产生影响。Gray等[17]应用37%的磷酸酸蚀人工龋5 s，涂渗透树脂，扫描电镜观察材料的渗透性，发现其脱钙能力较高，渗透效果较好。Paris等[18]对3种pH值不同的酸蚀凝胶的酸蚀效果进行比较，选用37%磷酸、5%盐酸和15%盐酸酸蚀早期邻面龋，激光共聚焦显微镜观察发现，15%盐酸使用90-120 s，表层釉质深度减少(31±6) μm，处理牙釉质表面2 min黏结剂的深度减少(18±11) μm，几乎可以完全去除龋损区域表层，酸蚀程度最理想。可见，15%的盐酸比37%的磷酸对釉质表层的腐蚀效果更好。乳牙与恒牙的表层结构以及有机质含量不同，但使用15%的盐酸酸蚀乳牙龋病表层120 s，也可完全去除表层。 3.3 渗透时间和作用次数由Washburn方程式可知，树脂渗透系数与渗透时间具有相关性，即渗透时间越长，越能阻断龋病区域的进展，保证良好的渗透效果。有学者研究得出，渗透剂的作用时间应至少在3 min，这样才可以完全的渗透到自然龋的病损牙组织[19]。对渗透树脂进行一次渗透后，表面会出现裂缝样非均匀性表现，因此可以对龋病区域进行重复树脂渗透，有实验证实对人工龋进行2次渗透树脂治疗，不仅可以有效的阻断病变进一步发展，并且可以增强龋病区域的显微硬度[20]。 3.4 干燥处理在使用酸蚀剂处理后，需要有大量的水来冲洗多余的酸蚀剂残留。但残留水分会使开放微孔的半径以及体积减小，进而减小驱动树脂渗透的毛细管力，这样会影响渗透树脂的效果。如果完全去除残留在开放微孔内的水分会使牙本质的胶原基质崩塌[21]，使龋病区域的微孔体积减少，同样也会影响渗透树脂的效果。因此，既去除微孔内水分，又不会使胶原纤维崩塌，这样的干燥处理对渗透性能有所帮助。文章应用的DMG公司生产的渗透树脂，采用化学脱水的方法处理[22]，即使用高浓度的乙醇作为干燥剂，来替代胶原基质间的水分，减少胶原基质的亲水性，使胶原纤维处于脱水扩张状态，保证微孔的开放，进而保证渗透效果[23]。"

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