新開發可注射式排齦材料之臨床試驗

Clinical Study of Cordless Gingival Retraction: Quantitative Analysis

魏怡欣(Wei Yi Hsin)

指導教授 ： 林哲堂教授

臺北醫學大學/口腔學院/牙醫學系碩博士班/碩士(2005年)

摘要

本研究目的是要探討新開發可注射式排齦材料在臨床上的表現，如適度擴大牙齦溝寬度，避免軟組織的傷害，減少患者的疼痛，出血的控制和操作時間。實驗材料包括二種市售排齦材料（Ultrapak1?，Expasyl?）以及Korlex-GR? 0% 和7% 三氯化鋁的注射式排齦材料。四種排齦材料分別用在15位牙齦健康無牙周病的年輕受試者，以polyvinylsiloxane印模材印模，未排齦者為對照組。製成的硬石膏模型以3-D雷射掃描機計測牙齦溝寬度以及牙齦萎縮的情形，以Wilcoxon signed ranks test統計排齦效果。材料之間的差異以Kruskal-Wallis分析及Mann-Whitney U test多重分析。結果顯示四種材料均有顯著排開牙齦的效果(p<0.05)，(牙齦溝寬度大於0.2mm)。在牙齦萎縮程度評估方面，統計分析結果顯示Ultrapak1? 排齦線相較於其它三組，有顯著的牙齦萎縮 (p<0.05)。藉由問卷評估操作時與操作後受試者的舒適度，綜合牙醫師客觀的觀察與患者的自述，顯示出本材料在施予過程中之疼痛程度與出血的控制，均優於傳統排齦線，操作時間也較短。上述結果顯示Korlex-GR?具適中的機械力，在無痛狀況下可以有效的撐開牙齦，提供印模所需的牙齦溝寬度，減少出血且可避免傷害牙齦，在臨床應用上具可行性。

並列摘要

Detailed and precise impression is required in the fabrication of a fixed dental prosthesis. To accurately record the subgingival finish line, traditional retraction cord is most frequently used by dentists to displace gingival tissue and control crevicular fluid and bleeding. Aside from being time-consuming, concerns have been raised regarding the possible impact of retraction cords on the gingival health. Therefore, the need to balance adequate gingival retraction while maintaining gingival integrity should be emphasized. The objective of the study is to quantitatively assess the clinical feasibility of Korlex-GR? (both 0% and 7% samples) and to compare it with Ultrapak1? medicated cord and Expasyl? retraction paste in terms of gingival retraction, gingival recession, patient comfort, hemorrhage control and application time. A total of 15 young patients with healthy periodontium were recruited into the study. The test materials were randomly and separately applied on the four maxillary incisors of each subject, Impressions were made with polyvinyl siloxane impression material before retraction, right after retraction and 14 days after retraction. The stone models were subjected to a 3-D laser scan to measure the width of the retracted sulcus and the positions of the gingival margin before and after retraction to determine gingival recession. For pain evaluation, the subjects were asked to rank the pain perceived on a scale of 1 to 4, immediately after each material was applied. For the evaluation of hemostasis, the operator ranked the bleeding condition of the test sites on a scale of 1 to 3 immediately after each material was removed. For the evaluation of chair time, the length of time consumed in applying each material was calculated in seconds. The Wilcoxon signed ranks test was used to determine gingival retraction, gingival recession, pain, hemostasis and application time caused by each material. The Krukal-Wallis test was used to determine the significant difference among the four materials, and the Mann Whitney U test was used for multiple comparisons. Results showed a significant increase in sulcus width in all test materials (p<0.05), with a sulcus width greater than 0.2mm, but no statistical difference was noted among these materials (p>0.05), this showed that Korlex-GR? was as good as the two other commercial brands in terms of gingival retraction. Gingival recession was also observed in all test materials (p<0.05). However, when different materials were compared Ultrapak 1? seemed to produce significantly more gingival recession than the other two injection type materials (p<0.05). The subjective feedback of the subjects indicated that Ultrapak 1? was significantly more painful than the injection types (p<0.05). With regards to hemostasis and application time, Ultrapak 1? caused significantly more bleeding than the injection types (p<0.05) and it also significantly consumed longer application time. In conclusion, Korlex-GR? is a safe and less painful gingival retraction material with optimum mechanical strength that increases sulcus width to an amount adequate for impression making, but causes minimal tissue injury. At the same time, the brevity of its application time and good hemorrhage control makes it convenient for use. It is therefore recommended for clinical application. Key words: gingival retraction, aluminum chloride, gingival recession, sulcus

並列關鍵字

gingival retraction ； aluminum chloride ； gingival recession ； sulcus

參考文獻

2. Laufer BZ, et al. The closure of the gingival crevice following gingival retraction for impression making. J Oral rehabil, 24(9): 629-35, 1997.

3. Hansen PA, Tira DE, Barlow J. Current methods of finish-line exposure by practicing prosthodontists. J Prosthodont, 8(3): 163-70, 1999.

4. Benson BW, et al. Tissue displacement methods in fixed prosthodontics. J Prosthet Dent, 55(2): 175-181, 1986.

5. Azzi R., et al. Comparative study of gingival retraction methods. J Prosthet Dent. 50(4): 561-5, 1983.

6. Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent, 53(4): 525-31, 1985.