硅酸三钙封闭牙本质小管的作用

Occlusion of dentinal tubules using tricalcium silicate

背景:多项体外实验证实硅酸三钙不仅可以通过自固化过程与牙本质紧密结合,而且在生理环境下能诱导牙本质再矿化,有效阻塞牙本质小管。目的:进一步验证硅酸三钙对牙本质小管的封闭作用。方法:选择正畸患者拔除的第一前磨牙制作离体牙本质盘36块,分别经0.29 mol/L EDTA内浸置2 min,6%柠檬酸蚀1 min后冲洗,蒸馏水超声清洗20 min 3种方法预处理,模拟具有牙本质小管不同开放程度的牙本质敏感症。以上每组随机分为3个亚组,即硅酸三钙组、氟化钠对照组、空白对照组,前2组每天早晚分别用对应材料涂刷表面,2 min/次,空白对照组不处理,其余时间全部置于人工唾液37℃恒温箱中保存。14 d后通过扫描电镜观察各组处理前后牙本质形态,并计算开放牙本质小管直径和面积。结果与结论:经不同预处理后牙本质小管都呈开放状态,但柠檬酸和EDTA预处理溶液较蒸馏水有更强的脱矿作用,牙本质小管更加清晰。各组经氟化钠或硅酸三钙涂擦后,牙本质小管口有不同程度沉积物,且开放牙本质小管面积及平均直径较空白对照组小(P<0.05);经硅酸三钙涂擦的牙本质小管几乎完全均质封闭,偶见有单个孤立开放的牙本质小管口,开放牙本质小管面积及平均直径都明显低于氟化钠对照组(P<0.05)。证实硅酸三钙可有效封闭牙本质小管,且效果优于氟化钠;在治疗牙本质过敏时,如果先用EDTA或酸蚀剂处理,脱敏效果会更完善。

BACKGROUND：A number of in vitro experiments have confirmed that the tricalcium silicate not only can be closely integrated with the dentin through self-curing process, but also can induce dentin remineralization in the physiological environment, thereby effectively blocking the dentinal tubules. OBJECTIVE：To further verify the effects of tricalcium silicate solution on the occlusion of dentinal tubules. METHODS：Thirty-six dentinal discs were made of free first premolars from orthodontic patients, and divided into three pretreatment groups randomly. The teeth were soaked in pretreatment solution for 2 minutes, namely 0.29 mol/L ethylene diamine tetraacetie acid, 6%citric acid, and rinsed ultrasonical y with deionized water 20 minutes, respectively. Every above-mentioned group was randomly assigned into experimental group （tricalcium silicate）, control group （sodium fluoride） and blank group, and corresponding materials in each group were used to coat the outer dentinal tubules （2 minutes/time）. Then, the dentinal discs were saved in artificial saliva in a 37 observed using scanning electron microscope. Diameter and area of open dentinal tubules were calculated. RESULTS AND CONCLUSION：After pretreatment, the dentinal tubules were at open state;except for the blank control group to maintain the original state, acid etching and ethylene diamine tetraacetie acid pretreatment solutions had a stronger capacity of demineralization, which led to the dentinal tubules open. After the dentinal tubules were treated with sodium fluoride and tricalcium silicate, there were varying degrees of sediments, and open dentinal tubule area and average diameter in the sodium fluoride and tricalcium silicate groups were lower than those in the control group （P〈0.05）. The dentinal tubule treated with tricalcium silicate was almost entirely closed homogeneously, and occasional y, a single open dentinal tubule was seen. Open dentinal tubule area and average diameter in the tricalcium silicate group were significantly lower than those in the sodium fluoride group （P〈0.05）. The findings verify that dentin occlusion using tricalcium silicate is superior to that using sodium fluoride;and dentin tubule pretreatment with acid etching or ethylene diamine tetraacetie acid is beneficial to desensitization effects.