MIH 影响的牙釉质和牙本质的粘结策略。

Bonding strategies for MIH-affected enamel and dentin.

机构信息

Department of Pediatric Dentistry, Dental School, University of Marburg and University Medical Center Giessen and Marburg, Campus Giessen, Schlangenzahl 14, D-35392 Giessen, Germany.

Department of Pediatric Dentistry, Dental School, University of Marburg and University Medical Center Giessen and Marburg, Campus Giessen, Schlangenzahl 14, D-35392 Giessen, Germany; Department of Operative Dentistry and Endodontics, Dental School, University of Marburg and University Medical Center Giessen and Marburg, Campus Marburg, Georg-Voigt-Str. 3, D-35039 Marburg, Germany.

出版信息

Dent Mater. 2018 Feb;34(2):331-340. doi: 10.1016/j.dental.2017.11.015. Epub 2017 Dec 6.

DOI:10.1016/j.dental.2017.11.015

PMID:29208311

Abstract

OBJECTIVES

Aim of the present study was to evaluate resin composite adhesion to dental hard tissues affected by molar incisor hypomineralisation (MIH).

METHODS

94 freshly extracted human molars and incisors (53 suffering MIH) were used. 68 teeth (35 with MIH) were used for μ-TBS tests in enamel and dentin, 26 (18 with MIH) for qualitative evaluation. Specimens were bonded with Clearfil SE Bond, Scotchbond Universal, and OptiBond FL. For MIH affected enamel, additional OptiBond FL groups with NaOCl and NaOCl+Icon were investigated. Beside fractographic analysis, also qualitative evaluations were performed using SEM at different magnifications as well as histological sectioning.

RESULTS

Highest μ-TBS values were recorded with dentin specimens (ANOVA, mod. LSD, p<0.05). Results were independent of adhesive and dentin substrate (p>0.05). Pre-test failures did not occur in dentin specimens. Sound enamel specimens exhibited significantly higher μ-TBS values than MIH enamel (p<0.05). The two-step self-etch adhesive (Clearfil SE Bond) and the two-step etch-and-rinse adhesive (Scotchbond Universal) showed the lowest values in affected enamel specimens (p<0.05) with most pre-test failures (p<0.05). OptiBond FL on affected enamel showed better results than Clearfil SE Bond (p<0.05). An additional pre-treatment of affected enamel with NaOCl or NaOCl and Icon did not enhance enamel bonding (p>0.05), however, it caused less pre-test failures (p<0.05). Micromorphological analyses revealed that conventional phosphoric acid etching produces a much less pronounced etching pattern in affected enamel and a porous structure as weak link for the resin-enamel bond was identified.

SIGNIFICANCE

Bonding to porous hypomineralized MIH enamel is the limiting factor in adhesion to MIH teeth. MIH-affected dentin may be bonded conventionally.

摘要

目的

本研究旨在评估受磨牙-切牙釉质不全（MIH）影响的牙体硬组织的树脂复合材料黏附力。

方法

使用 94 颗新鲜离体的人磨牙和切牙（53 颗受 MIH 影响）。68 颗牙（35 颗受 MIH 影响）用于评估釉质和牙本质的微拉伸结合强度（μ-TBS），26 颗（18 颗受 MIH 影响）用于定性评估。使用 Clearfil SE Bond、Scotchbond Universal 和 OptiBond FL 进行黏接。对于受 MIH 影响的釉质，还研究了用 NaOCl 和 NaOCl+Icon 处理 OptiBond FL 后的附加组。除了断口形貌分析外，还使用 SEM 在不同放大倍数下进行定性评估，以及进行组织学切片。

结果

μ-TBS 值最高的是牙本质标本（ANOVA，mod. LSD，p<0.05）。结果与黏合剂和牙本质底物无关（p>0.05）。牙本质标本没有预测试失败。正常釉质标本的 μ-TBS 值明显高于 MIH 釉质（p<0.05）。两步自酸蚀黏合剂（Clearfil SE Bond）和两步酸蚀-冲洗黏合剂（Scotchbond Universal）在受影响的釉质标本中显示出最低的值（p<0.05），且预测试失败的情况最多（p<0.05）。OptiBond FL 在受影响的釉质上的效果优于 Clearfil SE Bond（p<0.05）。用 NaOCl 或 NaOCl 和 Icon 预处理受影响的釉质并不能增强釉质黏合（p>0.05），但会减少预测试失败（p<0.05）。微观形貌分析表明，传统的磷酸酸蚀在受影响的釉质中产生的蚀刻图案不那么明显，多孔结构被认为是树脂-釉质结合的薄弱环节。