CN107714489B - 硬化牙本质表面预处理方法 - Google Patents
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Abstract
本发明提供一种硬化牙本质表面预处理方法,通过在复合树脂粘接充填前,采用35%磷酸凝胶预处理硬化牙本质表面30s;用H2O冲洗30s;干燥后,采用5%或10%NaClO溶液对硬化牙本质表面进行预处理60s,用H2O冲洗30s,干燥后,完成对硬化牙本质表面预处理。该种硬化牙本质表面预处理方法,通过采用一定浓度的次氯酸钠和一定浓度的磷酸的联合作用,改变了硬化牙本质表面的物理结构,提高了表面粗糙度,从而增强了复合树脂对硬化牙本质的粘接强度。
Description
技术领域
本发明涉及一种硬化牙本质表面预处理方法。
背景技术
在口腔临床工作中,牙本质粘结一直是临床医生关注的重点问题。牙本质粘接的牢固程度直接影响修复治疗的预后。根据牙本质性质的不同,可分为正常牙本质、龋坏牙本质、牙颈部非龋性硬化牙本质。目前,在临床工作中龋坏及其牙体缺损多为非正常的牙本质(龋坏牙本质、硬化牙本质)。其中,牙颈部非龋性硬化牙本质(cervical scleroticdentin,CSD)的粘接强度是临床治疗中的难点,现有的研究表明硬化牙本质的粘结强度比正常牙本质低26%~30%,导致充填物易脱落时有发生,给医患双方都带来困扰,耗费了双方的人力、物力和时间。有针对中国南方城市广州35~44岁和65~74岁的城、乡人群的研究,发现牙颈部非龋性缺损(MCCL,Non-Carious Cervical Lesions)的患病率分别为76.8%、81.3%。牙颈部非龋性缺损已成为影响人们健康和生活质量的口腔疾病之一。
牙本质在磨损和缓慢发展的龋刺激后,牙本质小管中成牙本质细胞突起变性,矿物盐沉积而封闭牙本质小管,形成硬化牙本质。颈部非龋性硬化牙本质的微观结构特点:沉积了大量菱形、短柱形、水滴形的磷钙矿微晶而堵塞的牙本质小管;光滑的超矿化表层;表层矿物质密度高于下层硬化牙本质;过度矿化表层微晶的支持基质是变性的胶原蛋白床。采用磷酸的全酸蚀预处理方法后,通过原子力显微镜(AFM)分析磷酸酸蚀对不同牙本质的影响发现,硬化牙本质相对粗糙度指数与正常、龋坏牙本质具有明显差异,进一步证明了硬化牙本质相比正常、龋坏影响牙本质对磷酸酸蚀具有更显著的抵抗作用。此外,硬化牙本质由于牙本质小管堵塞、表面过度矿化层、细菌和矿化的细菌基质存在,导致牙本质通透性下降;常规预处理后,硬化性牙本质在结构上与正常牙本质差异较大,对粘结剂形成扩散障碍,减少树脂突的形成。因此,牙本质表面结构发生一系列防御性变化而形成的硬化牙本质,是导致复合树脂粘接强度降低、以及牙体复合树脂充填物的脱落和充填失败的重要原因。
硬化牙本质的特殊的物理结构特点增高了充填物粘接的难度。目前,硬化牙本质在临床上一般采用自酸蚀粘接方案,但效果不佳。或是采用一定浓度磷酸的全酸蚀预处理方案,磷酸是临床上牙釉质粘接常用的预处理制剂,低浓度、短时间的磷酸预处理可以使牙釉质和牙本质轻度脱矿,增加表面粗糙度和粘接的面积。但由于硬化牙本质特殊的物理结果特点,依然存在充填物容易脱落的问题。因此,本发明设计一种预处理方法,改良单独采用磷酸预处理的作用效果,以增强硬化牙本质粘接的强度,减少临床治疗中充填物易脱落的技术问题,提高医疗服务质量,增进龋病病人的满意度。
在橡皮障隔湿条件下,5%或10%次氯酸钠是人口腔内进行根管治疗时常用的一种消毒冲洗液。一定浓度的次氯酸钠具有抗微生物和溶解坏死组织的能力,并可以清洁根管管壁,并使木糖醇失活。此外,一定浓度的次氯酸钠可以降低牙本质的弹性模量和弯曲强度,理论上可以降低树脂充填后微渗漏的发生。本设计采用一定浓度的次氯酸钠来增强磷酸预处理的作用效果,为充填物的粘接修复提供新思路。
发明内容
针对以上问题,本发明的目的是提供一种硬化牙本质表面预处理方法,能够更有效改变硬化牙本质表面复合树脂粘接的强度,以避免治疗中硬化牙本质补牙后,充填物易脱落的常见临床问题。
本发明的技术解决方案是:
一种硬化牙本质表面预处理方法,包括以下步骤,
在复合树脂粘接充填前,采用35%磷酸凝胶预处理硬化牙本质表面30s;用H2O冲洗30s;干燥后,采用5%或10%NaClO溶液对硬化牙本质表面进行预处理60s,用H2O冲洗30s,干燥后,完成对硬化牙本质表面预处理。
进一步地,在硬化牙本质表面预处理后,再选择一步法自酸蚀粘结剂常规涂擦,随后使用复合树脂充填并固化。
本发明的有益效果是:该种硬化牙本质表面预处理方法,通过采用一定浓度的次氯酸钠溶液和一定浓度的磷酸处理剂的联合作用,改变了硬化牙本质的表面形态和物理结构,提高了表面粗糙度,便于粘接时树脂突机械微锁扣关系的形成,从而增强了复合树脂对硬化牙本质的粘接强度。该种硬化牙本质表面预处理方法,将有助于解决临床治疗中充填物脱落的难题。
附图说明
图1是实施例一、实施例二硬化牙本质表面预处理方法处理后牙本质表面与正常牙本质表面对比示意图;
其中,H为实施例一采用35%磷酸凝胶30s+10%NaClO溶液60s预处理后的硬化牙本质表面,G为实施例二采用35%磷酸凝胶30s+5%NaClO溶液60s预处理后的硬化牙本质表面,B为常规单独采用35%磷酸凝胶30s预处理后的硬化牙本质表面,AI为硬化牙本质表面,A为正常牙本质表面。
图2是实施例一、实施例二与各对比例预处理后牙本质表面与正常牙本质表面对复合树脂粘接的微拉伸强度测试分析结果示意图。
图2中,S组(0~7):硬化牙本质,0:蒸馏水对照组,1:对比例一:35%磷酸凝胶30s,2:对比例二:5%NaClO溶液60s,3:对比例三:15%EDTA凝胶60s,4:对比例四:15%EDTA凝胶60s,5%NaClO溶液60s,5:对比例五:15%EDTA凝胶60s,10%NaClO溶液60s,6:实施例二:35%磷酸凝胶30s,5%NaClO溶液60s,7:实施例一:35%磷酸凝胶30s,10%NaClO溶液60s。
具体实施方式
下面结合附图详细说明本发明的优选实施例。
实施例
实施例针对硬化牙本质表面的结构特点,采用了35%磷酸凝胶30s+5~10%NaClO溶液60s的这一预处理方法,此方法为实施例首次提出,此方法可以显著改变正常牙本质及硬化牙本质的表面微结构状况,并可以显著提高硬化牙本质的粘接微拉伸强度。对其微拉伸粘结强度及粘结表面情况的改变进行比较分析,证实了这一预处理方法在增强硬化牙本质强度上的可行性和合理性,从而改善临床上硬化牙本质的粘结修复的预后。
实施例一提出的具体方法如下:
在复合树脂粘接充填前,采用35%磷酸凝胶预处理硬化牙本质表面30s;用H2O冲洗30s;干燥后,采用5%或10%NaClO溶液对硬化牙本质表面进行预处理60s,用H2O冲洗30s,干燥后,完成对硬化牙本质表面预处理。
在硬化牙本质表面预处理后,选择一步法自酸蚀粘结剂(AdperTM Easy One,3MESPE,美国)常规涂擦,再使用复合树脂(3M Filtek Z250A3,3M ESPE,美国)进行充填并固化。
实施例二提出的具体方法如下:
采用35%磷酸凝胶预处理硬化牙本质表面30s。冲洗30s,干燥。采用5%NaClO溶液对硬化牙本质表面进行了预处理60s,冲洗30s,干燥,完成对硬化牙本质表面预处理。随后,选择AdperTM Easy One一步法自酸蚀粘结剂,3M Filtek Z250A3复合树脂进行充填并固化。
通过下述实验,证实了实施例提出的这一方法的可行性和正确性。针对离体牙,分别采用了下述预处理方法:
对比例一:35%磷酸凝胶30s;
对比例二:5%NaClO溶液60s;
对比例三:15%EDTA凝胶60s;
对比例四:15%EDTA凝胶60s+5%NaClO溶液60s;
对比例五:15%EDTA凝胶60s+10%NaClO溶液60s;
实施例一:35%磷酸凝胶30s+10%NaClO溶液60s;
实施例二:35%磷酸凝胶30s+5%NaClO溶液60s。
随后,选择AdperTM Easy One一步法自酸蚀粘结剂,3M Filtek Z250复合树脂进行充填并固化。24h后,将粘接的片切制作微拉伸粘结试件,测试拉伸粘结强度和断裂模式。最后,采用SPSS17.0软件包对数据进行分析。结果证实了采用35%磷酸凝胶30s+10%NaClO溶液60s预处理硬化牙面表面可以得到很好的粘接效果。
实施例一和二的原理说明如下:5%或10%次氯酸钠具有消毒作用,可以溶解坏死组织,溶解胶原蛋白,并可以清洁根管,并降低牙本质的弹性模量和弯曲强度。此外,一定浓度的次氯酸钠可以降低牙本质的弹性模量和弯曲强度,理论上可以降低树脂充填后微渗漏的发生。磷酸是临床上牙釉质粘接常用的预处理制剂,低浓度、段时间的磷酸预处理可以使牙釉质和牙本质轻度脱矿。而颈部非龋性硬化牙本质的微观结构特点:沉积了大量菱形、短柱形、水滴形的磷钙矿微晶而堵塞的牙本质小管;光滑的超矿化表层;表层矿物质密度高于下层硬化牙本质;过度矿化表层微晶的支持基质是变性的胶原蛋白床。临床上针对牙本质一般采用自酸蚀方法,但效果不佳。5%或10%次氯酸钠和磷酸联合使用,可以更好地溶解矿物盐沉积而封闭牙本质小管的部分硬化牙本质,增高硬化牙本质表面粗糙,便于粘接时树脂突机械微锁扣关系的形成。
实施例一和二在采用35%磷酸凝胶、30s处理牙本质表面后,首次分别用5%或10%NaClO溶液、60s对硬化牙面表面进行了处理,可以显著改变硬化牙本质表面的微观结构,增多可以形成微树脂突的表面微结构,如图1所示。图1中,H为采用35%磷酸凝胶30s+10%NaClO溶液60s预处理后的硬化牙本质表面,G为采用35%磷酸凝胶30s+5%NaClO溶液60s预处理后的硬化本质表面,B为常规单独采用35%磷酸凝胶30s预处理后的硬化牙本质表面,AI为硬化牙本质表面,A为正常牙本质表面。由图1可以看出,实施例一采用35%磷酸凝胶30s+10%NaClO溶液和实施例二采用35%磷酸凝胶30s+5%NaClO溶液60s预处理硬化牙面表面,可以增加表明粗糙度,而提高复合树脂的粘接面积。
与采用其他预处理方法相比,采用35%磷酸凝胶30s+5%或10%NaClO溶液60s的预处理方法的处理效果可以改变实施例硬化牙本质表面粘接微观结构,参见图1。
此外,与采用其他预处理方法相比,硬化牙本质各组微拉伸粘结强度依次为:实施例一组>实施例二组>对比例一组>对比例三组>对比例四组>对比例五组>蒸馏水对照组>对比例二组,如图2。图2表中多重比较结果用上标字母表示,上标字母不同者差异有显著性P<0.05;上标字母相同者差异无显著性P>0.05。图2表中数据可说明:硬化牙本质各组微拉伸粘结强度依次为:实施例一组>实施例二组>对比例一组>对比例三组>对比例四组>对比例五组>蒸馏水对照组>对比例二组。实施例一组的微拉伸粘结强度最高,实施例二次之;实施例一和二组之间的微拉伸粘结强度并无显著性差异,但与对比例各个组相比均存在差异均显著P<0.05,如图2;对比例一组、对比例三组粘结强度均高于蒸馏水对照组,且对比例一组和对比例三两组之间无显著差异P>0.05。
因此,实施例采用35%磷酸凝胶30s+5%或10%NaClO溶液60s预处理硬化牙面表面后,再采用常规的复合树脂粘接方法,可以明显增强充填物的粘接微拉伸强度。
Claims (1)
1.一种硬化牙本质表面预处理方法,其特征在于:包括以下步骤,
采用35%磷酸凝胶预处理硬化牙本质表面30s;用H2O冲洗30 s;干燥后,采用5%或10%NaClO溶液对硬化牙本质表面进行预处理60s,用H2O冲洗30 s,干燥后,完成对硬化牙本质表面预处理,提高表面粗糙度,在硬化牙本质表面预处理后,再选择一步法自酸蚀粘结剂常规涂擦,随后使用复合树脂充填并固化。
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