不同粘接修复材料对窝洞充填修复边缘微渗漏的影响

Effect of various restorative materials on cavity filling microleakage

背景:微渗漏被认为是影响牙体修复效果的主要因素,许多学者认为应用粘接剂是减少修复体边缘微渗漏的有效方法。目的:通过对目前临床常用的5种牙科修复材料边缘微渗漏的实验研究,评价不同充填材料、不同粘接材料对窝洞充填修复边缘微渗漏的影响,以及热循环对各种修复材料边缘封闭的影响。设计、时间及地点:对比观察实验,于2007-01/2008-06在上海交通大学医学院附属新华医院完成。材料:选取50颗正畸拔除的新鲜上颌前磨牙,近或远中制备长方体形Ⅱ类洞型。样本随机分成5组,分别用全酸蚀粘接剂粘接纳米树脂修复(SB组)、自酸蚀粘接剂粘接纳米树脂修复(AP组);玻璃离子水门汀修复(Ket组);自酸蚀粘接剂粘接银汞合金修复(AgAp组);单纯银汞合金修复(Ag组)。方法:粘接和充填过程严格按厂商说明书操作。每组选取5颗牙进行0～55℃的热循环200次,另5颗牙热循环500次。所有样本放入0.5%碱性品红中37℃染色24h。取出样本在石膏修磨机上进行逐层磨片,并在体视显微镜下用软件测量轴壁和龈壁的微渗漏深度。主要观察指标:微渗漏深度。结果:经One-wayANOVA和SNK检验统计分析,热循环200次和500次后5组样本各组间比较均显示AP组的微渗漏大于其他各组(P<0.01),而其他各组间比较差异无显著性意义(P>0.01)。PairedSamplesttest统计显示同组中轴壁微渗漏小于龈壁(P<0.01);热循环500次后各组轴壁和龈壁的微渗漏均较热循环200次有明显增加(P<0.01)。结论:各组窝洞充填修复边缘均可见微渗漏。自酸蚀粘接剂粘接修复边缘封闭效果弱于其他4种充填方法;修复体轴壁抗微渗漏能力好于龈壁;热循环次数的增加会加重修复体的边缘微渗漏。

BACKGROUND： Microleakage is a major factor to influence odontal restoration, while adhesive agents have been considered to effectively relieve microleakage. OBJECTIVE： To evaluate the effect of various filling and adhesive materials on marginal microleakage, and to study the effect of heat cycle on border seal of repairing materials. DESIGN, TIME AND SETTING： A contrast study was performed in Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University from January 2007 to June 2008. MATERIALS： Fifty cuboid class II cavities were cut in fresh extracted human premolars for orthodontics purpose and randomly divided into five groups： single bond 2 ＋ Z350 （SB group）, Adper prompt ＋ Z350 （AP group）, Ketae-Molar （Ket group）, Adper prompt ＋ Amalgam alloy （AgAP group）, and Amalgam alloy （Ag group）. METHODS： The bonding systems and filling technique were used in strict accordance with the manufacture instructions. After placement of the restorations, half of each group underwent 200 cycles and the other half underwent 500 cycles （0 ℃ to 55 ℃）. The specimens were then dyed in 0.5% basic fuchsin for 24 hours at 37℃. Each specimen was sectioned buccolingually to obtain five to six sections, and then evaluated the microleakage at the occlusal enamel margin （axial wall） and the gingival margin （gingival wall） under a stereomicroscope. MAIN OUTCOME MEASURES： The depth of microleakage. RESULTS： After 200 and 500 cycles of thermoeycling, one-way ANOVA with SNK test revealed that on both occlusal enamel and gingival margin, microleakage of AP group was significantly greater than SB group, Ket group, AgAp group, and Ag group （P 〈 0.01）, but there was no significant difference between SB, Ket, AgAp, and Ag groups （P 〉 0.01）. Paired sample-t test showed that the micreoleakage on the occlusal enamel margin was significantly less than gingival margin （P 〈 0.01）. In addition, the microleakage on the occlusal enamel or gingival margin increased significantly along with the 500 cycles of thermocycling compared to 200 cycles （P 〈 0.01）. CONCLUSION： Marginal microleakage was found in each group. The sealing ability of the margin of self-etching adhesive system with resin composite was weaker than that of total-etching adhesive system with resin composite, glass ionomer cement, self-etching adhesive system with amalgam alloy and amalgam alloy only. The occlusal enamel margin showed less microleakage compared to gingival margin. The cycles of thermocycling influenced the microleakage of both occlusal enamel and gingival margin.