【作者】 代慧珍；

【导师】 吴补领；

【作者基本信息】 第四军医大学 ， 口腔临床医学， 2004， 硕士

【摘要】 随着患者对健康和美观要求的不断提高，复合树脂牙色材料被越来越多的应用于口腔临床，如：牙齿缺损的修复、牙周病松动牙的固定、正畸附件的黏接、牙槽骨和颌骨骨折的治疗等。复合树脂性能之所以能够明显改善，与黏接剂的发展和改进有很密切的关系。口腔黏接材料的发展，经历了从无机材料到有机高分子材料、从黏接牙釉质到黏接牙本质和软组织的历程。牙体黏接修复与传统非黏接修复相比有许多优点：黏接技术减小了修复材料与牙齿界面的微渗漏，从而降低了治疗后的敏感性和继发龋的发生；作用于牙体和修复材料的功能性压力被均匀地分配至牙(牙合)面，保护和增强被削弱的牙体结构；黏接技术也增加了牙体美观修复的可能性，以较少磨削牙齿而获得固位，得到最佳的治疗效果，使修复范围不断扩大。1955年Buonocore提出的“酸蚀技术”和复合树脂的问世，在几十年间口腔黏接材料和技术得到很大发展，为牙齿修复注入了全新的概念和理论。随着研究工作的日益深入，各种新型材料的不断涌现，为口腔黏接修复带来空前繁荣。但不同黏接剂性能和修复效果的对比研究较少。本研究拟观察几种树脂黏接剂(Durafill、Prime & Bond NT、Clearfil SE Bond)影响细胞生长的情况、黏接剂(Prime &Bond NT、Clearfil SE Bond)间接盖髓后的牙髓反应及人牙龋洞修复后的临床效果，评估几种复合树脂黏接剂的细胞毒性、对牙髓的保护作用和修复后敏感情况，从而为临床正确使用黏接剂，达到复合树脂修复牙缺损的最佳效布侧早砚J气月卜月叹创七学位论文果提供依据。研究共包括三个部分:l、树脂豁接剂Durafill、Prime&Bond NT、Clearfil SE Bond对体外培养的成纤维细胞毒性研究 通过培养建系的鼠成纤维细胞(L929)，将三种勃接剂及充填树脂制成固定模块，以RPMn 640培养液制成浸提液，并稀释成100%、75%、50%、25%。以4x104/ml、lxlo场1、0.6xlo4蒯个细胞的细胞悬液，分别接种于96孔板，培养24h，以不同浓度浸提液1 00林l替换，培养2、4、7d。用MTT法测定光吸收值，取平均值。结果显示:成纤维细胞培养2、4、7d三个时间点，三种猫接剂光吸收值不同(P<0 .05)，其中Clearfil SE Bond较其它两组光吸收值大。随着时间延长，三种薪接剂的光吸收值均逐渐增大;在四种不同浓度的培养条件下，三种勃接剂光吸收值亦不同(P<0 .05)，其中Clearfil SE Bond较其它两组光吸收值大，随着浓度增加，三种豁接剂的光吸收度逐渐减小。结果说明:三种勃接剂的细胞毒性均较弱(接触7d不超过2级)，呈明显的时间、浓度依赖性，其中clearfil SE Bond的毒性最小(为l级)。2、复合树脂勃接体系Clearfil SE Bond、Prime&BondNTl’ed接盖髓效果的动物实验研究 88颗成年犬尖牙、前磨牙、磨牙，在牙颊面颈部距牙龋1刃nrn备V类洞，近髓腔而不穿髓，实验样本平均剩余牙本质厚度553.6脚，分别用Prime&Bond NT、Clea币1 SE Bond盖髓即刻固化、及盖髓后20min固化，Clearfil AP一X树脂充填。对照组用Timelime盖髓，Clearfil AP一X树脂充填。术后30、90d，颈总动脉插管，灌注4%多聚甲醛固定，骨锯分离牙齿，固定、脱钙、脱水，包埋、5林m切片。苏木精一伊红染色、Mollary‘s三色法、Glam染色，观察修复性牙本质形成、牙髓反应及细菌渗漏情况。结果显示:30d、%d，NT组的炎症反应较SE组严重(P<0.05);且无修复性牙本质形成。SE组3Od有少量修复性牙本质形成，90d出现明显的修复性牙本质。氢氧化钙组较两实验组在牙髓反应和修复性牙本质形成方面均有明显优势(p<0.01)。延迟固化常.门阵皿大月卜祠叹创七拳亡七论丈使牙髓反应加重。结果说明:自酸蚀薪接剂较全酸蚀豁接剂对牙髓刺激性小，修复效果好，但尚达不到氢氧化钙组的盖髓效果。勃接剂即刻固化能减小其对牙髓的刺激。3、复合树脂豁接体系Clearfil SE Bond、Prime&Bond NT直接修复活髓牙缺损的临床研究 通过对第四军医大学547名学员的口腔健康状况检查，遴选出52名学员的85牙(I类洞)进行复合树脂薪接体系直接修复。中龋57牙，分三组，一组用聚梭酸锌粘固剂垫底，其余两组分别涂Cle肚五1 SE Bond、P丘me&Bond NT，Clearfi1AP一X树脂修复。深龋28牙，分两组，其中一组用聚梭酸锌粘固剂垫底，另一组涂Clearfil SE Bond，Clearfil AP一X树脂修复。结果显示:术后Zd，中龋三组间敏感例数和敏感程度没有统计学差异(P>0.05)，深龋两组间敏感例数和敏感程度亦没有统计学差异，但是在中龋和深龋对应组间有统计学差异(p<0.05)。深龋组敏感例数多，表现较严重。随着修复时间延长，各实验组敏感例数和程度逐渐降低。在观察期内，各实验组牙髓活力均无异常改变。 总之，豁接剂性能较以前有明显改善，细胞毒性和对牙髓的刺激达到了临床使用的安全要求，但不同翻接剂性能有差别。结合本实验结果，提示:自酸蚀勃接剂在深龋洞修复时较全酸蚀薪接剂更具优越性，更安全。更多还原

【Abstract】 With the enhance of health and esthetic pursuits from patients, resin composites are widely used in oral clinic, like in the cases of restoring of dental defect, fixation of loosened teeth, bonding between orthodontic attachments and teeth, and treatment of fracture of alveolar bone and jaw. The performance of compound resin has been obviously improved, which has a lot to do with the development in the adhesive systems. With the improvement of dental bonding materials, from inorganic materials to organic macromolecule materials, they are used to bond enamel, dentine, even soft tissue. Bonding restorations have a number of advantages over traditional, non-adhesive methods. The adhesive techniques can reduce the microleakage at the restorative material-tooth interface, decrease the postoperative sensitivity and recurrent caries. Resulting functional stress, which occurs in both tooth structure and restorative materials, can be more widely distributed. The weakened tooth structure can be protected and reinforced. Adhesive restorative techniques have also expanded the range of indications for esthetic restorative dentistry, allowing deteriorated or debonded restorations to be repaired or replaced with minimal loss of tooth structure. The occurrence of "etching technique" discovered by Buonocore in 1960s and the appearance of resin composites, dental bonding materials and the related techniques have given rise to many new concepts and theories. But there is little of contrastive study on the performances and restorative effects of different adhesives. In this study, several adhesives were used to estimate the cell cytotoxicity on mouse fibroblasts, observe the pulp response, and to examine the postoperative sensitivity of cariesof human teeth. It was hoped to pave a way for the correct use of adhesives and to get better restorative effects of resins.1. Study on the cytotoxicity of adhesives (Durafill, Prime & Bond NT, Clearfil SE Bond) on mouse fibroblasts cultured in vitro.Adhesives and corresponding filling resin were made into modules, which were dipped in RPMI1640 medium. Then the RPMI1640 medium were diluted to the concentration of 100%, 75%, 50%, 25% respectively. The mouse fibroblasts cultured in vitro in different cell-densities were inoculated. After 24 hours of culture, the impregnant of adhesives replaced the culturing liquid. MTT staining and spectrophotometric assay were used to determine the optical density (i.e. OD) and calculate the mean. Results: When the fibroblasts were cultured for 2,4 and 7 days, OD of the three adhesives were found to be different (P<0.05), with OD of Clearfil SE Bond being higher than the other two. OD of the three adhesives increased gradually with time. In the culture condition of four kinds of concentrations, OD of the three bonding agents were also different (P<0.05) , with OD of Clearfil SE Bond being higher than the other two. OD of the three adhesives decreased gradually as the concentration increased. Result: Cytotoxicity of the three adhesives was weak, and cytotoxicity increased with the culture time and concentration enhancement. Among the three adhesives, the cytotoxicity of Clearfil SE Bond was the least.2. Study on the effect of indirect capping pulp with adhesives systems (Prime & Bond NT, Clearfil SE Bond).Deep Class V cavities, close to the pulp cavity but not pulp-penetrating, were prepared on the buccal surface of 88 dens caninus, molars and premolars of dogs. The thickness of the remained dentine of the specimens was 553.6um. Specimens were treated respectively with Clearfil SE Bond and Prime & Bond NT cured instantly and after 20 minutes, and were then restored with resin composite Clearfil AP-X. The samples of the control group were restored with Clearfil AP-X after pulp capping with Timelime. The dogs were killed 30 or 90 days later and the teeth were extracted. After fixation, demineralization and paraffin embedding, serial sections were obtained and they were stained with H/E, Mallory s technique and Glam, ready for the observation of更多还原