오렌지 주스로 침식된 영구치의 항 우식 제품의 법랑질 재광화 효과 비교

Abstract

The purpose of this study is to compare the remineralization effect of permanent teeth by repeatedly applying three types of anti-cariogenic products to permanent teeth eroded with orange juice and photographing them with QLF-D (Quantitative light-induced fluorescence digital) equipment. This study was approved by Ewha Womans University Mokdong Hospital IRB (approved number 2020-04-034-001) and Dankook University IRB (approved number 2020-05-016). From June 2020 to October 2020, 7 teeth were collected from Mokdong Hospital of Ewha Womans University and 29 teeth were collected from Jukjeon Dental Hospital of Dankook University. In conclusion, 36 teeth were collected from above two hospitals and all the teeth were put out for orthodontic treatment or put out, because there was no proper treatment method. The collected teeth had been stored in a CO2 Incubator at 37°C in Mokdong Hospital of Ewha Womans University until they were used in this experiment. The extracted teeth were disinfected in 5% sodium hypochlorite solution, washed and dried, and then fixed on a putty (ExaFlex Putty, GC Co., Alsip, IL, USA) to expose the buccal and lingual surfaces. A total of 36 teeth were randomly selected, and Group 1: controls , Group 2: cavity shield (3M ESPE Inc., US), Group 3: MI varnish (GC Co., Tyokyo, Japan), Group 4: CPP -ACP+ (Tooth Mousse Plus, GC Co., Tyokyo, Japan) was divided into specimens were prepared. Groups 1, 2, 3, and 4 were eroded for 2 minutes with 6ml orange juice (Delmont, Lotte chilsung Co., Seoul, Korea). Groups 2, 3, and 4 except the control group applied anti-cariogenic products according to the manufacturer's instructions, and after 3 minutes, they were cleaned with gauze without brushing and rinsed with distilled water. Anti-cariogenic products were repeatedly applied 4 times. And the 1st, 2nd, 3rd and 4th groups were stored in 37℃ artificial saliva (Xerova Solution, Kolmar, Seoul, Korea). Prior to photographing, the tooth specimen was sufficiently dried with a dental compressed air, and then performed in the same environment. The time of QLF-D using is before and after erosion, and after application of anti-caries products at 0,3,7,14 days. All teeth's buccal and lingual sides were photographed with the following condition. The teeth were put in black acrylic box (Calibration unit, Aiobio, Seoul, Korea) to be photographed and all the photos were taken in the same darkroom at the same distance. The QLF-D dedicated analysis program (QA2, Inspektor research systems BV, Amsterdam, The netherlands) was used to find the difference between the results ; ∆F (lesion depth, unit %) and ∆Q (fluorescence dissipation unit% for lesion depth, unit px2 of lesion area) of each group. Since the location of the erosion of the tooth and the area of the lesion are different for each group, the same lesion at the same location was measured for each period. Lesion depth ∆F, lesion volume ∆Q were used to calculate the average value for each group. A skilled single researcher did the same job to measure and get the above values ; at least twice. The average value for each group was calculated by getting the result ; ∆F and ∆Q within the range in a tooth. ∆(S)Q is rooted Q value to reduce the standard deviation from the quantified ∆Q value. The collected data was had to statics analysis SAS 9.4 (SAS Institute Inc., Cary, NC, USA). The significance level was P<0.05, and the following results were obtained. When the changes in ∆F (lesion depth), ∆Q (lesion volume) and ∆(S)Q (√lesion volume) before and after erosion of the teeth of each group were observed, the whole of teeth were erosied to orange juice for about 2 minutes. The erosion occurred sufficiently and the erosion were statistically significant (p<0.05). The difference in the amount of remineralization for eroded lesions was statistically significant remineralization of all anti- cariogenic products when comparing the control and three anti- cariogenic products (p<0.05). There were differences in remineralization between the three products depending on the depth and area of the eroded lesion, but it was difficult to conclude that a specific product was excellent, and there was no statistically significant difference between the products (p>0.05).;본 연구의 목적은 오렌지 주스로 침식된 영구치에 세 가지 종류의 항 우식 제품을 반복 도포하고 QLF-D(Quantitative light-induced fluorescence digital) 장비로 촬영하여 영구치의 재광화(remineralization)효과를 비교하기 위함이다. 본 연구는 이대 목동 병원 IRB(승인번호 2020-04-034-001), 단국대학교 IRB(승인번호2020-05-016) 두 기관의 승인을 받아 2020년 6월부터 2020년 10월까지 교정치료 목적 또는 치료 불가하여 발거 된 건전한 치아를 대상으로 이대 목동 병원 7개, 단국대학교 죽전 치과병원 29개 총 36개의 치아를 수집하였다. 수집된 치아는 본 실험에 사용하기까지 이대 목동 병원에 있는 37℃ 항온 항습조에 보관하였다. 발거 한 치아는 5% 차아염소산 나트륨 용액에 소독 후 치면을 세척 및 건조한 후 협, 설면이 노출되도록 퍼티(ExaFlex Putty, GC Co., Alsip, IL, USA)에 고정하였다. 총 36개의 치아를 무작위로 선정하여 1군: 대조군, 2군: Cavity shield(3M ESPE Inc., US), 3군: MI varnish(GC Co., Tyokyo, Japan), 4군:CPP-ACP+(Tooth Mousse Plus, GC Co., Tyokyo, Japan)로 나누어 시편을 제작하였다. 1군, 2군, 3군, 4군을 6ml 오렌지 주스(Delmont, Lotte chilsung Co., Seoul, Korea)로 2분간 침식시켰다. 대조군을 제외한 2, 3, 4군은 항 우식 제품을 제조사의 지시 사항에 따라 도포하고 3분 후 칫솔질 없이 거즈로 닦고 증류수로 헹구었다. 항 우식 제품들은 4회 반복 도포 하였다. 그리고 1군, 2군, 3군, 4군을 37℃ 인공 타액(Xerova Solution, Kolmar, Seoul, Korea)에 보관하였다. 촬영 전 치아 시편을 3-way syringe로 충분히 건조 시킨 후 동일한 환경에서 시행되었다. QLF-D 촬영 시점은 침식 전, 침식 후, 항 우식 제품 도포 후 0, 3, 7, 14일이고, 동일한 암실에서 검은색 아크릴 상자(Calibration unit, Aiobio, Seoul, Korea)안에 시편을 넣어 동일한 거리에서 1개의 치아 당 협, 설면으로 총 2면을 촬영하였다. 각 군의 ∆F(병소 깊이, 단위 %)와 ∆Q(병소 깊이에 대한 형광 소실도 단위 %, 병변의 면적의 곱 단위 px2)의 변화량을 비교하기 위해 QLF-D 전용 분석 프로그램(QA2, Inspektor research systems BV, Amsterdam, The netherlands)을 이용하여 평가하였다. 각 군마다 치관에 침식된 위치와 면적이 다르므로 동일한 위치에 있는 같은 병변을 기간별로 측정하였다. 숙달된 1인 조사자가 최소 2회 이상 같은 병변을 측정한 범위 내의 도출되는 결과값 ∆F, ∆Q값을 수집하여 각 군의 평균값을 산출하였다. ∆(S)Q는 정량화 되어 나오는 ∆Q값에서 표준편차를 줄이기 위해 루트를 씌웠다. 수집된 자료는 SAS 9.4(SAS Institute Inc., Cary, NC, USA)를 이용하여 다음과 같은 결과를 얻었다. 각 군의 협, 설면의 침식 전, 후의 ∆F(병소 깊이), ∆Q(병소 부피), ∆(S)Q(√병소 부피)의 변화량을 관찰하였을 때, 영구치는 오렌지 주스에 2분 정도 노출이 되어도 침식이 충분히 일어나며 통계적으로 유의미하였다.(p<0.05) 침식된 병소에 대한 재광화량 차이는 대조군과 세 가지 항 우식 제품을 비교하였을 때 항 우식 제품 모두 통계적으로 유의미하게 재광화가 나타났다.(p<0.05) 세 가지 제품 간의 재광화 차이는 침식된 병소의 깊이와 면적에 따라 제품 간 차이가 나는 것도 있었지만, 특정 제품이 우수하다고 단정하는 것은 어렵고 제품 간의 통계적으로 유의미한 차이가 없었다.(p>0.05)