因科技發達材料進步,目前矯正所用的黏著劑大部分都有不錯的表現,在動態治療期間,大多數矯正器(bracket)皆能確實黏著於牙齒表面不脫落,然而到了治療結束時,我們反而要為了矯正器如何拆除而頭痛。
尤其是本院臨床上常使用4-META系統的黏著劑,因具有優越的黏著強度,拆除矯正器時反而面臨如病患抱怨不適,甚至有疼痛感等問題。為了符合病患的期望,我們希望可以不需藉由額外的儀器或設備,僅利用試劑的塗抹來達成減低矯正用黏著樹脂的黏著強度,使矯正器的拆除過程不會造成病人的不適。
本研究所使用的樹脂黏著劑為Super-Bond C&B®(Sun Medical Company, Kyoto, Japan),合併使用金屬矯正器與陶瓷矯正器(Tomy company, Tokyo, Japan)進行矯正器黏著,使用120顆因矯正治療而拔除的人類小臼齒,隨機分成12組,實驗分別以金屬與陶瓷矯正器進行以下實驗:控制組:常溫蒸餾水(15分鐘)、實驗組1(尤加利油15分鐘)、實驗組2(尤加利油以卡波莫製成之膠狀溶液15分鐘)、實驗組3(尤加利油以卡波莫製成之膠狀溶液30分鐘)、實驗組4(尤加利油以蘆芭膠製成之膠狀溶液15分鐘)、實驗組5(尤加利油以蘆芭膠製成之膠狀溶液30分鐘),然後以材料試驗機(JSV H1000立式自動測試台搭配HANDY FORCE GAUGE(HF-50)) 進行矯正器拆除試驗,所採取的crosshead speed定為1mm/min。
拆除後使用數位行動放大鏡(ViTiny® Fun 50,5X~20X)觀察樹脂殘留分布情形與牙釉質表面狀況,採用Adhesive Remnant Index (ARI) score記錄分析殘留樹分布情形。
實驗結果顯示,除了尤加利油以蘆芭膠製成之膠狀溶液15分鐘,對於輔助金屬矯正器的拆除效果不明顯之外,其餘都是有效的,而且殘留樹脂分布情形使用尤加利油後,分離界面有從牙釉質與樹脂移轉到樹脂與矯正器的趨勢。使用尤加利油對於輔助陶瓷矯正器的拆除效果則不明顯,而且分離界面有從樹脂與矯正器移轉到牙釉質與樹趨勢。
膠狀尤加利油對於輔助金屬矯正器的拆除是有效的,但是其作用與機轉還不明確,期待更深入的研究與探討。
As medical treatment being developed with material progress, the orthodontic treatment time was reduced and the uncomfortable feeling has been reduced too. The pain that the patients complained most frequently was when the brackets were removed. The higher the bonding strength cause the more enamel damage and patients uncomfortable when debonding. However, there are still some difficulties in the brackets debonding.
Many methods like ultrasonic, electrothermal and laser debonding techniques were developed to overcome those problems. But those methods still have some problems like pulp temperature rise, expansive equipments. Only some research investigated the effects of chemical solvents on the debonding.
This study investigated the effect of eucalyptol gel used on the debonding orthodontic brackets. Two types of brackets and gel form were used in this study. It was hypothesized that used eucalyptol gel can make it easier to debond bracket.
Orthodontic metal and ceramic brackets were bonded to previously extracted premolars. Groups of 10 bonded teeth were divided into 12 groups(control, eucalyptol 15min, Lubrajel® eucalyptol gel 15 min, Lubrajel® eucalyptol gel 30 min, Carbopol 941® eucalyptol gel 15 min, Carbopol 941® eucalyptol gel 30 min). Each tooth was debonded using JSV H1000 Testing Machine. The crosshead speed was set as 1mm/min. The records include debonding force(N) and adhesive remnant index (ARI) at the debonding site.
A statistically significant decrease in shear bonding strength was found in metal brackets using eucalyptol regardless of it was liquid or gel form(p<0.05). No statistically different in shear bonding strength was found in ceramic brackets using eucalyptol regardless of it was liquid or gel form. But there was no difference in ARI scores among all the groups.
Conclusion
In our study use of Carbopol 941® eucalyptol gel 15 min could be the most efficient to reduce the shear bonding strength force for the metal orthodontic bracket debonding procedure