伢典化学机械去龋法的扫描电镜研究

目的：利用扫描电镜技术观察伢典和传统车针去龋后窝洞表面的微观形态。方法：选取累及牙本质深层龋坏的离体牙9颗，分为对照组，机械组，伢典组3组，每组3颗。用扫描电镜观察窝洞表面形态。结果：对照组表面有很多碎屑、残渣等，无牙本质小管完整形态。传统车针组的牙本质表面有不规则的颗粒和碎片，有玷污层形成。牙本质小管口堵塞。伢典组的牙本质表面没有玷污层，牙本质小管口清晰可见。结论：伢典能有效去除玷污层。     

Carisolv去龋对牙本质粘结界面影响的实验研究

目的:研究Carisolv去龋对牙本质粘结界面的影响。方法:24颗新鲜拔除的中度龋损的第三磨牙,随机分成ABCD4组。每个牙的龋洞分成两半,一半用Carisolv去龋,另一半用涡轮车针去龋后,做如下处理:A组不处理;B组320ml/L磷酸酸蚀,扫描电镜观察牙本质表面形态;C组不酸蚀,DyractAP复合体充填;D组320ml/L磷酸酸蚀后复合树脂充填,扫描电镜观察牙本质-充填体界面。结果:A组:Carisolv去龋后牙本质表面玷污层少,大部分牙本质小管口开放,清晰可见,表面粗糙不平;涡轮车针去龋后牙本质表面覆盖较厚玷污层,牙本质小管口堵塞,很少见到开口。B组:Carisolv去龋组和涡轮车针去龋组均去除了玷污层,牙本质小管口开放,但Carisolv组牙本质小管无管塞,而涡轮车针组牙本质小管残留部分管塞。C组:观察牙本质-复合体界面见Carisolv去龋组有较多树脂突形成,深入牙本质小管及管周;而涡轮车针去龋组未见明显树脂突起形成。D组:观察牙本质-树脂界面见2组树脂突的密度和长度无明显差异,但Carisolv去龋组树脂突之间的侧枝连接较涡轮车针去龋组多见。结论:Carisolv去龋后牙本质表面玷污层少,牙本质小管口开放,表面粗糙不规则,利于粘结,尤其在使用不需酸蚀的复合体充填时优势突出。     

化学机械去龋对牙本质粘结效果的电镜观察

目的扫描电镜观察化学机械去龋对牙本质粘结效果的影响。方法观察比较化学机械去龋和慢速球钻去龋后牙本质表面以及牙本质和4种粘结系统粘结界面的超微结构。结果与球钻去龋相比，化学机械去龋后的牙本质表面玷污层少，牙本质和Prime＆Bond　NT（PB）＋复合体的粘结界面出现树脂突结构，和Adper　Prompt-L-Pop（AP）＋树脂的粘结界面中树脂突更密集，混合层更致密、均一。结论从超微结构上看，化学机械去龋技术有利于牙本质的粘结。     

Morphological and microtensile bond strength evaluation of three adhesive systems to caries-affected human dentine with chemomechanical caries removal

Objectives

To evaluate the influence of chemomechanical caries removal on bond strengths of three adhesive systems to caries-affected human dentine.

Methods

45 extracted human third molars with occlusal moderate caries were used. One half of each cavity was prepared with chemomechanical method and the other half with bur as the control. Three adhesive systems, Prime&Bond NT (Dentsply, Germany) without any previous conditioning, an etch-and-rinse adhesive (One-Step, Bisco, USA) and a self-etching adhesive (Adper Prompt-L-Pop, 3M ESPE, USA), were applied. The compomer or resin crowns were, then, built up. The prepared specimens were sectioned for scanning electron microscopy (SEM) examination and microtensile bond strength (MTBS) testing. Data were analysed using two-way ANOVA with subsequent application of Student-Newman-Keuls test at p < 0.05.

Results

Opened dentinal tubules and less smear layer were visible by SEM after chemomechanical caries removal, whilst an obvious smear layer covering the dentine surface with occluded tubules was exhibited after bur excavation. Resin tags were seen only in specimens with chemomechanical excavation when Prime&Bond NT system was applied. Statistical analysis of the values of MTBS failed to show significant difference between caries removal methods. However, the values of MTBS for One-Step system achieved with two caries removal methods were both significant higher than other adhesive systems.

Conclusions

Chemomechanical caries removal did not influence the bond strengths of the adhesive systems used in this study to caries-affected human dentine. Highest bond strength was achieved with application of etch-and-rinse adhesive system.     

两种不同方法治疗老年龋齿患者的感受性比较

目的：比较传统车针去龋和伢典化学机械去龋治疗老年龋齿的患者感受性。方法：选取门诊患者55人,随机分成对照组和实验组。分别采用车针去龋和伢典化学机械去龋。比较患者对两种去龋方法的治疗感受及对伢典味道和气味的感觉及接受程度。结果：77%患者感觉伢典去龋时不紧张;90%患者对伢典味道和气味能够接受;81%患者能够接受伢典治疗。结论：伢典化学机械去龋相比于传统车针去龋能被大多数患者接受。     

Artificial methods of dentine caries induction: A hardness and morphological comparative study

Objective

To assess the ability of two chemical and a microbiological methods to produce dentine caries lesions resembling naturally developed dentine caries lesions.

Design

Forty sound second primary molars were divided into four experimental groups according to the method to produce artificial caries lesions: (1) sound (negative control); (2) acidified gel; (3) pH-cycling; and (4) microbiological, all for 14 days. Ten second primary molars presenting natural dentine caries lesions comprised the (5) positive control group. After the artificial caries induction, all samples were longitudinally sectioned and polished in order to obtain Knoop microhardness values from 10 to 500 μm depth from the bottom of the cavities. Morphological analysis of the surfaces was carried out by SEM. Hardness data were compared among the five experimental groups using One-Way ANOVA and post hoc SNK's test.

Results

The hardness values of chemically created caries-like lesions did not differ from that of natural caries lesions on shallower depths. The results indicated that chemical caries induction methods promote a superficial demineralization and that pH-cycling is more effective than acidified gel. The former, produced a thicker layer of demineralization, with similar hardness values than natural lesions. Despite the microbiological method provided an excessive softness of the primary dentine, this method presented morphology more comparable to natural lesions.

Conclusions

pH-cycling is more appropriated to simulate a substrate that resembles affected caries dentine layer, after caries removal. The microbiological method seems more indicated to simulate a dentine caries lesion with an infected layer, previously to caries removal.     

白屈菜红碱对变形链球菌细胞形态学影响的透射电镜观察

目的：通过透射电镜（transmission electron microscope,TEM）观察白屈菜红碱（chelerythrine,CHE）对变形链球菌（streptococcus mutans,S.mutans）作用后的形态学影响,探讨其抑菌机制。方法：选择变形链球菌ATCC25175作为实验菌株,实验分白屈菜红碱溶液处理组（实验组）及对照组,将2组细菌在37℃厌氧环境（80%N2、20%CO2）下培养24h,透射电镜观察细菌细胞结构的变化。结果：白屈菜红碱通过抑制变形链球菌的细胞分裂而抑制其生长,并对荚膜、细胞壁、细胞膜等结构产生显著影响,使其完整性受到破坏。结论：白屈菜红碱可以改变变形链球菌超微结构,这可能是其抑制细菌生长的机制之一。     

The influence of different restorative materials on secondary caries development in situ

Objectives

The effect of direct restorative materials on caries lesion formation was investigated with an 8-week in situ study with split-mouth design, testing the hypothesis that no difference in mineral loss next to a restoration would be found between different composite-based-materials and amalgam.

Methods

Six groups (n = 18) of restored dentine samples were prepared using amalgam, a microhybrid, a nanohybrid and a silorane composite. The composites were adhesively bonded with systems with or without an antibacterial monomer (Clearfil-SE-Protect, Clearfil-SE-bond, respectively), except for the silorane group (Silorane-System-Adhesive). Non-restored dentine samples were used as control (primary caries). Samples were inserted into slots, in lower prosthesis especially made for the experiment. Subjects were instructed to dip the lower prosthesis in a sucrose solution 4 times per day. At baseline and 8 weeks, samples were radiographed extra-orally and the integrated mineral loss was calculated. Data were statistically analyzed using multiple linear regression with a multilevel model (p = 0.05).

Results

Nine subjects were selected, and only outer lesions were observed. The hypothesis was partially rejected, as the microhybrid composite bonded with the antibacterial system and the nanohybrid composite presented statistically significant lower mineral loss compared to amalgam. Also, no significant differences were seen for these groups compared to control.

Conclusion

Within the limits of this study, the restorative material may influence outer lesion progression. Amalgam was not found to be related to lower secondary caries progression in dentine compared to composite-based materials after 8 weeks in situ.

Clinical Significance

Although patient factors play a major role in caries progression, the restorative material may affect outer secondary lesion progression.     

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目的应用扫描电镜观察传统高速牙钻法、空气喷砂法、CarisolvTM化学机械法去龋后牙本质表面玷污层,肉眼观察窝洞洞底表面。方法将2006年3月至2006年6月南昌大学附属口腔医院收集的新近拔除伴中度龋坏的15颗患牙,依据去龋方法的不同分为3组:传统高速牙钻组、空气喷砂组和CarisolvTM化学机械组。去龋后肉眼观察窝洞洞底表面,并用扫描电镜对牙本质表面玷污层进行观察。结果3种方法均可有效去龋。传统高速牙钻组去龋后窝洞洞底牙本质表面平整、光亮而且透明;空气喷砂组牙本质表面粗糙、凹凸不平;CarisolvTM化学机械组牙本质表面光泽较暗。扫描电镜下观察,CarisolvTM化学机械组去龋后牙本质小管附近玷污层少,牙本质小管栓塞率仅为4.4%,明显低于其他2组(P均<0.05);空气喷砂组牙本质小管清晰可见,周围玷污层仅有少量分布;传统高速牙钻组牙本质小管清晰度较差,周围玷污层大量分布,牙本质小管栓塞率明显高于其他2组(P均<0.05)。结论CarisolvTM化学机械法能有效去龋,清除牙本质玷污层。     

Dentine microhardness after different methods for detection and removal of carious dentine tissue

There are several methods for identifying carious dentinal tissue aiming to avoid removal of healthy dentinal tissue.

Objectives

The purpose of this study was to test different methods for the detection of carious dentinal tissue regarding the amount of carious tissue removed and the remaining dentin microhardness after caries removal.

Material and methods

The dentin surfaces of 20 bovine teeth were exposed and half of the surface was protected with nail polish. Cariogenic challenge was performed by immersion in a demineralizing solution for 14 days. After transverse cross-section of the crown, the specimens were divided into four groups (n=10), according to the method used to identify and remove the carious tissue: "Papacárie", Caries-detector dye, DIAGNOdent and Tactile method. After caries removal, the cross-sectional surface was included in acrylic resin and polished. In a microhardness tester, the removed dentin thickness and the Vickers microhardness of the following regions were evaluated: remaining dentin after caries removal and superficial and deep healthy dentin.

Results

ANOVA and Tukey''s test (α=0.05) were performed, except for DIAGNOdent, which did not detect the presence of caries. Results for removed dentin thickness were: "Papacárie" (424.7±105.0; a), Caries-detector dye (370.5±78.3; ab), Tactile method (322.8±51.5; bc). Results for the remaining dentin microhardness were: "Papacárie" (42.2±10.5; bc), Caries-detector dye (44.6±11.8; abc), Tactile method (24.3±9.0; d).

Conclusions

DIAGNOdent did not detect the presence of carious tissue; Tactile method and "Papacárie" resulted in the least and the most dentinal thickness removal, respectively; Tactile method differed significantly from "Papacárie" and Caries-detector dye in terms of the remaining dentin microhardness, and Tactile method was the one which presented the lowest microhardness values.     

乳牙化学去龋法的细菌学研究

目的：比较化学去龋法和机械去龋法清除细菌的效果。方法：选取40个龋坏深至牙本质的乳磨牙,中龋或深龋,随机分为化学法去龋组和机械法去龋组,每组20个牙,去龋前后使用无菌挖匙对龋坏牙本质进行取样,分别在4种不同的培养基上进行厌氧培养和计数。结果：两种方法去龋后,除机械法去龋组放线菌外,两种方法其他细菌数显著减少,有统计学意义（P〈0．05）,化学法去龋组比机械法去龋组的总菌数量减少更显著（p〈0．05）。结论：化学去龋法比机械去龋法清除乳牙龋坏细菌效果好。     

化学手器去龋材料的体外实验研究

目的 探讨Ｎ－单氯氨基丁酸化学手器去龋材料的去龋作用,为临床应用提供理论依据。方法 采用离体龋坏牙实验,通过龋齿检知液、光学显微镜、挪描电镜观察,比较该法龋材料与常规牙科电动机械去龋效果、玷污层以及对表面牙组织结构的影响。结果 龋齿检知液、光镜和电镜的观察发现,Ｎ－单氯氨基丁酸去龋材料与牙科电动机械龋齿检知液阳性率均为零,无残留龋,实验组细胞侵入层１例,统计学χ＾２检验分析两组阳性率差异无显著性（     

Evaluation of the chemomechanical removal of dentine caries in vivo with a new modified Carisolv gel

Carisolv is a minimally invasive method for softening and removing dentine caries. A new, modified Carisolv gel has been developed in order to optimise the efficiency if its chemical caries dissolution. The aim of the present study was to compare the caries removal efficiency of the original gel with that of the new gel, which contains almost double the concentration of sodium hypochlorite. Ten dentists treated 202 cavities in 170 patients; 104 cavities were randomised to the new gel and 98 to the original gel. Their mean treatment times for caries removal were 6.7±4.1 min and 7.6±4.2 min, respectively (P>0.05). In close-to-pulp lesions, constituting 32% of the cavities, the mean times for caries removal were 9.0±7.0 min and 11.6±4.4 min for the new and original gels, respectively (P<0.01). Questionnaires revealed that 81% of the patients preferred chemomechanical treatment to drilling. In conclusion, the improved efficiency of the modified Carisolv gel did reduce the time for caries removal in deep lesions. However, it still needs more time than conventional drilling.     

Penetration of an antibacterial dentine-bonding system into demineralized human root dentine in vitro

In this study, the penetration of three proprietary dentine-bonding agents (Prime & Bond 2.1, Single Bond, Liner Bond 2) and experimental dentine-bonding systems incorporating an antibacterial monomer, 12-methacryloyloxydodecylpyridinium bromide (MDPB), into artificial root caries lesions was evaluated, and the bactericidal activity of each material against Streptococcus mutans or Lactobacillus casei impregnated into demineralized dentine blocks was assessed. All of the commercial dentine-bonding agents were capable of penetrating into the artificial carious lesions to more than 150 microm. The depth of penetration of the experimental systems, which were based on Liner Bond 2, was not significantly different from that of their parent product. Liner Bond 2 primer exhibited the greatest bactericidal effects among the three proprietary dentine-bonding agents tested. Bactericidal activities of experimental primers containing MDPB were greater than those of any other products, and the application of 4% MDPB-containing primer resulted in complete killing of bacteria in demineralized dentine. The results indicate that the penetration of dentine-bonding agents into extensively demineralized root dentine is possible in vitro, and the experimental dentine-bonding systems containing the antibacterial monomer MDPB are capable of killing bacteria within demineralized dentine. This could be of benefit when managing root caries lesions.     

2种方法预防儿童恒牙龋病的效果和成本评价

目的比较氟保护漆和氟化泡沫预防儿童恒牙龋病的临床效果及人均防龋成本,寻找适合在学校开展的儿童恒牙龋病预防适宜技术。方法将来自4个学校24个班级的695名7~8岁儿童分为3组。氟保护漆组应用氟保护漆,半年应用1次;氟化泡沫组应用氟化泡沫,半年应用1次;对照组仅做口腔卫生宣教。采用SPSS18.0软件包对数据进行统计学分析。采用方差分析比较2年后3组间新增龋面均的差异。比较2年后3组儿童第一恒磨牙的防龋效果;并统计氟保护漆组和氟化泡沫组的经费投入,计算人均防龋成本。结果 2年后,有667名儿童接受了龋病复查,随访率为96.0%。氟保护漆组、氟化泡沫组和对照组的新增龋面均分别为0.15±0.45、0.18±0.55、0.30±0.79,多重比较结果显示氟保护漆组与对照组相比,新增龋面均显著减少,差异有统计学意义(P=0.023);氟化泡沫组与对照组相比,新增龋面均差异无统计学意义(P=0.085)。氟保护漆组、氟化泡沫组的人均成本投入分别为87.37元、29.75元。结论半年使用1次氟保护漆对儿童恒牙有良好的防龋效果,但氟化泡沫的人均成本低。     

Carisolv化学机械去龋临床应用效果的初步评价

目的评价Carisolv化学机械去龋临床应用效果。方法选取100个中、深龋恒牙等分为2组,实验组用Carisolv化学机械法去龋,对照组用慢速球钻去龋,记录去龋时间、医患双方对患者术中疼痛反应的评价等。结果2组去龋时间分别是(6.17±1.92)min、(2.83±0.93)min,以Carisolv组为长(P<0.01);去龋术中疼痛感以Carisolv组较小(P<0.01)。结论Cari-solv化学机械去龋法是龋病治疗中一个可供选择的方法。     

部分去腐治疗乳牙急性龋的Meta分析

目的比较部分和完全去腐治疗乳牙急性龋的效果。方法计算机检索The Cochrane Library、Pub Med、EMbase、Wan Fang Data、CBM、CNKI数据库,查找相关随机对照实验(RCT),检索时限为1978年—2015年8月。由2位评价员独立筛选文献、提取资料和评价研究质量后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入6个RCT,共计562例患者,758个患牙。Meta分析结果显示:部分去腐的牙髓暴露可能性低于完全去腐,差异有统计学意义[RR=0.13,95%CI(0.05,0.37)];在术后牙髓病变(RR=0.92,95%CI(0.34,2.50))和修复失败(RR=1.07,95%CI(0.67,1.70))方面,两者差异没有统计学意义。结论部分去腐法治疗乳牙急性龋的效果是肯定的,值得在临床工作中推广使用。由于纳入研究设计存在一些缺陷,还需要今后开展更多高质量,大样本的随机对照实验来验证此结论。     

Current update of chemomechanical caries removal methods

Chemomechanical caries removal is an excellent method for minimally invasive caries excavation, and the removal agents are either sodium hypochlorite (NaOCl)‐ or enzyme‐based. The NaOCl‐based agents include GK‐101, GK‐101E (Caridex) and Carisolv, and the enzyme‐based agents include Papacarie and the experimental material, Biosolv. This review outlines the changes in chemomechanical caries removal methods and focuses on recently published laboratory and clinical studies. The historical development, mechanism of action, excavation time and biological effects on pulp and dental hard tissues are described. Based on existing evidence, the currently available chemomechanical caries removal methods are viable alternatives to conventional rotary instrument methods. Chemomechanical methods could be extremely useful in very anxious, disabled and paediatric patients. It does seem some of these agents would still benefit from quicker excavation times in order to achieve more universal acceptance. However, as a means of conserving the caries‐affected dentine, chemomechanical caries removal is possibly much more successful than conventional rotary instrumentation.     

部分去龋法治疗恒磨牙深龋的疗效观察

目的:探讨部分去龋治疗恒磨牙深龋的临床疗效.方法:对102颗恒牙深龋进行部分去龋法结合树脂严密充填,随访6个月以上,评价其牙髓存留率及治疗主观感受.结果:随访到的97颗患牙中,90颗充填物完好,牙髓活力正常,治疗成功率为92.8％;79.9％的患者治疗感受为轻度不适或无反应.结论:部分去龋法治疗恒牙深龋,可以减少牙髓暴露的风险,减轻患者治疗时的不适,获得较好的充填治疗效果,值得临床推广.