대한치과보존학회지 : Vol. 33, No. 2, 2008 근관세척법이 Resilon/Epiphany sealer와 Gutta-percha/AH 26 sealer의근관상아질과의접착에미치는영향 김서경 황윤찬 황인남 오원만 * 전남대학교치의학전문대학원보존학교실, 치의학연구

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1 근관세척법이 Resilon/Epiphany sealer와 Gutta-percha/AH 26 sealer의근관상아질과의접착에미치는영향 김서경 황윤찬 황인남 오원만 * 전남대학교치의학전문대학원보존학교실, 치의학연구소, BK21 ABSTRACT EFFECT OF IRRIGATION METHODS ON THE ADHESION OF RESILON/EPIPHANY SEALER AND GUTTA-PERCHA/AH 26 SEALER TO INTRACANAL DENTIN Seo-Kyong Kim, Yun-Chan Hwang, In-Nam Hwang, Won-Mann Oh* Department of Conservative Dentistry, School of Dentistry, DSRI, Chonnam National University, BK21 The purpose of this study was to evaluate whether intracanal irrigation method could affect the adhesion between intracanal dentin and root canal filling materials (Gutta-percha/AH 26 sealer and Resilon/Epiphany sealer). Thirty extracted human incisor teeth were prepared. Canals were irrigated with three different irrigation methods as a final rinse and obturated with two different canal filling materials (G groups : Gutta-percha/AH 26 sealer, R groups : Resilon/Epiphany sealer) respectively. Group G1, R1 - irrigated with 5.25% NaOCl Group G2, R2 - irrigated with 5.25% NaOCl, sterile saline Group G3, R3 - irrigated with 5.25% NaOCl, 17% EDTA, sterile saline Thirty obturated roots were horizontally sliced and push-out bond strength test was performed in the universal testing machine. After test, the failure patterns of the specimens were observed using Image-analyzing microscope. The results were as follows. 1. Gutta-percha/AH 26 sealer groups had significantly higher push-out bond strength compared with the Resilon/Epiphany sealer groups (p < 0.05). 2. Push-out bond strength was higher when using 17% EDTA followed by sterile saline than using NaOCl as a final irrigation solution in the Resilon/Epiphany sealer groups (p < 0.05). 3. In the failure pattern analysis, there was no cohesive failure in Group G1, G2, and R1. Guttapercha/AH 26 sealer groups appeared to exhibit predominantly adhesive and mixed failure patterns, whereas Resilon/Epiphany sealer groups exhibited mixed failures with the cohesive failure occurred within the Resilon substrate. [J Kor Acad Cons Dent 33(2):98-106, 2008] Key words: Push-out bond strength, Gutta-percha/AH 26 sealer, Resilon/Epiphany sealer, Obturation materials, Irrigation methods * Corresponding Author: Won-Mann Oh Department of Conservative Dentistry, School of Dentistry, Chonnam National University 8 Hak-dong, Dong-gu, Gwangju, , Korea Tel: Fax: wmoh@chonnam.ac.kr - Received , revised , accepted

2 Ⅰ. 서론 성공적인근관치료를위해적절한근관충전은매우중요하며, 거타퍼차 (gutta-percha) 와근관 sealer 가근관충전에함께사용되고있다. Grossman 등 1) 은이상적인근관 sealer 의특성으로서경화시근관벽과충전재사이에적절한접착을형성해야한다고했다. Tagger 등 2) 은근관 sealer 의기본적인요구조건으로서경화시근관벽과의좋은접착을이루기위해혼합시끈적끈적해야한다고보고하였다. 근관벽과근관충전재와의접착이잘되면첫째근관벽과충전재사이에액체가침투 (percolation) 할공간이적어지고 3), 둘째는포스트식립시근단부충전재의탈락을방지할수있다 2). 근관충전시근관밀폐유지의관점에서볼때근관충전재의근관상아질에대한결합력 (bonding strength) 이매우중요하다. 그러나지금까지근관충전재로사용되어온 gutta-percha 는밀폐효과가충분하지않다고보고되고있다 4). 최근새로운 Resilon system 의개발이보고되었는데 5), 이는폴리에스터레진계열충전재 (polyester resinbased filling material) 인 Resilon 과자가산부식프라이머 (self-etching primer) 그리고메타크릴레이트계열의레진 sealer (methacrylate-based resin sealer) 인 Epiphany sealer 로구성되어있다. Shipper 등 5) 은 Resilon system 으로충전시상아질 - 충전재질경계에서의무간극결합을보고했고, Tay 등 6) 은 SEM 연구를통해 Resilon 과 Epiphany sealer 간의훌륭한적합상태를보고하였다. Resilon/Epiphany sealer 충전시우수한밀폐효과를얻을수있고, 치질을강화시킬수있다고한다 7). 근관내상아질면의도말층제거여부와근관세척법에따른근관충전재의상아질결합력에대한평가가비교적많이보고되어있으나최신재료인 Resilon system 에대한연구는많지않다. 따라서본실험에서는기존의근관충전재인 Gutta-percha/AH 26 sealer 와새로운충전재인 Resilon/Epiphany sealer 로근관충전시근관세척법이접착력에미치는영향을비교관찰하여이를바탕으로실제임상에서최신재료인 Resilon/Epiphany sealer 로충전시가장적절한근관세척법에대한올바른지침을제공하고자한다. 1. 실험재료 Ⅱ. 실험재료및방법 수에보관하였다. 근관충전재로 DiaDent gutta-percha point (DiaDent Group International Inc., Chongju, Korea) 와레진 sealer인 AH 26 root canal sealer (DeTrey/Dentsply, Konstanz, Germany), 그리고새로운레진계열충전재인 Resilon (Epiphany point, Pentron Clinical Technologies, Wallingford, USA) 과메타크릴레이트계열의레진 sealer인 Epiphany Root Canal Sealer와 Primer (Pentron Clinical Technologies, Wallingford, USA) 를사용하였다. 2. 실험방법 1) 근관형성과충전 #10 K-파일을근관내에삽입하여치근단공을통과시켜근첨개방을확인하고치아길이를측정한후, 작업장길이를 0.5 mm짧게정하였다. Gate-Glidden drill (#1, #2, #3, MANI Inc., Tochigi-Ken, Japan) 로치관부 1/3 부위를성형하고 Protaper Universal (Dentsply-Maillefer, Ballaigues, Switzerland) 파일을사용하여제조회사의지시에따라크라운다운법으로근관성형을시행하였다. #5 Finishing File로근첨을형성하였다. 근관성형매단계마다 21 gauge의 Syringe를이용하여 5 ml의 5.25% NaOCl로근관을세척하였고, RC-prep TM (Premier Dental Preducts, Norristown, PA, USA) 을이용하여근관을윤활하였다. 최종세척법은아래와같이충전재료별각각 3 군으로분류하여시행하였다 (Table 1). 5.25% NaOCl 세척시에는 21 gauge needle로 5 ml를근관내에삽입하여세척후 1분간적용하였고, sterile saline은 5 ml를세척후 1분간적용하였으며, 17% EDTA (Pulpdent, Pulpdent Corporation, Watertown, MA, USA) 는 2 ml를세척후 1분간적용시켰다. Paper point로근관을건조시킨후각각 Gutta-percha point와 AH 26 sealer, 그리고 Resilon point와 Epiphany sealer로 System B Heat Source (Analytic Technology, SanDiego, CA, USA) 와 Obtura Ⅱ (Obtura/Spartan, Fenton, MO, USA) 을이용하여 continuous wave of condensation technique으로근관충전하였다. Resilon/Epiphany sealer 충전후에는완전한밀폐를위해치관부를 40초동안광중합 (Optilux 501, Demetron/Kerr, Danbury, CT, USA) 하였다. 각각의치아는 sealer 경화를위해치근부위만생리식염수를적신거즈에싸서실온에서 48시간동안보관하였다. 최근에발거된치아중에서균열, 개방된근첨, 흡수성병소, 큰우식병소등이없는건전한상악전치 30 개를사용하였다. 치근표면의잔사제거후사용할때까지생리식염 2) 시편제작각각의충전된치아를아크릴릭레진에매몰하여, 주수하에 130 rpm 의속도로 Low-speed diamond saw (TOP- 99

Table 1. Group classification Group No. of Tooth Obturation system Irrigation method (Final rinse) G1 5 5.25% NaOCl G2 5 Gutta-percha/ 5.25% NaOCl and then sterile saline G3 5 AH 26 sealer 5.

3 Table 1. Group classification Group No. of Tooth Obturation system Irrigation method (Final rinse) G % NaOCl G2 5 Gutta-percha/ 5.25% NaOCl and then sterile saline G3 5 AH 26 sealer 5.25% NaOCl, 17% EDTA (1 min) and then sterile saline R % NaOCl R2 5 Resilon/ 5.25% NaOCl and then sterile saline R3 5 Epiphany sealer 5.25% NaOCl, 17% EDTA (1 min) and then sterile saline MET METSAW MSH , R&B INC., Daejon, Korea) 를이용하여약 1 mm두께로치아의장축에수직으로절단하였다. 각각의시편을 reflected light microscope 상에서관찰하고, 충전부위의양쪽직경과높이를 digital caliper (No. 99MAD014M, Mitutoyo, Kawasaki, Japan) 로측정하였다. 측정된직경중작은값이 0.8 mm와 1.5 mm사이, 즉치근의중간부 1/3 에해당하는시편만실험에이용되었고한치아당대략 4-5 개의시편이사용되었다. 3) Push-out bond strength 측정 Push-out bond strength 측정을위해 10 kg (load cell) 하중하에 1 mm /sec 의 crosshead 속도로만능물성시험기 (US/STM-5, United Calibrator, Huntington Beach, CA, USA) 를사용하였다. 절단된시편의치근단부쪽이 0.5 mm직경의 stainless steel punch 가닿도록놓았으며 (Figure 1), 근관충전재의돌출이나 load/time curve 상에서 load 의갑작스런감소로나타내어지는최대힘 (N) 을측정하였다. 각시편의직경 (R, r) 과높이 (h) 로충전부위의표면적 ( mm 2, 식 1) 을구한뒤각각의측정된힘 (N) 을나눔으로써 debond stress ( 식 2) 를구하였다. Surface area ( mm 2 ) = {(R + r ) / 2} * π * h - 식 1 Debond stress ( MPa ) = Debonding force (N) / Area ( mm 2 ) - 식 2 4) 파절양상의분류 800 배율의 Image-analyzing microscope (Camcope, Sometech INC., Seoul, Korea) 으로각시편의파절된계면을관찰하여 sealer 와상아질의계면에서일어난파괴를접착성 I (adhesive type I), sealer 와충전재 (Guttapercha, Resilon) 의계면에서일어난파괴를접착성 II (adhesive type II), 각계면과충전재에서일어난파괴가혼합되어일어난파괴를혼합성 (mixed), 충전재자체에서만일어난파괴를응집성 (cohesive) 파절양상으로분류하여기록하였다. Direction of cross-head 5) 통계분석개별실험군의평균값과표준편차를구한뒤근관충전재와근관세척법간의유의성을비교하기위해이원분산분석을시행하였고, Scheffe test 를이용하여사후검정하였다 (p < 0.05). Ⅲ. 실험결과 1. Push-out bond strength Punch Endodontic obturation Tooth specimen Epoxide resin Void for debonded obturation Figure 1. Diagram for the push-out bond strength test 7). 각군의측정된 push-out bond strength 는다음과같다 (Table 2, Figure 2 및 3). Push-out bond strength 의근관충전재별, 근관세척법별비교를위하여이원분산분석을실시한결과, 근관충전재에대한주효과 [p = < 0.05] 와근관세척법에대한주효과 [p = < 0.05] 가나타났으며, 근관충전재와근관세척법에대한상호작용 [p = > 0.05] 이나타났다. 100

Table 2. Push-out bond strength for each group (Mean ± S.D. ( MPa )) Group Obturation system Push-out bond strength (Mean ± S.D. ( MPa )) G1 3.21 ± 0.92 G2 Gutta-percha/AH 26 sealer 3.13 ± 0.92 G3 3.

05) Figure 3. Comparison of push-out bond strength for same irrigation methods. * statistically significant (p < 0.05). 즉, Gutta-percha/AH 26 sealer 충전군이 Resilon/ Epiphany sealer 충전군보다통계적으로유의하게높은 push-out bond strength 를나타내며, 17% EDTA, sterile saline 순으로근관세척시 5.

4 Table 2. Push-out bond strength for each group (Mean ± S.D. ( MPa )) Group Obturation system Push-out bond strength (Mean ± S.D. ( MPa )) G ± 0.92 G2 Gutta-percha/AH 26 sealer 3.13 ± 0.92 G ± 1.2 R ± 0.71 R2 Resilon/Epiphany sealer 2.61 ± 0.83 R ± 1.09 Figure 2. Comparison of push-out bond strength for same obturation systems. * statistically significant (p < 0.05) Figure 3. Comparison of push-out bond strength for same irrigation methods. * statistically significant (p < 0.05). 즉, Gutta-percha/AH 26 sealer 충전군이 Resilon/ Epiphany sealer 충전군보다통계적으로유의하게높은 push-out bond strength 를나타내며, 17% EDTA, sterile saline 순으로근관세척시 5.25% NaOCl 세척에비해 push-out bond strength 가증가하지만, 접착력은근관세척법보다는근관충전재의영향을더많이받는다고할수있다 (p < 0.05). Gutta-percha/AH 26 sealer 충전군에서는 17% EDTA, sterile saline 순으로세척한 G3 군이 3.38 ± 1.2 MPa로가장높은결합강도를나타내었으나, G1, G2, G3 군사이에통계적으로유의한차이를나타내지않았다. Resilon/Epiphany sealer 충전군중 17% EDTA, sterile saline 순으로세척한 R3 군은 3.31 ± 1.09 MPa로 R1 군에비해통계적으로유의하게높은값을나타내었다 (Table 2, Figure 2, p < 0.05). 2. 파절양상의결과 Gutta-percha/AH 26 sealer 충전군의경우, G1 군에서는접착성파절양상이 76.5%, 혼합성이 23.5% 로관찰되었고, G2 군에서는접착성 61.5%, 혼합성 38.5% 을, G3 군에서는접착성 61.9%, 응집성 4.8% 및혼합성 33.3% 가관찰되었다. 응집성파절양상은 G1 군과 G2 군에서는관찰되지않았고, 오직 G3 군의 1 개의시편에서만관찰되었다. Resilon/Epiphany sealer 충전군의경우, R1 군에서접착성파절양상이 81.8%, 혼합성이 18.2% 관찰되었고, R2 군에서는접착성 31.3%, 응집성 31.3%, 혼합성 37.5% 을, R3 군에서는접착성 47.6%, 응집성 42.9%, 혼합성 9.5% 가관찰되었다. R1 군에서는응집성파절양상이관찰되지않았고, R2 및 R3 군에서만각각 5 개및 9 개의시편에서관찰되었다 (Table 3). 101

Table 3. Failure pattern analysis Failure mode No.

58.80% 17.60% 23.50% G2 percha/ 7 1 0 5 4 / 17 (23.5%) AH 26 53.80% 7.70% 38.50% G3 sealer 8 5 1 7 2 / 23 (8.7%) 38.10% 23.80% 4.80% 33.

50% R3 8 2 9 2 1 / 22 (4.5%) 38.10% 9.50% 42.90% 9.50% A B C Figure 4. Failure patterns in Gutta-percha/AH 26 sealer groups. A. Type I adhesive failure between the AH 26 sealer and dentin ( 800) B.

5 Table 3. Failure pattern analysis Failure mode No. of Group Obturation premature system Adhesive Adhesive Cohesive Mixed failure type I type II (specimens, %) G / 25 (32%) Gutta % 17.60% 23.50% G2 percha/ / 17 (23.5%) AH % 7.70% 38.50% G3 sealer / 23 (8.7%) 38.10% 23.80% 4.80% 33.30% R / 18 (38%) Resilon/ 63.60% 18.20% 18.20% R2 Epiphany / 18 (11.1%) sealer 18.80% 12.50% 31.30% 37.50% R / 22 (4.5%) 38.10% 9.50% 42.90% 9.50% A B C Figure 4. Failure patterns in Gutta-percha/AH 26 sealer groups. A. Type I adhesive failure between the AH 26 sealer and dentin ( 800) B. Type II adhesive failure between the Gutta-percha and AH 26 sealer ( 800) C. Cohesive failure within the Gutta-percha ( 800) Abbreviation. G : Gutta-percha, S : AH 26 sealer, D : dentin 102

A B C D Figure 5. Failure patterns in Resilon/Epiphany sealer groups. A. Type I adhesive failure between the Epiphany sealer and dentin ( 800) B.

Cohesive failure within the Resilon representing monoblock concept ( 800) Abbreviation.

14 개시편에서관찰되어현저한차이를나타내었다. Gutta-percha/AH 26 sealer 충전군의응집성파절양상은 Guttapercha 자체내부가파열되어금이가는양상이지만, Resilon/Epiphany sealer 충전군의경우상아질과의계면을따라얇게뜯겨지는소견이특징적이었다 (Figure 4, 5).

Branstetter 와 von Fraunhofer 10) 는근관 sealer 의접착력이항상중요한특성은아니더라도적절한접착력은치아를강화시킬뿐아니라, 포스트삽입시 guttapercha 가탈락되는것을효과적으로막는장점이있다고보고했다.

6 A B C D Figure 5. Failure patterns in Resilon/Epiphany sealer groups. A. Type I adhesive failure between the Epiphany sealer and dentin ( 800) B. Type II adhesive failure between the Resilon and Epiphany sealer ( 800) C. Cohesive failure within the Resilon ( 800) D. Cohesive failure within the Resilon representing monoblock concept ( 800) Abbreviation. R : Resilon, S : Epiphany sealer, D : dentin Gutta-percha/AH 26 sealer 충전군의경우대부분접착성과혼합성파절양상을보이고응집성파절양상이 51 개시편중 1 개시편에서만관찰된반면에 Resilon/ Epiphany sealer 충전군의경우 48 개시편중 14 개시편에서관찰되어현저한차이를나타내었다. Gutta-percha/AH 26 sealer 충전군의응집성파절양상은 Guttapercha 자체내부가파열되어금이가는양상이지만, Resilon/Epiphany sealer 충전군의경우상아질과의계면을따라얇게뜯겨지는소견이특징적이었다 (Figure 4, 5). Ⅳ. 총괄및고찰 근관 sealer 는근관충전재와근관벽사이의작은틈과불규칙한벽을채우고, 근관벽이나상아세관에잔존하는미생물의성장을조절하며, 가압충전시충전재가잘들어갈수있도록하는윤활제역할을한다 8). 이상적인근관 sealer 의 요구조건중의하나로근관충전재와치질과의접착성을들수있다 9). Branstetter 와 von Fraunhofer 10) 는근관 sealer 의접착력이항상중요한특성은아니더라도적절한접착력은치아를강화시킬뿐아니라, 포스트삽입시 guttapercha 가탈락되는것을효과적으로막는장점이있다고보고했다. 또한 Zmener 등 11) 은미세누출은대부분근관 sealer 와근관벽사이에서발생하기때문에근관 sealer 와근관벽과의접착은매우중요하다고했다. 접착력검사에서접착력이크게나타나더라도근관 sealer 가근관벽전체를밀폐시키지않을수있기때문에미세누출검사에서미세누출이높게측정될수있다 12). 그러나근관 sealer 가전근관벽을통해근관충전재와근관벽에강한접착을보이는경우미세누출을줄일수있다고사료된다. 최근열가소성 polycaprolacton-based filling material 인 Resilon, 자가산부식프라이머인 Epiphany primer 그리고이원중합이가능한레진 sealer 인 Epiphany sealar 로구성된새로운근관충전시스템인 Resilon system 이 103

7 시판되고있다. 이는상아질접착제 (dentin adhesive) 및접착강화제 (dentin primer) 의접착성질을근관충전에이용하려는시도로개발되었으며 5,13), 근관내상아질과 monoblock 을형성해미세누출을감소시키고치아의파절강도를증가시킨다고보고되었다 5,13). 반면이에반하는실험결과도있으며 14), 특히 Tay 등 15) 은 Resilon 이알카리환경하에서 gutta-percha 에비해가수분해가크게일어나생분해 (biodegradation) 현상이나타날수있다고했다. 본연구에서는기존의 Gutta-percha/AH 26 sealer 와새로운충전시스템인 Resilon system 의근관세척법에따른근관내접착력을비교해보고자 push-out bond strength 를측정하였다. Resilon system 제조회사에서근관성형시접착력의저하를이유로 NaOCl 을최종세척액으로사용하지말것을권고하고있다. Nikaido 등 16) 은 5% NaOCl 을근관세척액으로사용시 NaOCl 이염화나트륨과산소로분해되고이산소가레진의중합을방해한다고보고한바있다. 본실험결과 5.25% NaOCl 을최종세척액으로사용한 R1 군에서 5.25% NaOCl 사용후, sterile saline 으로세척한 R2 군보다평균적으로더낮은값을나타내었으나통계적으로유의한차이를보이지는않아 5.25% NaOCl 사용유무가 Resilon/Epiphany sealer 접착력에크게영향을주는것같지는않다. 근관충전재간비교시세가지근관세척법모두에서 Gutta-percha/AH 26 sealer 충전군의 push-out bond strength 가 Resilon/Epiphany sealer 충전군보다높으며, 접착력이근관세척법보다는근관충전재의영향을더많이받는것으로나타났다 (p < 0.05). 즉, 새로운근관충전시스템인 Resilon/Epiphany sealer 가 Gurtta-percha/AH 26 sealer 에비해근관상아질에더낮은접착력을나타내며이는다른연구결과등 17,18) 과유사하다. Gesi 등 14) 은낮은접착력의한원인으로 Resilon 내의디메타크릴레이트 (dimethacrylate) 의낮은농도와자유유리기 (free radical) 의부족 19) 을언급한바있고, Skidmore 등 20) 은 Resilon/Epiphany sealer 로근관충전후치관부를 40 초간광중합함으로써급격한중합수축이발생할수있다고보고하였다. 레진의광중합은레진흐름에의한스트레스완충효과를억제하여급격한중합수축을일으키고 21-23), 이는근관상아질에대한레진계열의근관 sealer 의탈락을야기할것으로여겨진다. 또한 Tay 등 6) 은근관충전시중합이완료되지않은 Epiphany sealer 를응축하는과정이 Epiphany primer 와근관상아질과의결합을방해한다고언급하였다. 이러한이유로근관상아질에대한 Epiphany sealer 의완벽한접착은달성하기힘들것으로사료된다. 동일한근관충전재상비교시 Gutta-percha/AH 26 sealer 충전군에서 17% EDTA 로세척한 G3 군이통계적으로유의성은없었지만, 수치상으로는가장높은접착력을 나타내었다. Resilon/Epiphany sealer 충전군에서는 17% EDTA 로세척한 R3 군이 R1 군에비해통계적으로유의하게높은값을보였다 (p < 0.05). Goldman 등 24) 과 Baumgartner 와 Mader 25) 는 NaOCl 과 EDTA 를병용해서사용했을때도말층제거에가장효과적이며, 이는 NaOCl 에의한유기물질의제거와 EDTA 에의한무기물질의탈회작용에의해관주와관간상아질부위까지점진적인상아질의용해를야기하여상아세관입구의직경을 2.5 ~ 4 μm까지확대시키기때문이라고보고했다. 또한 17% EDTA 가근관상아질처리에이용되어도말층이제거될때 Epiphany sealer 가근관상아질과긴밀한접착을형성한다고한다 5). 이는새로운근관충전재인 Resilon/Epiphany sealer 를사용시에는근관세척액으로 17% EDTA 를사용하는것이바람직함을시사한다. 본연구의파절양상관찰시 Gutta-percha/AH 26 sealer 충전군에서 G1 군과 G2 군은접착성파절양상이혼합성파절양상보다우세한, 그중에서도 type I 이 type II 보다우세하게나타나는파절양상을보였다. G3 군에서 G1, G2 군에서는관찰되지않았던응집성파절양상이나타났고, 혼합성파절양상이증가되었다. 즉, AH 26 sealer 는상아질보다 Gutta-percha 에대한접착력이더크며 17% EDTA 처리시근관상아질에대한 AH 26 sealer 의접착력이증가할것으로사료된다. 반면 Resilon/Epiphany sealer 충전군에서는응집성과혼합성파절양상이훨씬우세한특징을보였다. R1 군의경우 G1 및 G2 군과유사한파절양상을나타내며 R2 및 R3 군의경우접착성파절양상에비해응집성과혼합성파절양상이높게나타났다. 응집성파절양상은 Gutta-percha 처럼내부가갈라지는형태가아니라, 상아질과의접착계면을따라 Resilon 이얇게찢겨지는형태가특징적이었다. Resilon/Epiphany sealer 제조회사에의하면메타크릴레이트계열의레진 sealer 인 Epiphany sealer 가디메타크릴레이트를통해폴리에스터레진계열충전재인 Resilon 과결합할수있다고한다. 즉이는 Resilon 과 Epiphany sealer 사이의상대적으로높은접착력에의해 Resilon 자체가찢겨나가게된것으로여겨진다. Resilon/Epiphany sealer 충전시 EDTA 로도말층을제거한경우더양호한접착력을보임을통해, 근관치료시충전직전에 17% EDTA, sterile saline 으로근관세척함으로더우수한근관밀폐효과를기대할수있을것이다. Resilon/Epiphany sealer 가 Gutta-percha/AH 26 sealer 보다근관상아질에낮은접착력을나타내는본결과를토대로, 근관상아질에대한결합력을증가시키기위한 Epiphany sealer 의적절한사용법의개발및물리적성질개선과함께미세누출을줄일수있는방안에대한연구가필요하리라사료된다. 104

8 Ⅴ. 결론 본연구에서는 Gutta-percha/AH 26 sealer 과 Resilon/Epiphany sealer 의두가지근관충전법에서세가지근관세척법사용시 push-out bond strength 를측정, 비교후파절양상을관찰하여다음의결과를얻었다. 1. Gutta-percha/AH 26 sealer 충전군에서 Resilon/ Epiphany sealer 충전군보다 push-out bond strength 가높게나타났다 (p < 0.05). 2. Resilon/Epiphany sealer 충전군중 17% EDTA, sterile saline 순으로세척시 5.25% NaOCl 세척에비해 push-out bond strength 가높게나타났다 (p < 0.05). 3. 파절양상을분석시모든군은접착성과혼합성파절양상을나타내었고, G1, G2, R1 군은응집성파절양상이나타나지않았으며, Resilon/Epiphany sealer 충전군은 Gutta-percha/AH 26 sealer 충전군에비해응집성과혼합성파절양상이더높은비율로나타났다. 이상의결과는새로운근관충전시스템인 Resilon/ Epiphany sealer 가기존의 Gutta-percha/AH 26 sealer 보다더낮은접착력을나타내며 Resilon/Epiphany sealer 로근관충전시에는근관세척액으로 5.25% NaOCl 사용후 17% EDTA, sterile saline 순으로최종세척해야함을시사한다. 참고문헌 1. Grossman LI, Oliet S, Del Rio CE. Endodontic Practice, 11th edn, p255. Lea & Febiger, Philadelphia. 2. Tagger M, Tagger E, Tjan AH, Bakland LK. Measurement of adhesion of endodontic sealers to dentin. J Endod 28: , O/rstavik D, Eriksen HM, Beyer-olsen EM. Adhesive properties and leakage of root canal sealers in vitro. Int Endod J 16:59-63, Torabinejad M, Ung B, Kettering JD. In vitro bacterial penetration of coronally unsealed endodontically treated teeth. J Endod 16: , Shipper G, O/rstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 30: , Tay FR, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH, Mak YF, Lai CS, Raina R, Williams MC. Ultrastructural evaluation of the apical seal in roots filled with a polycaprolactone-based root canal filling material. J Endod 31: , Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture Resistance of endodontically treated roots using a new type of resin filling material. J Am Dent Assoc 135: , Sly MM, Moore BK, Platt JA, Brown CE. Push-out Bond Strength of a New Endodontic Obturation System (Resilon/Epiphany). J Endod 33: , Johnson WT, Gutmann JL. Obturation of the cleaned and shaped root canal system. In: Cohen S, Hagreaves KM. Pathways of the pulp. 7th ed. Mosby, St Louis, p , Branstetter J, von Fraunhofer JA. The physical properties and sealing action of endodontic sealer cements : a review. J Endod 8: , Zmener O, Spielberg C, Lamberghini F, Rucci M. Sealing properties of a new epoxy resin-based rootcanal sealer. Int Endod J 30: , Wennber A, O/ rstavik D. Adhesion of root canal sealers to bovine dentine and gutta-percha. Int Endod J 23:13-19, Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture resistance of roots endodontically treated with a new resin filling material. J Am Dent Assoc 135: , Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay FR, Ferrari M. Interfacial strength of Resilon and guttapercha to intraradicular dentin. J Endod 31: , Tay FR, Pashley DH, Williams MC, Raina R, Loushine RJ, Weller RN, Kimbrough WF, King NM. Susceptibility of a polycaprolactone-based root canal filling material to degradation. I. Alkaline hydrolysis. J Endod 31: , Nikaido T, Takano Y, Sasafuchi Y, Burrow MF, Tagami J. Bond strengths to endodontically-treated teeth. Am J Dent 12: , Ungor M, Onay EO, Orucoglu H. Push-out bond strengths: the Epiphany-Resilon endodontic obturation system compared with different pairings of Epiphany, Resilon, AH Plus and gutta-percha. Int Endod J 39: , Sagsen B, Er O, Kahraman Y, Akdogan G. Resistance to fracture of roots filled with three different techniques. Int Endod J 40:31-35, Burtscher P. Stability of radicals in cured composite materials. Dent Mater 9:218-21, Skidmore LJ, Berzins DW, Bahcall JK. An in vitro comparison of the intraradicular dentin bond strength of Resilon and gutta-percha. J Endod 32: , Bouillaguet S, Troesch S, Wataha JC, Krejci I, Meyer JM, Pashley DH. Microtensile bond strength between adhesive cements and root canal dentin. Dent Mater 19: , Ferracane JL. Developing a more complete understanding of stresses produced in dental composites during polymerization. Dent Mater 21:36-42, Alster D, Feilzer AJ, de Gee AJ, Davidson CL. Polymerization contraction stress in thin resin composite layers as a function of layer thickness. Dent Mater 13: , Goldman M, Goldman LB, Cavaleri R, Bogis J, Lin PS. The efficacy of several endodontic irrigating solutions : a scanning electron microscopic study. part 2. J Endod 8: , Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of four root canal irrigation regimens. J Endod 13: ,

9 국문초록 김서경 황윤찬 황인남 오원만 * 전남대학교치의학전문대학원보존학교실, 치의학연구소, BK21 본연구에서는근관세척법이두가지근관충전재 (Gutta-percha/AH 26 sealer, Resilon/Epiphany sealer) 의근관상아질과의접착에미치는영향을평가하였다. 총 30 개의발거된상악전치를각각 5 개씩 6 개의군으로분류하여근관성형을하고마지막세척을다음과같이시행한후 G1, G2, G3 군은 Gutta-percha/AH 26 sealer 로, R1, R2, R3 군은 Resilon/Epiphany sealer 로근관충전하였다. G1, R1 군 : 5.25% NaOCl 세척 G2, R2 군 : 5.25% NaOCl 세척후 sterile saline 세척 G3, R3 군 : 5.25% NaOCl 세척후 17% EDTA, sterile saline 순으로세척각군의충전된치아를아크릴레진에매몰하고약 1 mm두께로절단한후만능물성시험기상에서 push-out bond strength 를측정하였고실험후파절양상을 Image-analyzing microscope 으로관찰하여다음과같은결과를얻었다. 1. Gutta-percha/AH 26 sealer 충전군에서 Resilon/Epiphany sealer 충전군보다 push-out bond strength 가높게나타났다 (p < 0.05). 2. Resilon/Epiphany sealer 충전군중 17% EDTA, sterile saline 순으로세척시 5.25% NaOCl 세척에비해 push-out bond strength 가높게나타났다 (p < 0.05). 3. 파절양상을분석시모든군은접착성과혼합성파절양상을나타내었고, G1, G2, R1 군은응집성파절양상이나타나지않았으며, Resilon/Epiphany sealer 충전군은 Gutta-percha/AH 26 sealer 충전군에비해응집성과혼합성파절양상이더높은비율로나타났다. 주요어 : Push-out bond strength, Gutta-percha/AH 26 sealer, Resilon/Epiphany sealer, 근관충전재, 근관세척법 106

대한치과보존학회지 : Vol. 32, No. 6, 2007 isthmus, apical delta 등근관계의복잡한구조때문에완전한밀봉을통한전근관계의삼차원적충전이어렵다 3). 일반적으로측방가압법은 spreader 를이용하여많은 gutta-percha point 를근첨부에가

대한치과보존학회지 : Vol. 32, No. 6, 2007 isthmus, apical delta 등근관계의복잡한구조때문에완전한밀봉을통한전근관계의삼차원적충전이어렵다 3). 일반적으로측방가압법은 spreader 를이용하여많은 gutta-percha point 를근첨부에가 Continuous wave of obturation technique에서플러거의다양한적용깊이에따른근단부폐쇄효율비교 ABSTRACT 이상진 박정길 허복 김현철 * 부산대학교치의학전문대학원치과보존학교실 COMPARISON OF APICAL SEALING EFFICACIES USING DIFFERENT PLUGGING DEPTH IN CONTINUOUS WAVE