【作者】 王琪；

【导师】 刘士有；

【作者基本信息】 天津医科大学 ， 口腔内科学， 2004， 硕士

【摘要】 目的：通过观察人牙本质人工脱矿前后的硬度、超微结构、元素成分的变化，比较脉冲CO₂激光、38％氟化氨银以及二者联合对抗牙本质脱矿的作用，并分析其作用机制，为寻找既能有效预防龋病又能为牙本质敏感症脱敏的临床治疗方法提供实验依据。 方法：将15颗符合试验要求的人离体前磨牙每牙预备成相同的4块牙本质标本，随机把这4块标本分别归入4组，即A组（空白对照组）、B组（脉冲CO₂激光处理组）、C组（38％氟化氨银处理组）和D组（脉冲CO₂激光与38％氟化氨银联合处理组）。对以上各组样本再行人工脱矿处理（Ph-循环）。人工脱矿前后均进行显微硬度测试、扫描电镜和X线能谱分析。所得数据应用SPSS统计软件进行随机区组（配伍）方差分析及LSD检验。 结果：显微硬度测试结果显示，各组硬度脱矿前由高到低分别为：D、C、A、B（P＜0.01），各组硬度脱矿后顺序为：D、C、B、A（P＜0.01），这样，由显微硬度测试所揭示的各组增强牙本质抗脱矿能力由高到低的顺序为：D、C、B、A（P＜0.01）；由X线能谱分析得出的原子比重变化由低到高的各组为：B、D、C、A。扫描电镜显示：A组，脱矿前后牙本质小管清晰，小管开口明显，脱矿后的组织更松散，有机质相对明显；B组，脱矿前表面熔融，牙本质小管形态消失，然而，经脱矿后，熔融结构基本剥脱，牙本质小管开口重新出现：C组，脱矿前较厚的熔融层经脱矿消失，牙本质小管开口重新出现；D组，存在较厚的熔融层，脱矿前后无明显变化。 结论：应用脉冲CO₂激光或38％氟化氨银处理，均可提高人牙本质抗脱矿的能力并能封闭牙本质小管开口，但二者联合使用又分别弥补了各自的不足，形成了协同作用，既增强了抗脱矿能力，又提高牙体硬组织自身硬度和牙本质小管封闭的持久性，从而实现防龋、抑龋和对牙本质敏感症的脱敏效果。更多还原

【Abstract】 Objective: This study determined the synergistic effect on acid resistance and dentinal desensitization in human dentine as a function of pulsed CO2 laser irradiation combined with 38%Ag(NH3)2F treatment.Methods: Each molar from 15 extracted molars was made into four identical dentinal specimens, which were randomly divided into 4 groups, each one receiving different treatment: A (control group); B (pulsed CO2 laser irradiation); C (coated with 38%Ag(NH3)2F); D (laser irradiation + fluoride). Then, all groups were demineralized artifially. Micro-hardness test, SEM and X-ray energy spectrum analysis were taken prior and after demineralization. Statistic methods: two-way ANOVA and LSD test with SPSS 10.0.Results: The groups prior demineralization in hardness order:D,C,A,B(P<0.01); the groups after demineralization in hardness order:D,C,B,A (P<0.01) ; the groups in acid resistance order: D,C,B,A(P<0.01) ; the groups in the order of At% change of elements:B,D,C,A(P<0.01). Under SEM: group A showed clear dentinal tubuliprior and after demineralization; group B showed melted surface without dentinal tubule opens prior demineralization whereas melted layer disappearing with tubule reopening after demineralization; group C showed thicker melted layer without dentinal tubule opens prior demineralization whereas melted layer disappearing with tubule reopening after demineralization; group D showed that there were no dramatic difference caused by demineralization with the thickest melted and recrystalized layer on dentine surface.Conclusion: The synergistic effect on acid resistance in human dentine as a function of pulsed CO2 laser irradiation combined with 38%Ag(NH3)2F treatment was formed, despite of their individual disadvantages. Not only was the effect on acid resistance in human dentine reinforced, but also the mechanical properties and dentinal tubule sealing were maintained.更多还原