表面处理对激光非破坏性拆除氧化锆修复体后牙本质再粘接效果的影响  

Effect of surface treatment on dentin rebonding after laser non⁃destructive removal of zirconia prosthesis

作　　者：李小婷 江磊[1] 卢枳岑 蔡春燕 于皓[1] LI Xiaoting;JIANG Lei;LU Zhicen;CAI Chunyan;YU Hao(School of Stomatology,Department of Prosthodon-tics,Hospital of Stomatology,Fujian Medical University,Fujian Key Laboratory of Oral Diseases,Fuzhou 350002,China;Minjiang Teachers College,Fuzhou 350108,China)

机构地区：[1]福建医科大学口腔医学院,福建医科大学附属口腔医院修复科,福建省口腔疾病研究重点实验室,福建福州350002 [2]闽江师范高等专科学校,福建福州350108

出　　处：《口腔疾病防治》2025年第3期195-202,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：福建省自然科学基金面上项目(2021J01808)。

摘　　要：目的探讨使用Er:YAG激光拆除修复体后,牙本质表面的变化及不同表面处理方式对牙本质再粘接效果的影响,为口腔临床操作提供参考。方法本研究已通过单位伦理审查委员会批准。应用计算机辅助设计与计算机辅助制作(computer aided design and computer aided manufacturing,CAD/CAM)技术制作氧化锆试件(4 mm×4 mm×1.5 mm)102个。收集拔除人阻生第三磨牙110颗,制备牙本质块(4 mm×4 mm×2 mm)102个。将氧化锆试件与牙本质块用树脂水门汀粘接后,而后用Er:YAG激光拆除。随机选取3个拆除后的牙本质块,X射线能量色散谱仪(energy dispersive X-ray spectroscopy,EDX)分析牙本质表面元素组成。将拆除后牙本质块随机分成3组(n=33),分别进行不同的表面处理:对照组(不做任何处理)、喷砂组(颗粒大小为50μm Al2O3喷砂处理)、激光照射组(Er:YAG激光照射,参数为10 Hz,60 mJ,0.6 W)。各组随机选取3个牙本质块进行扫描电镜(scanning electron microscope,SEM)观察;各组剩余30个牙本质块使用光学体式显微镜,在20倍下观察牙本质表面残留的树脂,用树脂残留指数(adhesive remnant index,ARI)法计分。而后使用树脂水门汀按照标准程序与3组经过不同表面处理的牙本质块再粘接,形成牙本质-树脂粘接试件(n=30),每组再分为两个亚组进行老化(n=15),其中一亚组进行37℃恒温水浴24 h,另一亚组37℃恒温水浴24 h后再接受5000次冷热循环,测量各组微剪切粘接强度,并分析断裂模式。比较3组牙本质表面ARI组间差异及粘接强度、断裂模式的组间差异以及组内老化前后差异。结果Er:YAG激光拆除氧化锆,牙本质表面未见明显损伤,但牙本质内C元素及Si元素显著增加。经过不同表面处理后,喷砂、激光照射组ARI低于对照组(P<0.05),而喷砂组与激光照射组间ARI差异无统计学意义(P>0.05)。牙本质表面形貌也呈现出差异:对照组牙本质表面可见牙本质表面残留大量Objective To investigate the changes of dentin surface and the effects of different surface treatments on the rebonding effect following non-destructive restoration removal by an Er:YAG laser and to provide reference for oral clinical operation.Methods This study was approved by the ethics review committee of the unit.Using computer-aid-ed design and computer-aided manufacturing(CAD/CAM)technology,102 zirconia specimens(4 mm×4 mm×1.5 mm)were fabricated.In total,110 impacted third molar teeth were extracted,and 102 dentine blocks(4 mm×4 mm×2 mm)were prepared.The zirconia specimen and dentin blocks were bonded with resin cement before removal with an Er:YAG laser.Three disassembled dentin blocks were randomly selected,and the components of dentin surface elements were analyzed by energy dispersive X-ray spectroscopy(EDX).The removed dentin blocks were randomly divided into three groups(n=33)based on the different surface treatments:control group(no treatment),sandblasting group(50μm,Al2O3 sandblasting),and laser irradiation group(Er:YAG laser irradiation,parameters were set to 10 Hz,60 mJ,0.6 W).Three dentin blocks were randomly selected in each group for scanning electron microscopy(SEM)observation,and the residual resin on dentin surface of remaining 30 dentin blocks in each group were observed under an optical microscope at 20 times magnification.Scores were obtained using the adhesive remnant index(ARI)method.Three groups of dentin blocks(n=30)that underwent different surface treatments were rebonded with resin cement according to standard pro-cedures and then divided into two subgroups for aging(n=15).One subgroup was subjected to a 37℃water bath for 24 h,and the other subgroup was subjected to 5000 thermal cycles after a 37℃water bath for 24 h,and the micro-shear bonding strength of each group was measured.The microshear bonding strength of each group was measured,and fracture modes were analyzed.The differences of dentine surface ARI between the three groups,as well as the inter-group differences in

关 键 词：喷砂 氧化锆 牙本质 ER:YAG激光 粘接强度 牙本质粘接 冷热循环老化 树脂残留指数 

分 类 号：R78[医药卫生—口腔医学]