修復処置におけるう蝕象牙質除去の客観性についての臨床的評価  [in Japanese] Clinical Evaluation of the Objectivity of Caries Removal for Restorative Treatments  [in Japanese]

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Author(s)

    • 伊藤 祥作 ITOH Shousaku
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 薮根 敏晃 YABUNE Toshiaki
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 山本 洋子 YAMAMOTO Hiroko
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 林 美加子 HAYASHI Mikako
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 岩見 行晃 IWAMI Yukiteru
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 山田 朋美 YAMADA Tomomi
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 松下 真美 MATSUSHITA Manami
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 山口 幹代 YAMAGUCHI Mikiyo
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 北川 晴朗 KITAGAWA Haruaki
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 池田 峻 IKEDA Shun
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 古谷 優 FURUYA Yu
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry
    • 前薗 葉月 MAEZONO Hazuki
    • 大阪大学大学院歯学研究科口腔分子感染制御学講座(歯科保存学教室) Department of Restorative Dentistry and Endodontology, Division of Oral Infections and Disease Control, Osaka University Graduate School of Dentistry

Abstract

目的:本研究では,客観的色彩評価法,レーザーう蝕診断器(DIAGNOdent,KaVo)およびう蝕硬さ測定システム(Cariotester,三栄エムイー)によって,口腔内での通法によるう蝕象牙質除去の客観性を数値的に検討した.材料と方法:大阪大学歯学部附属病院に来院した患者の永久歯の象牙質う蝕のうち,歯髄に対する診断結果が臨床的正常歯髄または歯髄充血であり,う蝕象牙質除去後に肉眼的な露髄が認められない22症例(急性う蝕病巣13症例,慢性う蝕病巣9症例)を研究対象とした.これらの対象症例について,通法に従ってう蝕検知液(Caries Detector,クラレノリタケデンタル)を用いてう蝕歯質を除去し,コンポジットレジンで修復した.その際,う蝕象牙質除去後の残存象牙質表面に対して,う蝕検知液にて染色を行った状態で色補正用標準色見本とともにCCDカメラで撮影した後,DIAGNOdentによる蛍光強度の評価とCariotesterによるヌープ硬さ測定を実施した.また,CCDカメラによる撮影画像から,色補正用色見本の色変化を基にした色補正を行って,残存象牙質表面のCIE1976L*a*b*表色系によるL*,a*,b*を算出した.結果:う蝕象牙質除去後の急性う蝕病巣と慢性う蝕病巣のL*,a*,b*,DIAGNOdent値およびヌープ硬さの変動係数は14.7〜95.0となり,各診断パラメータのばらつきが大きいことがわかった.また,急性および慢性う蝕病巣のL*,a*,b*,急性う蝕病巣のDIAGNOdent値の級内相関係数は0.87〜0.98,慢性う蝕病巣のDIAGNOdent値,急性および慢性う蝕病巣のヌープ硬さの級内相関係数は0.42〜0.65であった.結論:急性う蝕病巣および慢性う蝕病巣における,通法の色や硬さによるう蝕象牙質除去の客観性はいずれも不十分であることがわかった.また,客観的色彩評価と急性う蝕病巣のレーザーう蝕診断は評価結果の再現性は高かったが,ヌープ硬さ測定と慢性う蝕病巣のレーザー診断結果の再現性は中等度であった.

Purpose: This study evaluated the objectivity of caries removal in clinical situations numerically by an objective color method, a laser fluorescence device (DIAGNOdent, KaVo) and Knoop hardness evaluation (Cariotester, Sanei ME). Methods: This experiment examined 22 permanent teeth with dentinal carious lesions (13 acute lesions and 9 chronic lesions) from patients in Osaka University Dental Hospital. The clinical pulpal conditions of these teeth were clinical normal pulp or pulp hyperemia and the teeth did not have pulp exposure. The carious lesions of the teeth were removed clinically with a caries detector dye (Caries Detector, Kuraray Noritake Dental) and the cavities were restored with a resin composite. After removal of carious dentin, images of the residual dentinal surfaces stained with the caries detector dye, together with color-matching stickers, were taken with a CCD camera. In addition, the dentinal surfaces were evaluated by the DIAGNOdent and their Knoop hardness numbers were measured by the Cariotester. Next, corrected L*, a* and b* values of the surfaces (CIE 1976 L*a*b* color system) were calculated from the color changes of the stickers in the images. Results: In both acute and chronic lesions, the range of the coefficient of variation of the L*, a* and b* values, DIAGNOdent values and Knoop hardness numbers of the surfaces were 14.7-95.0. Therefore, these diagnostic parameters of the surfaces vary widely. In addition, the range of the intraclass correlation coefficients of the L*, a* and b* values in both acute and chronic lesions and those of the DIAGNOdent values in acute lesions were 0.87-0.98 The range of the DIAGNOdent values in chronic lesions and those of the Knoop hardness numbers in both acute and chronic lesions were 0.42-0.65. Conclusions: The objectivity of the clinical diagnosis of carious dentin in both acute and chronic lesions was insufficient. In addition, the reproducibility of laser evaluation in acute lesions and color evaluation were very high. However, those of laser evaluation in chronic lesions and hardness evaluation were moderate.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 56(5), 442-453, 2013

    The Japanese Society of Conservative Dentistry

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