대한치과보존학회지 : Vol. 35, No. 1, 2010 직접치수복조재에따른비글견치수의조직반응에대한연구 배지현 1 김영균 2 윤필영 2 조병훈 3 최용훈 1 * 분당서울대학교병원 1 치과보존과, 2 구강악안면외과, 3 서울대학교치과대학치과보존학교실 ABSTRACT P

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1 배지현 1 김영균 2 윤필영 2 조병훈 3 최용훈 1 * 분당서울대학교병원 1 치과보존과, 2 구강악안면외과, 3 서울대학교치과대학치과보존학교실 ABSTRACT PULP RESPONSE OF BEAGLE DOG TO DIRECT PULP CAPPING MATERIALS: HISTOLOGICAL STUDY Ji-Hyun Bae 1, Young-Gyun Kim 2, Pil-Young Yoon 2, Byeong-Hoon Cho 3, Yong-Hoon Choi 1 * 1 Department of Conservative Dentistry, 2 Department of Oral Maxillofacial Surgery, Seoul National University Bundang Hospital 3 Department of Conservative Dentistry, School of Dentistry, Seoul National University The purpose of this study was to evaluate the pulp tissue reaction to direct pulp capping of mechanically exposed beagle dogs pulp with several capping materials. A total of 36 teeth of 2 healthy beagle dongs were used. The mechanically exposed pulps were capped with one of the followings: (1) Mineral Trioxide Aggregate (MTA: ProRoot MTA, Dentsply, Tulsa, USA), (2) Clearfil SE Bond (Dentin adhesive system: Kuraray, Osaka, Japan), (3) Ultra-Blend (Photo-polymerized Calcium hydroxide: Ultradent, South Jordan, USA), (4) Dycal (Quick setting Calcium hydroxide: LD Caulk Co., Milford, USA) at 7, 30, and 90 days before sacrificing. The cavities were restored with Z350 flowable composite resin (3M ESPE, St. Paul. MN, USA). After the beagle dogs were sacrificed, the extracted teeth were fixed, decalcified, prepared for histological examination and stained with HE stain. The pulpal tissue responses to direct pulp capping materials were assessed. In MTA, calcium hydroxide, and photo-polymerized calcium hydroxide groups, initial mild inflammatory cell infiltration, newly formed odontoblast-like cell layer and hard tissue bridge formation were observed. Compared with dentin adhesive system, these materials were biocompatible and good for pulp tissue regeneration. In dentin adhesive system group, severe inflammatory cell infiltration, pulp tissue degeneration and pulp tissue necrosis were observed. It seemed evident that application of dentin adhesive system in direct pulp capping of beagle dog teeth cannot lead to acceptable repair of the pulp tissue with dentine bridge formation. [J Kor Acad Cons Dent 35(1):5-12, 2010] Key words: Direct pulp capping, Pulp inflammation, Dentinal bridge, Histological evaluation, Beagle dog -Received , revised , accepted Ⅰ. 서론 환자를치료하는치과의사의궁극적목표는환자의치아 *Corresponding Author: Yong-Hoon Choi Department of Conservative Dentistry, Seoul National University Bundang Hospital 300 Gumi-dong, Bundang-gu, Seongnam-si Gyeonggi-do, , Korea Tel: Fax: yhchoi@snubh.org 를보존하여저작, 발음, 심미의치아의기능을유지하는것이다. 임상진료시충치제거나와동형성과정중치수노출을경험하게된다. 특히소아및청소년기의유치열, 혼합치열또는성인의영구치열에가해지는외상은흔히치아파절등을야기하며치수의생활력에치명적인손상을입히게된다. 이렇게치수가노출된경우, 더이상치수에손상을주지않고치수의생활력을유지하기위해직접치수복조술이적용된다. 치수염증을나타내는동통등의기왕력이없다면직접치수복조는시간과노력, 비용이드는힘든근관치 5

2 료과정을거치지않고, 치아의생활력과기능을유지할수있는좋은방법이다. 치수복조재료의선택은직접치수복조술의성공에중요한요소이다. 이상적인치수복조재는치수의염증을유발하지않고, 치질과결합하여미세누출이없으며, 상아질교를형성하고, 임상적으로사용하기편한것이다. 1) 성공적인직접치수복조술을위해수산화칼슘, MTA, 접착성레진등의많은약재들이연구되고쓰여지고있지만치료효과와예후에대해서는아직도많은논란이있으며, 특히최근에는기존에이상적인치수복조재로인정되어온수산화칼슘에대한회의와반론이제기되고있다. 2-5) 치수염증의원인은세균의미세누출이라는생각으로상아질접착제와치과용복합레진이치수복조재로사용되었지만, 여러연구에서상반된결과를보고하였고, 6-11) 생체친화성으로다양한용도로사용되는 MTA 12-16) 에대해서도단점이보고되고있는실정이다. 17) 이번실험에서는최근에접착력과밀폐능력이우수하여임상적으로많이사용되는 Clearfil SE Bond 를이용한직접치수복조술과생체친화성으로다양한용도로사용되는 MTA 를이용한직접치수복조술, 그리고임상적으로사용하기편리하게제작된광중합형수산화칼슘제재를이용한직접치수복조술에대해평가하기위해서, 전통적으로많이사용되는수산화칼슘과비교하였다. 본실험의목적은인위적으로노출시킨비글견의치수조직을기존의수산화칼슘제재와 MTA, 접착성레진, 광중합형수산화칼슘제재를사용하여직접치수복조한후각재료에따른치수의반응을광학현미경하에서조직학적으로관찰하여비교분석함으로써, 임상가들의치수복조재선택에도움을주고자함이다. 1. 실험대상 Ⅱ. 실험재료및방법 생후 일, 체중 kg 정도의비글견암수한마리씩을실험대상으로선정하였으며, 한마리당 18 개의소구치, 대구치를실험대상치아로선정하였다. 2. 실험재료 본실험에는 Mineral Trioxide Aggregate (MTA: ProRoot. MTA, Dentsply, Tulsa, USA) self-etching adhesive 인 Clearfil SE Bond (Kuraray, Osaka, Japan), 광중합형수산화칼슘제재인 Ultra-Blend (Ultradent, South Jordan, USA), 수산화칼슘제재인 Dycal (LD Caulk Co., Milford, USA) 이치수복조제로사용되었다. 와동충전에는복합레진인 Z350 flowable composite resin (3M ESPE, St. Paul. MN, USA) 이수복제로사용되었다. 3. 실험방법 비글견희생 90 일전, 체중당 10 mg 의 Ketamine HCL (Zoletil 50, Virbac, Carros, France) 과체중당 0.2 mg 의 Xylazine HCl (Rumpen, Bayer Korea, Seoul, Korea) 을정맥주사하여마취상태를유지하였다. 2% 염산리도카인 (1 : 100,000 epinephrine, 광명, 한국 ) 을이용하여국소침윤마취한후, 큐렛을이용하여치아에붙어있는치석을제거하고, 구강내를 0.5% chlorhexidine 으로소독하였다. 무작위로선정된치아에대해소독된 #330 카바이트바를고속핸드피스에부착하여충분한물분사하에치아의협면에가로 2 mm, 세로 2 mm, 깊이 1.5 mm 의와동을형성하고, 저속핸드피스에서 #1/2 카바이드바를이용하여치수를노출시켰다. 와동을식염수로세척하고소독된면구로압박하여지혈시킨후, 각각의치수복조재를제조사의지시에따라적용하고, 와동은 Clearfil SE Bond 와 Z350 flowable composite resin (3M ESPE, St. Paul. MN, USA) 으로충전하였다. 희생 30 일전, 7 일전에도각군별로 3 개의치아에같은방법으로직접치수복조와와동수복을실시하였다. 와동형성시와같은방법으로전신마취하고경부를개방한다음경동맥을통하여고정액인 4% formaldehyde 로관류고정하고 KCl 을정맥주입하여심정지를확인한후, 상하악골을적출하여 4% formaldehyde 용액에서일주일간고정하였다. 각치아를잘라서 20% formic acid 로 2 개월간탈회한다음, 기존의방법대로수세, 탈수및명화과정을거친후파라핀포매하였다. 치수노출부의중앙을관통하도록협설방향으로 5 μm 두께로절단한다음 Hematoxylin- Eosin 염색을시행하여광학현미경으로관찰하였다. Costa 등이 9) 사용한 criteria 를이용하여각표본의치수조직반응을평가하였다 (Table 1, 2). Table 1. Criteria for grading inflammatory cell response Grade Characterization 0 None or a few scattered inflammatory cells present in the pulpal area corresponding to pulp exposure, characteristic of normal tissue 1 Slight inflammatory cell infiltration with polymorphonuclear or mononuclear leukocytes 2 Moderate inflammatory cell infiltration involving the coronal pulp 3 Severe inflammatory cell infiltration involving the coronal pulp or abscess present 6

3 Table 2. Criteria for grading hard tissue formation Grade Characterization 0 Absent 1 Modest hard tissue deposition beneath the exposed area 2 Moderate hard tissue deposition beneath the exposed area 3 Heavy hard tissue deposition beneath the exposed area, appearing as a complete dentin bridge Ⅲ. 실험결과 본실험에서얻어진각치수복조재에대한비글견의치수반응은 Table 3 과같다. 1. MTA 군 7 일경과한군에서는경조직의형성은관찰되지않았으며, odontoblast-like cell 이재료하방에서관찰되었고, 치수조직의위축과부분괴사도관찰되었다 (Figure 1a). 30 일표본에서는경조직이관찰되었다. 두표본에서는연속적이지않은경조직이관찰되었고, 한표본에서는연속된상아질교양상을보였다 (Figure 1b). 90 일후에는두표본에서연속된상아질교를관찰할수있었다 (Figure 1c). 2. Clearfil SE Bond 군 7 일표본에서는염증세포의침윤과치수세포의괴사를관찰할수있었다 (Figure 2a). 30 일과 90 일후에는치수세포의괴사가더욱진행한양상을보였다 (Figure 2b, c). 경조직의생성은 90 일경과후한표본에서관찰할수있었다. 3. Ultra-blend 군 7 일경과한군과 30 일경과한군에서는경조직의형성은보이지않았고, 전반적으로중등도의염증반응이관찰되었다. 치수조직의변성과괴사된부분도관찰되었다 (Figure 3a, b). 90 일경과한군에서는염증세포침윤소견을보였고, 두표본에서경조직층의형성이관찰되었고하방에는 odontoblast-like cell 이관찰되었으며, 인접상아질에서는 3 차상아질형성이관찰되었다 (Figure 3c). 4. Dycal 군 7 일경과한군에서는염증세포의침윤과치수세포의괴사소견이관찰되었고경조직의형성은관찰되지않았다. (Figure 4a) 30 일경과한군에서는불규칙하고얇게형성된경조직층이관찰되었으며염증세포의침윤과치수조직의변성을관찰할수있었다 (Figure 4b). 90 일경과한후에는두꺼운경조직층의형성이관찰되었다 (Figure 4c). Table 3. Inflammatory responses and hard tissue formation resulted with 4 pulp capping materials Material Experimental Number of Inflammatory response Hard tissue formation period specimens MTA 7 D D D SE Bond 7 D D D Ultra-Blend 7 D D D Dycal 7 D D D

a b c Figure 1. a. Pulp capping with MTA at 7 days.

Newly formed dentinal bridge was observed. c.

The thickness of hard tissue increased, compared with that

Inflammatory cells infiltrated accompanied by soft tissue

Coronal pulp tissue necrosis beneath the exposure site was

Severe pulp tissue necrosis beneath the exposure site was

Inflammatory cell infiltration and hemorrhage was observed.

Odontoblast-like cells arranged beneath exposure site.

Complete dentinal bridge protected the exposure site.

4 a b c Figure 1. a. Pulp capping with MTA at 7 days. Inflammatory cells infiltrated around the capping material under odontoblastlike cell. b. Pulp capping with MTA at 30 days. Newly formed dentinal bridge was observed. c. Pulp capping with MTA at 90 days. The thickness of hard tissue increased, compared with that of 30 days. a b c Figure 2. a. Pulp capping with SE Bond at 7 days. Inflammatory cells infiltrated accompanied by soft tissue disturbances. b. Pulp capping with SE Bond at 30 days. Coronal pulp tissue necrosis beneath the exposure site was observed. c. Pulp capping with SE Bond at 90 days. Severe pulp tissue necrosis beneath the exposure site was seen. a b c Figure 3. a. Pulp capping with Ultra-blend at 7 days. Inflammatory cell infiltration and hemorrhage was observed. b. Pulp capping with Ultra-blend at 30 days. Odontoblast-like cells arranged beneath exposure site. Pulp degeneration and partial pulp necrosis was seen. There was no hard tissue formation. c. Pulp capping with Ultra-blend at 90 days. Complete dentinal bridge protected the exposure site. a b c Figure 4. a. Pulp capping with Dycal at 7 days. Pulp tissue degeneration was seen. b. Pulp capping with Dycal at 30 days. Partial pulp tissue degeneration and hard tissue formation were observed. c. Pulp capping with Dycal at 90 days. Complete hard tissue formation and normal soft tissue organization beneath the exposure site. 8

5 Ⅳ. 총괄및고찰 치수노출후의치수조직소견의변화에관한 Kakehashi 등의연구를보면무균상태에서기계적으로노출된치수에아무약제도도포하지않았을때염증반응없이상아질형성을보고한바, 치수는적당한환경에서자연치유능력을가지고있다고볼수있다. 18) 이상적인치수복조재료는이런치수의자연치유능력을해치지않으며미세누출이없어치수의무균상태를유지해줄수있는것이라할것이다. 1) 수산화칼슘제재는칼슘이온에의한재석회화기능과상아질교형성, fibroblast를자극하여연조직과경조직의치유유도, 높은염기성으로염증에의한낮은 ph환경을중화시키고우식부의산성도를중화시키는효과, 박테리아살균성과박테리아정균성등의효과로치과치료의여러분야에서사용되어왔다. 2,3,19) 치수노출부위에수산화칼슘을적용하면일반적으로하부의결체조직이재구성되고약재에인접한부위에경조직이침착됨으로써그치유과정이완료된다고보고하고있다. 20,21) 본실험에서도수산화칼슘으로치수복조한후에나타나는일반적인치수조직소견과비슷하게, 초기에는치수노출부에염증세포의침윤이일어나경도에서중등도의염증반응이일어나고치수조직이파괴되었고, 그후이들이치수결체조직으로대체되고재구성되어치수노출부조직의치유와세포증식이관찰되었고, 얇게형성된경조직층이관찰되어초기광물화가시작됨을알수있었다. 시간이지남에따라경조직의침착과두꺼운경조직층의형성을볼수있었다. 치수복조재로중요한역할을하는수산화칼슘의주요성분은칼슘이온이다. 칼슘이온이세포자극, 이주, 증식및분화를유도하고석회화의개시재로작용하여상아질교를형성하여치수를보호한다. 2) 치수와복조재사이에상아질교의형성은, 상아질교가정상상태의상아질을의미하는것도아니고, 결손부를포함하는 tunnel 결함을가지고있어서영구적인봉쇄장벽을의미하는것도아니기때문에 2,3) 논란의여지가있지만, 조직의치유나자극에대한반응으로해석할수있다. 23) 이번실험에서도상아질교의형성을조직의치유와자극에대한긍정적인반응으로평가하였다. 석회화에서칼슘이온의역할을살펴보면, calcium carbonate granulation이 von kossa-positive calcium salt granulation의침착을유도하여조직의치유를촉진하고조상아세포의분화와상아질침착을돕는다. 24) 여기서 calcium carbonate granulation은 Ca 2+ 과CO2와 CO 3- 이결합하여형성된다. 24) Holland 등은이때사용되는칼슘이온은조직에서오는것이아니라수산화칼슘제재에서유리된다고하였다. 24) 이런칼슘이온은 MTA에서도유리된다. MTA의주성분 은 tricalcium silicate, tricalcium aluminate, tricalcium oxide, silicate oxide로생체친화적이고골형성을유도하며, 폐쇄능력이좋고, 습기가있는구강내에서의적용이좋아서치근단역충전, 천공치료, 치근단형성술식등의근관치료분야와치수복조등의보존치료에많이사용되고있다. 12,13) 수산화칼슘은 MTA의구성성분이아니지만, MTA의주성분인 tricalcium oxide는수분을만나면수산화칼슘이되고, 수산화칼슘과같은기전으로경조직을형성한다. 14,15) 많은논문에서직접치수복조제로 MTA를사용했을때좋은결과를보고했고, 수산화칼슘제재와비교해서도염증이적고상아질교형성도좋은것으로보고하였다. 13,14,16) 본실험에서도초기에는치수의위축과부분괴사가관찰되었지만시간이지날수록경조직이침착되어연속된상아질교를관찰할수있었고수산화칼슘제재와비슷한결과를보여주었다. 하지만이런 MTA는경화시간이 2시간이넘어초기경화시간중미세누출의가능성이있고, 혼합후조작이불편하고적용이힘들며, 경화후변색이되고, 가격이고가라는단점이있다. 17) 치수의자연치유능력을보존할수있도록미세누출이없고세균의오염을막아치수의무균상태를유지해줄수있는치아와접착되는치과용복합레진이치수복조재로사용되었지만, 여러연구에서상반된결과를보고하였다. 4,6-11) 접착력이향상된접착성레진은치수에근접한깊은와동에서도치수염증을보이지않고, 변연에서발생하는미세누출만막을수있다면접착성레진을노출된치수의직접치수복조재로사용할수있다고보고한연구도있는반면, 7) 실험동물의종류에따라치수반응이다르고 4) 특히사람의치아에서는레진으로직접치수복조를한경우심한염증소견을보고한연구도있다. 8,9) 조직학적관찰에서세균이관찰되지않아도치수염증의결과를보고한바, 세균의미세누출이레진직접치수복조의실패원인이라는것을반박한논문도발표되었다. 10) 본연구에서는초기염증반응이후후기반응이양호하여레진치수복조를주장하는연구결과 7) 와는다르게, 접착성레진으로직접치수복조한경우, 초기에염증세포의침윤과치수세포의괴사가관찰되었고, 시간이지날수록치수세포의괴사가더욱진행한양상을보여서접착성레진은직접치수복조재로적당하지않다는결과를얻을수있었다. 접착성레진을이용한레진수복이 technique-sensitive하기도하지만, Bis-GMA, HEMA, UDMA, TEGDMA 등레진성분의세포독성, self-etching adhesive의산성, 미중합단량체 10,11) 등이치수염증의원인으로사료된다. 수산화칼슘은변연봉쇄능력이떨어지고, 시간이지남에따라용해되어영구적인봉쇄를얻을수없으며, 용해되어형성된빈공간으로세균이침투할가능성이증가할수있다. 4,5) 또한수산화칼슘에의해생성된상아질교는결손부를 9

6 포함하는 tunnel 결함을가지고있어서세균침투가가능하여영구적인봉쇄장벽의역할을할수는없다. 2-4) 이런수산화칼슘제재의문제점을개선하기위해서레진성분을포함시킨광중합형수산화칼슘제재들이개발되었다. 이러한재료들의주요특징은용해도가낮아서영구적인밀봉이가능하고물성이개선되었으며, 사용이간편하고경화시간을조절할수있다는장점이있다. 5) 광중합형수산화칼슘제재가초기염증반응없이경조직형성을보여수산화칼슘보다도좋은결과를보고한연구결과도있었지만, 25) 본실험에서는초기의염증반응과중기의경조직층의형성을보였으나기존의수산화칼슘에미치지못하는결과를보였다. 광중합형수산화칼슘제재는레진을함유하고있으므로직접치수복조에적용할경우레진성분이치수괴사나상아질교형성에영향을준것으로사료된다. MTA가염증반응이적고경조직형성을보여수산화칼슘보다좋은결과를보이거나수산화칼슘과유사한결과를보인것과비슷하게 13,14,16) 본실험에서는 MTA와수산화칼슘이비슷한결과를보였다. 그러나광중합형수산화칼슘이수산화칼슘보다좋은결과를보인기존의논문 25) 과는다르게광중합형수산화칼슘과수산화칼슘도비슷한결과를가져와결론적으로 MTA, 수산화칼슘, 광중합형수산화칼슘이유사한결과를보여주었다. Anti-oxidant agent, calcium sulfate, growth factors, bone sialoprotein, dentin sialoprotein, and bone morphogenetic protein 등의많은재료들이복조재로적당한지연구되고있지만이전의재료에비하여좋은결과를보이지못하고있고, 26-28) 치수의염증을유발하지않고경조직을형성하고치수의생활력을보존하며임상적으로사용하기편리한직접치수복조재를찾기위하여많은연구가진행되어야할것이다. Ⅴ. 결론 치수가노출된경우 MTA 와수산화칼슘제재, 광중합수산화칼슘제재는초기염증반응이후조상아세포층, 경조직형성을보여직접치수복조재로적당하였으며, 접착성레진은심한염증반응과치수조직의괴사양상을보여직접치수복조재로적당하지않다는결론을얻을수있었다. 참고문헌 1. Tziafas D, Smith AJ, Lesot H. Designing new treatment strategies in vital pulp therapy. J Dent 28:77-92, Farhad A, Esfahan ZM. Calcium hydroxide: a review. Int dent J 55: , Cox CF. Re-evaluating pulp protection: calcium hydroxide liners vs cohesive hybridization. J Am Dent Assoc 125: , Cox CF, Bergenholtz G, Heys DR, Syed SA, Fitzgerald M, Heys RJ. Pulp-capping of the dental pulp mechanically exposed to oral microflora: a 1-2 year observation of wound healing in the monkey. J Oral Pathol 14: , Lee TH. The physical properties of light-activated pulp capping material, substituted for Ca(OH)2 pastes. : Seoul National Univ.; Brännström M, Nyborg H. Pulpal reaction to composite resin restorations. J Prosth Dent 27: , Stanley HR, Bowen RL, Cobb EN. Pulp responses to a dentin and enamel adhesive bonding procedure. Oper Dent 13: , Hebling J, Giro EMA, Costa CAS. Biocompatibility of an adhesive system applied to exposed human dental pulp. J endod 25: , Costa CAS, Nascimento ABL, Teixeira HM, Fontana UF. Response of human pulps capped with a self-etching adhesive system. Dent Mater 17: , Koliniotou-Koumpia E, Tziafas D. Pulpal responses following direct pulp capping of healthy dog teeth with dentine adhesive systems. J Dent 33: , Stanley HR, Swerdlow H, Buonocore MG. Pulp reactions to anterior restorative material. J Am Dent Assoc 75: , Torabinejad M, Pitt Ford TR. Root-end filling materials : a review. Endod Dent Traumatol 12: , Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP. Using mineral trioxide aggregate as a pulp-capping material. J Am Dent Assoc 127: , Faraco IM Jr, Holland R. Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. Dent Traumatol 17: , Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF, Dezan Jr E. Reaction of rat connective tissue to implanted dentin tubules filled with mineral trioxide aggregate or calcium hydroxide. J Endod 25: , Asgary S, Mohammad JE, Masoud P, Farzin G, Hessam R. A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108: , Torabinejad M, Hong CU, MacDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 21: , Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 20: , Rehman K, Saunders WP, Foye RH, Sharkey SW. Calcium ion diffusion from calcium hydroxide-containing materials in endodontically-treated teeth ; an in vitro study. Int Endod J 29: , Hayashi Y. Ultrastructure of initial calcification in wound healing following pulpotomy. J Oral Pathol 11; , Yamamura T. Differentiation of pulpal cells and inductive influences of various matrices with reference to pulpal wound healing. J Dent Res 64; , Goldberg F, Massone EJ, Spielberg C. Evaluation of the dentinal bridge after pulpotomy and calcium 10

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8 국문초록 배지현 1 김영균 2 윤필영 2 조병훈 3 최용훈 1 * 분당서울대학교병원 1 치과보존과, 2 구강악안면외과, 3 서울대학교치과대학치과보존학교실 본연구에서는인위적으로노출시킨비글견의치수조직을기존의수산화칼슘제재와 MTA, 접착성레진, 광중합형수산화칼슘제재를사용하여직접치수복조한후각재료에따른치수의반응을광학현미경하에서조직학적으로관찰하여비교분석하였다. 2 마리비글견의 36 개치아를이용하여, 실험적으로치수를노출시키고노출된치수에치수복조재를적용한후와동은복합레진으로충전하여직접치수복조술을시행하였다 : (1) Mineral Trioxide Aggregate (MTA: ProRoot MTA, Dentsply, Tulsa, USA), (2) Clearfil SE Bond (Dentin adhesive system: Kuraray, Osaka, Japan), (3) Ultra-Blend (Photopolymerized Calcium hydroxide: Ultradent, South Jordan, USA), (4) Dycal (Quick setting Calcium hydroxide: LD Caulk Co., Milford, USA). 희생전 90 일, 30 일, 7 일전에각복조재별로 3 개씩의와동을충전하였고비글견을희생시키고조직시편을제작하였다. 시편을 H&E 염색후광학현미경으로치수염증반응과경조직형성정도를관찰하였다. MTA 군은초기에는경조직형성이관찰되지않고치수조직의위축과부분괴사가관찰되었으나시간이지나면서경조직형성이관찰되었다. Clearfil SE Bond 군은초기에염증세포의침윤과치수세포의괴사를관찰할수있었고시간이지날수록치수세포의괴사가더욱진행한양상을보였다. Ultra-blend 군과 Dycal 군은 MTA 군과비슷하게초기에는경조직형성을보이지않고중등도의염증반응이관찰되었으며시간이지나면서경조직형성이관찰되었다. MTA, 수산화칼슘제재와광중합수산화칼슘제재는초기의치수염증반응이후조상아세포층, 상아질교형성을보여직접치수복조재로적당하였으며, 접착성레진은심한염증반응과치수조직의괴사양상을보여직접치수복조재로부적당하다는결론을얻을수있었다. 주요단어 : 직접치수복조, 치수염증, 상아질교, 조직학적평가, 비글견 12

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