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        不同牙面處理對(duì)隱形矯治附件粘接的影響

        2023-05-09 14:22:04劉曉羽寧思佳張蕾蘇比努爾·艾海提阮曉慧
        醫(yī)學(xué)美學(xué)美容 2023年5期

        劉曉羽 寧思佳 張蕾 蘇比努爾·艾海提 阮曉慧

        【摘 要】目的 比較三種不同方法處理牙面對(duì)隱形矯治器附件粘接強(qiáng)度的影響。方法 收集2022年3月-5月新疆醫(yī)科大學(xué)第二附屬醫(yī)院口腔正畸科的21例錯(cuò)頜畸形患者因正畸減數(shù)拔除的前磨牙共84顆,將其隨機(jī)分為A組、B組、C組、D組,各21顆。A組不作牙面處理為對(duì)照組,B組采用拋光杯處理牙面,C組采用矽離子處理牙面,D組采用噴砂粉處理牙面。對(duì)處理后的牙面均進(jìn)行酸蝕,每組隨機(jī)選擇1顆樣本于掃描電鏡下觀察牙面情況。將每組剩余樣本再平分為1組、2組,各10顆,1組使用3 M Z350XT固體樹(shù)脂制作附件粘接,2組使用3 M Z350XT流動(dòng)樹(shù)脂制作附件粘接,測(cè)試各組剪切力強(qiáng)度并進(jìn)行比較。結(jié)果 各組牙面處理后牙釉質(zhì)結(jié)構(gòu)存在差異,其中A組酸蝕后的牙釉質(zhì)表面粗糙,魚(yú)鱗狀釉質(zhì)結(jié)構(gòu)基本完整;B組酸蝕后的牙釉質(zhì)表面粗糙程度較A組增加,釉柱間釉質(zhì)不規(guī)則結(jié)構(gòu)增加;C組酸蝕后牙釉質(zhì)表面呈現(xiàn)明顯的篩孔狀結(jié)構(gòu),釉柱間質(zhì)溶解,孔隙增大;D組釉質(zhì)酸蝕后,表面較粗糙,釉質(zhì)結(jié)構(gòu)分布不均勻。B1、C1、D1組剪切強(qiáng)度均高于對(duì)照A1組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);B2、C2、D2組剪切強(qiáng)度均高于對(duì)照A2組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 用三種方式處理牙面均可增加樹(shù)脂附件在牙面的粘接強(qiáng)度;在使用固體樹(shù)脂粘接附件時(shí),矽離子處理牙面為增加粘接強(qiáng)度的最優(yōu)選擇;在使用流動(dòng)樹(shù)脂粘接附件時(shí),選擇噴砂處理的粘接效果最佳。

        【關(guān)鍵詞】牙面處理;隱形矯治附件;剪切力;口腔正畸

        中圖分類號(hào):R783.5文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):1004-4949(2023)05-0090-04

        Effects of Different Dental Surfaces on Adhesion of Invisible Orthodontic Accessories

        LIU Xiao-yu1, NING Si-jia1, ZHANG Lei2, Subinuer?Aihaiti1, RUAN Xiao-hui1

        (1.Department of Stomatology, the Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang, China; 2.Department of Dental Prosthetics and Implantation, the First Affiliated Hospital of Xinjiang Medical University, Urumqi

        830000, Xinjiang, China)

        【Abstract】Objective To compare the bond strength of clear aligner attachments treated with three different dental surfaces methods. Methods A total of 84 premolars extracted from 21 patients with malocclusion due to orthodontic extraction in the Department of Orthodontics, the Second Affiliated Hospital of Xinjiang Medical University from March to May 2022 were collected and randomly divided into group A, group B, group C and group D, with 21 premolars in each group. Group A was the control group without tooth surface treatment, group B was treated with polishing cup, group C was treated with silicon ion, and group D was treated with sandblasting powder. After acid etching, one sample from each group was randomly selected to observe the tooth surface under scanning electron microscope. Each group of remaining samples was equally divided into group 1 and group 2, with 10 pills in each group. Group 1 was bonded with 3 M Z350XT solid resin, and group 2 was bonded with 3 M Z350XT flowable resin. The shear strength of each group was tested and compared. Results There were differences in enamel structure among all groups after dental surface treatment. Among them, the enamel surface of group A without dental surface treatment was rough and the fish-scale enamel structure was basically complete after acid etching. After the polishing cup treatment, the roughness of enamel surface in group B was higher than that in group A, and the irregular structure of enamel between enamel columns was increased. After the silicon-ion treatment, the enamel surface of group C showed obvious sieve structure, the enamel column interstitial dissolved, and the pores increased. The enamel of group D was rougher and unevenly distributed after acid etching. The shear strength of groups B1, C1 and D1 was higher than that of group A1, and the difference was statistically significant (P<0.05). The shear strength of groups B2, C2 and D2 was higher than that of group A2, and the difference was statistically significant (P<0.05). Conclusion All the three treatment methods can increase the bonding strength of the resin attachment. When using solid resin attachments, silicon ion treatment is the best choice to increase the bond strength. The adhesive effect of sandblasting is the best when using flowable resin to bond attachments.

        【Key words】Dental surface treatment; Invisible correction accessory; Shear force; Orthodontic

        近年來(lái),隱形矯治技術(shù)得到發(fā)展,因其具有舒適、美觀的優(yōu)勢(shì),已逐漸廣泛應(yīng)用于正畸患者治療中。隱形矯治器中附件可增加矯治器的固位力,并給予牙齒精準(zhǔn)的矯治力[1]。因此附件的粘接在矯治過(guò)程中起著至關(guān)重要的作用。附件的粘接是以酸蝕刻技術(shù)為原理在粘接劑-復(fù)合界面的共聚過(guò)程,酸蝕使牙釉質(zhì)面形成微孔結(jié)構(gòu),電鏡下可見(jiàn)蜂窩狀凹凸不平,從而增大了牙釉質(zhì)接觸的表面積與自由能。當(dāng)樹(shù)脂進(jìn)入到微孔中,會(huì)形成樹(shù)脂突,樹(shù)脂突與釉質(zhì)之間會(huì)產(chǎn)生機(jī)械嵌合力,與交錯(cuò)的網(wǎng)狀結(jié)構(gòu)共同提供了機(jī)械固位。臨床上處理牙面的方法較多,包括拋光杯蘸取不含氟牙膏處理牙面、矽離子處理牙面、噴砂處理牙面等,上述方式均可改變?cè)烂娴拇植诙龋壳搬槍?duì)不同粗糙度牙面對(duì)酸蝕效果的影響方面的研究較少;而三種牙面處理方法在臨床中均為常見(jiàn)操作,但是操作步驟與復(fù)雜程度不同,并且選用兩種常用類型樹(shù)脂制作附件,在其粘接強(qiáng)度與操作便利性方面稍有不同[2]。基于此,本研究比較了三種不同方法處理牙面對(duì)隱形矯治器附件粘接強(qiáng)度的影響,旨在尋求更加高效且操作方便的方法提高附件的粘接強(qiáng)度并應(yīng)用于臨床,以降低附件的脫落率,提高正畸療效,現(xiàn)報(bào)道如下。

        1 材料與方法

        1.1 實(shí)驗(yàn)材料與設(shè)備 拋光杯為T(mén)PC拋光杯P-C505,矽離子為日本松風(fēng)矽離子PN0171,噴砂粉為瑞士EMS碳酸氫鈉噴砂粉(65 μm),樹(shù)脂為3 M Z350XT樹(shù)脂與3 M Z350XT流動(dòng)樹(shù)脂,酸蝕劑為古莎格魯瑪酸蝕劑,粘接劑為3M/ESPE第八代粘接劑,光固化燈為啄木鳥(niǎo)光固化機(jī)LED-B型,噴砂機(jī)為瑞士EMS臺(tái)式噴砂機(jī)。

        1.2 實(shí)驗(yàn)分組與樣本制備 收集2022年3月-5月新疆醫(yī)科大學(xué)第二附屬醫(yī)院口腔正畸科的21例錯(cuò)頜畸形患者因正畸減數(shù)拔除的前磨牙共84顆。納入標(biāo)準(zhǔn):牙體組織完好、無(wú)裂紋;拔除前無(wú)齲壞、牙髓疾病、釉質(zhì)發(fā)育不全的牙齒。排除標(biāo)準(zhǔn):有裂紋的牙齒以及牙面曾粘接過(guò)托槽或充填治療后的牙齒。拔除牙齒后用刮治器去除牙體附著的軟組織,清洗后置于人工唾液中浸泡。將收集的84顆離體牙隨機(jī)分為A組、B組、C組、D組,各21顆。A組不做牙面處理為對(duì)照組,B組采用拋光杯+不含氟牙膏處理牙面15 s,C組采用矽離子處理牙面15 s,D組采用噴砂粉處理牙面15 s。處理后的牙面均酸蝕30 s,采用氣槍加壓沖洗牙面10 s,再用氣槍吹干牙面,確保酸蝕后牙面呈白堊色,干燥隔濕下,酸蝕面均勻涂布粘接劑,光固化10 s。每組隨機(jī)選擇1個(gè)樣本用于電鏡檢查。將每組剩余樣本再隨機(jī)均分為1組、2組,各10顆。1組選擇3 M Z350XT固體樹(shù)脂制作附件進(jìn)行粘接,2組選擇3 M Z350XT流動(dòng)樹(shù)脂制作附件進(jìn)行粘接。剪下隱形矯治器前磨牙區(qū)4 mm×2 mm大小矩形附件模板,在模板內(nèi)放置適量3 M固體樹(shù)脂或3 M流動(dòng)樹(shù)脂,輕輕加壓置于牙面上,去除模板外多余樹(shù)脂,光照20 s。將離體牙灌注在石膏模型中,牙冠部分暴露在外。

        1.3 實(shí)驗(yàn)方法 ①將每組隨機(jī)選擇的1個(gè)樣本牙面在酸蝕后進(jìn)行掃描電鏡觀察;②將灌注石膏模型的離體牙置于萬(wàn)能電子力學(xué)測(cè)試機(jī)上,切刀具刃寬10 mm,厚0.5 mm,刀頭施力方向和牙面平行,刀頭移動(dòng)速度定為0.5 mm/min。附件受瞬時(shí)過(guò)大力時(shí)脫落,計(jì)算機(jī)會(huì)記錄此時(shí)對(duì)每個(gè)樣本施加的剪切力值(F),通過(guò)公式計(jì)算出剪切強(qiáng)度(P),即粘接強(qiáng)度:P=F/S(F為附件脫落瞬間所承受的力,單位N;S為附件模板的面積,單位mm2)。

        1.4 統(tǒng)計(jì)學(xué)方法 采用SPSS 26.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料以(x-±s)表示,行F檢驗(yàn),P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。

        2 結(jié)果

        A組、B組、C組、D組牙面掃描電鏡下圖像見(jiàn)圖1。各組牙面處理后牙釉質(zhì)結(jié)構(gòu)存在差異,其中A組酸蝕后的牙釉質(zhì)表面粗糙,魚(yú)鱗狀釉質(zhì)結(jié)構(gòu)基本完整,見(jiàn)圖1a;B組酸蝕后的牙釉質(zhì)表面粗糙程度較A組增加,釉柱間釉質(zhì)不規(guī)則結(jié)構(gòu)增加,見(jiàn)圖1b;C組酸蝕后牙釉質(zhì)表面呈現(xiàn)明顯的篩孔狀結(jié)構(gòu),釉柱間質(zhì)溶解,孔隙增大,見(jiàn)圖1c;D組釉質(zhì)酸蝕后,表面較粗糙,釉質(zhì)結(jié)構(gòu)分布不均勻,見(jiàn)圖1d。各組附件剪切強(qiáng)度測(cè)試結(jié)果顯示:B1、C1、D1組剪切強(qiáng)度均高于對(duì)照A1組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表1。B2、C2、D2組剪切強(qiáng)度均高于對(duì)照A2組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表2。

        3 討論

        無(wú)托槽隱形矯治技術(shù)是相對(duì)傳統(tǒng)托槽固定矯治器來(lái)說(shuō)一項(xiàng)新的矯治方式,其綜合了正畸學(xué)與圖像采集技術(shù)等[3],給患者以更舒適的體驗(yàn)感完成正畸治療。正畸附件可以增加與矯治器的接觸面積,增加矯治器的固位力,從而精準(zhǔn)控制矯治器對(duì)牙齒的轉(zhuǎn)矩與移動(dòng)效率[4]。而附件的有效粘接具有重要意義,每一副矯治器均需要與附件緊密貼合,否則無(wú)法達(dá)到預(yù)期的矯治效果[5]。附件的脫落與粘接面的處理以及摘戴矯治器的頻率均有密切關(guān)系[6],尋求粘接強(qiáng)度更高的方法來(lái)提高附件的粘接強(qiáng)度及牙齒的移動(dòng)效率是有必要的。酸蝕刻技術(shù)較為傳統(tǒng)的牙釉質(zhì)-樹(shù)脂的粘接方式[7],磷酸蝕刻會(huì)使釉質(zhì)表面形成孔隙結(jié)構(gòu),從而樹(shù)脂進(jìn)入孔隙形成樹(shù)脂突嵌合。牙釉質(zhì)表面存在一層由復(fù)雜微生物菌落以及各種有機(jī)物構(gòu)成的菌斑生物膜[8],如果不去除,則會(huì)影響粘接效果。國(guó)外有學(xué)者[9]用鬃毛牙刷、拋光杯和氣動(dòng)拋光機(jī)對(duì)牙面進(jìn)行拋光,經(jīng)電鏡下檢測(cè),拋光杯在冠根兩方面均表現(xiàn)出良好的拋光效果,去除了碎屑并使組織面更光滑。

        [10] David C,Cardoso de Cardoso G,Isolan CP,et al.Bond strength of self-adhesive flowable composite resins to dental tissues:A systematic review and meta-analysis of in vitro studies[J].J Prosthet Dent,2022,128(5):876-885.

        [11] 牛林,張輝,董少杰,等.多尺度下人牙釉質(zhì)微觀結(jié)構(gòu)特性觀察[J].山西醫(yī)科大學(xué)學(xué)報(bào),2017,48(10):1075-1078.

        [12] 鈕曄,安貝爾,敬怡,等.5種不同去牙面正畸殘余粘接劑方法比較[J].上海口腔醫(yī)學(xué),2019,28(2):136-140.

        [13] Martos R,Hegedüs V,Szalóki M,et al.A randomised controlled study on the effects of different surface treatments and adhesive self-etch functional monomers on the immediate repair bond strength and integrity of the repaired resin composite interface[J].J Dent,2019,85:57-63.

        [14] Patcas R,Zinelis S,Eliades G,et al.Surface and interfacial analysis of sand-blasted and acid-etched enamel for bonding orthodontic adhesives[J].Am J Orthod Dentofacial Orthop,2015,147(4 Suppl):S64-75.

        [15] Massé L,Etienne O,Noirrit-Esclassan E,et al.Dentine disorders and adhesive treatments:A systematic review[J].J Dent,2021,109:103654.

        編輯 扶田

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