관하여여러연구들이진행되어왔다. Kious 등 3 의연구에서는, 실험에사용된접착제들이모두혼합후 2 분안에 50 N 의부하에서 25 μm이하의피막도를가졌다. Windeler 는접착제의작업시간은접착제의점성변화와직접적으로연관이있으며, 작업시간은보철물장착시최소한의피막도에이르는시
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1 ORIGINAL ARTICLE 이유승 김성훈 2 * 이재봉 2 한중석 2 여인성 2 하승룡 3 김희경 4 서울대학교치의학대학원, 2 서울대학교치의학대학원치과보철학교실, 3 아주대학교의과대학치의학과, 4 중앙보훈병원치과병원치과보철과 Effect of working time on the film thickness of dental resin cements Yu-Seung Yi, Sung-Hun Kim 2 *, Jai-Bong Lee 2, Jung-Suk Han 2, In-Sung Yeo 2, Seung-Ryong Ha 3, Hee-Kyung Kim 4 School of Dentistry, Seoul National University, Seoul, Republic of Korea 2 Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea 3 Department of Dentistry, School of Medicine, Ajou University, Suwon, Republic of Korea 4 Department of Prosthodontics, Veterans Health Service Medical Center, Seoul, Republic of Korea Purpose: The aim of this study was to compare the film thicknesses of several resin cements as a function of time after mixing and to examine the effect of working time on the film thicknesses. Materials and methods: The film thickness ( μm ) of 4 resin cements (n=0), composite resin (Panavia F 2.0), 3 self-adhesive resin (Clearfil SA luting, Zirconite, RelyX U200) cements was measured at 20-second intervals after mixing of the cements up to 200 seconds under a load of 50 N. Linear regression was fitted to verify the effect of working time on the film thickness of each cement. Data were compared to the working time recommended by manufacturers using Wilcoxon test (α=.05). Results: All of the materials showed a positive linear correlation between the film thickness and working time. There was no statistically significant difference between the working time based on our results and the values recommended by the manufacturers even though there was a discrepancy between those two values. Conclusion: The film thickness of resin cements could increase with the increase of working time. Working time to meet the ISO standard of 50- μm maximum film thickness could be different from the manufacturer s recommended value. (J Korean Acad Prosthodont 205;53:325-9) Key words: Resin cements; Film thickness; Working time 서론 고정성보철물의장기적성공을위해서는보철물의유지력및저항성, 치아삭제량, 보철물의견고성, 치주조직의보존및추후관리등이중요한요소로작용한다. 또한보철물의변연적합도는최소한의변연접착제공간을갖는정확한보철물과이차우식예방을위해필수적이라고할수있다. 2 보철물의불완전한장착은접착제의피막도와관련이있으며, 3,4 접착제의피막도는수복물의장기적성공과연관이있다고할수있다. 접착제의피막도는혼합온도, 혼수비, 보철물장착시가해지는부하, 접착제의선택등에영향을받을수있으며, 5,6 접착제 의입자크기, 삭제된치아의형태, 접착제혼합후보철물의장착시까지의시간등도접착제의피막도에영향을미칠수있다. 7 치과용레진시멘트는미세변연누출의감소, 유지력의증가및개선된물리적특성을장점으로하고있다. 8-2 레진시멘트의피막도에영향을미치는요소및피막도가레진시멘트의접착력과보철물의안정성에미치는효과에관한기존의연구들이있어왔다. 4,6,7,3 또한, 보철물의정확한접착을위해서레진시멘트는적당한시간동안최소한의피막도를유지하여야한다. 치과용시멘트의작업시간과접착체의점성변화및피막도와의연관성에 *Corresponding Author: Sung-Hun Kim Department of Prosthodontics and Dental Research Institute, School of Dentistry, Seoul National University, 0, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea : , ksh250@snu.ac.kr Article history: Received July 22, 205 / Last Revision August 3, 205 / Accepted September 3, 205 c cc 205 The Korean Academy of Prosthodontics This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pissn , eissn
2 관하여여러연구들이진행되어왔다. Kious 등 3 의연구에서는, 실험에사용된접착제들이모두혼합후 2 분안에 50 N 의부하에서 25 μm이하의피막도를가졌다. Windeler 는접착제의작업시간은접착제의점성변화와직접적으로연관이있으며, 작업시간은보철물장착시최소한의피막도에이르는시간으로정의할수있다고하였다. 4 국제표준화기구 (ISO) 에서는치과용레진시멘트의작업시간을접착제의피막도가 50 μm에도달하는시간으로규정하였으며 50 N 의하중이 80 초동안가해지며광중합이동시에조사되었다. 5 그러나접착제의혼합부터하중이가해지는시점까지의시간은제시되지않았다. 보철물의접착시가해지는하중은치과의사에따라차이가있을수있으며객관적으로표준화하기는어려우나, 본연구에서는보철물의장착및접착시치과의사로부터가해지는손가락압력은 2 N 에서 67 N 의범주라는 Zortuk 등 6 의연구를토대로하여, 50 N 의장착부하를사용하였다. 또한, 하중기의중심구를통하여광중합을동시에조사하였다. 본연구에서는임상에서사용되는몇가지레진시멘트의혼합후부하를가하기까지소요되는시간에따른피막도의변화를비교하고, 레진시멘트의혼합후부하를가하는시점까지의시간과피막도의연관성에관하여알아보고자하였다. 재료및방법 이실험에서는 4 종의치과용레진시멘트가사용되었다 (Table ). 각시멘트의피막도는 ISO 의기준 (ISO 997) 에부합하게측정하였으며 50 N 의부하에서 Mylar matrix strip 을사용하였다. 본실험은 20 ±2 의온도와 50% ± 0% 의상대습도하에서시행하였으며, 모든재료는제조사의지시에따라조작하였다. 각시멘트당 0 개의시편을준비하였다. 손으로혼합하는시멘트의경우제조사에서지시한시간에따라혼합한후평평한유리판위의투명한 Mylar matrix strip 사이에위치시켰고, 자동혼합시멘트의경우 strip 위에바로위치시켰다. 위치시킨시멘트는 strip 위로넘치지않는최소한의양을사용하였다. 혼합후 strip 위에위치시킨후평평한유리판을덮고 20, 40, 60, 80, 00, 20, 40, 60, 80, 200 초후에각각 50 N 의부하를가하였다. 부하 와동시에유리판의중앙부에위치한구멍을통해 LED 광조사를 5 초간시행하였다. 모든측정은각시편당세번씩측정하였다. 각시멘트의피막도는 μm까지측정가능한 micrometer (Absolute Digimatic, Model ; Mitutoyo Corp, Kanagawa, Japan) 를사용하여측정하였다. 시멘트의두께에서 Mylar strip 의두께를뺀값을각시편당세번씩측정하여그값을평균하였다. SPSS 통계프로그램 (version 9, SPSS Inc., Chicago, IL, USA) 을사용하였다. 선형회귀분석을통해작업시간에따른레진시멘트의피막도의변화에관하여알아보고, Wilcoxon 검정을사용하여본연구의측정값과제조사에서제시하는작업시간을유의수준 0.05 로비교분석하였다. 결과 측정한시멘트의평균피막도를 Fig. 에도해하였다. ISO 규정에따라 5 50 μm의피막도를기준선으로명시하였다. 모든레진시멘트에서 50 μm이하의피막도를얻을수있었으나, 50 μm이하의피막도를유지하는최대한의작업시간은시멘트간의차이를보였다. 모든레진시멘트에서시멘트의혼합후부하까지의시간이증가할수록피막도가증가하는양의상관관계를보였다. RelyX U200 은선형회귀분석에서가장높은양의상관관계 (r = 0.98, R 2 = 0.95) 를보였다. 선형회귀방정식 (y = 0.8x ) 으로얻어진 50 μm의피막도까지도달하는시간은 초로다른시멘트에비해가장짧았다. Clearfil SA 는전반적으로양의상관관계를보였으며 (r = 0.79, R 2 = 0.62), 혼합후첫 60 초까지는피막도가빠르게증가하였으나, 그이후일정기간유지되다가 40 초후다시피막도가증가하였다. 50 μm의피막도까지도달하는시간은선형회귀방정식 (y = 0.09x ) 을통해 69.4 초로계산되었다. Zirconite 의피막도는시간의증가에따라서서히증가하다가 80 초에서빠른증가를보였다 (r= 0.85, R 2 = 0.72). 50 μm의피막도까지도달하는시간은 9.9 초로나타났다 (y = 0.8x ). Panavia F2.0 의피막도역시시간에따라선형증가를보였으며 (r = 0.89, R 2 = 0.79), 50 μm의피막도까지도달하는시간은 40.5 초로나타났다 (y = 0.x ). Table. Resin cements tested in this study Product Manufacturer Characteristics Mixing method Lot No. Panavia F2.0 Kurary America, NY, USA Composite resin Proprietary dispenser, A: 00543A Hand mixed 20 sec B: 0004A Clearfil SA luting Kurary America, NY, USA Self-adhesive resin Proprietary dispenser, 0008BA Hand mixed 0 sec Zirconite BJM Lab., Or-Yehuda, Israel Self-adhesive resin Proprietary dispenser, Auto mixed RelyX U200 3M ESPE, MN, USA Self-adhesive resin Proprietary dispenser, Hand mixed 0 sec 326 대한치과보철학회지 53 권 4 호, 205 년 0 월
3 Fig.. Mean values of the film thicknesses of each cement as a function of time after mixing. Table 2. Manufacturer's recommended working time and the time when the thickness reached 50 μm Product Recommended working time Mean (SD) Mean Differences P value Panavia F2.0 3 min. after mixing 40.5 (6.5) Clearfil SA Luting 60 sec. after mixing 69.4 (3.) Zirconite - 2 min. 9.9 (3.8) RelyX U200 2 min. from start of mixing 75.3 (2.2) 제조사에서제시한각시멘트의작업시간과본연구결과에따른각시멘트의피막도가 50 μm에도달하는시간을 Table 2 에나타내었다. 제조사의작업시간과측정값간에수치상의차이를보였으나통계적으로유의성있는차이는없었다. 고찰 본연구에서는치과용레진시멘트의혼합후부하를가하는시점까지의시간에따른피막도의변화에관하여분석하였다. 또한 ISO 규정에따라레진시멘트의혼합후피막도가 50 μm에도달하는시간을작업시간으로하였다. 본연구결과에따르면실험에사용된네가지시멘트모두에서작업시간이증가함에따라피막도는증가하였다. 피막도의증가는보철물의유지력의감소, 접착제의접착력의감소및용해도의증가등과연관이있다. 7 본연구결과에서실험에사용된시멘트모두 ISO 기준에의한 50 μm이하의피막도를얻었다. 50 μm의피막도에이르는시 간을각시멘트의작업시간으로하였을때, Clearfil SA Luting 은 초로가장긴작업시간을나타내었고, RelyX U200 이 75.3 초로가장짧은작업시간을보였다. Clearfil SA Luing 과 Zirconite 는제조사에서추천되는작업시간보다긴작업시간을보였고, Panavia F2.0 과 Rely U200 은제조사에서추천되는작업시간보다짧은작업시간을보였다. Zirconite 가제조사의작업시간과가장유사한값을나타내었고, Clearfil SA Luting 이가장차이나는값을보였다. 본연구결과에의하면제조사에서추천하는작업시간과실제임상에서의작업시간과는차이가있을수있으며, 특히 Panavia F2.0 과 Rely U200 과같이제조사의작업시간보다짧은측정값을보인시멘트의경우사용시좀더주의가필요하다고할수있다. 치과용시멘트의피막도에관한여러연구들이있어왔다. Windeler 4 는 zinc phosphate 시멘트를사용하여시간에따른피막도의변화를살펴보았으며, 시멘트의작업시간이경화시간을의미하는것은아니라고하였다. 또한혼합온도를낮추었을경우좀더긴작업시간을얻었다고보고하였다. White 등 6 은 대한치과보철학회지 53 권 4 호, 205 년 0 월 327
4 zinc phosphate, glass ionomer, polycarboxylate, resin 시멘트를사용하여장착시의부하가피막도에영향에미치며, 그양상은시멘트의종류에따라차이가있다고보고하였다. 그의연구에따르면, 레진시멘트가최소한의피막도를갖기위하여가장큰장착부하가필요하다고보고하였다. Kious 등 3 은 resin-modified glass ionomer, composite resin, self-adhesive resin 시멘트를사용하여 50 N 의부하에서시간에따른피막도의변화를관찰하였으며, 모든시멘트에서혼합후 2 분이내에 25 μm이하의피막도를얻었다. 본연구에서는최근에사용되는레진시멘트들을사용하였으며, 치과용시멘트의피막도를측정한기존의논문들에비해좀더짧은시간간격으로측정함에따라시간에따른피막도의변화를자세하게파악할수있었다. 또한, 치과의사로부터가해지는손가락압력과유사한수치인 50 N 의부하 6 를사용하고광중합을동시에시행함으로써좀더임상상황과유사한조건하에서측정하였다. 결론 레진시멘트의혼합후시간이경과함에따라피막도는증가한다. 피막도가 50 μm에도달하는시간은제조사에서추천하는작업시간과차이가있을수있다. ORCID Sung-Hun Kim Jung-Suk Han In-Sung Yeo Seung-Ryong Ha Hee-Kyung Kim References. Shillingburg HT, Sather DA Jr, Wilson EL Jr, Cain JR, Mitchell DL, Blanco LJ, Kessler JC. Fundamentals of fixed prosthodontics. 4th ed. Quintessense Pub., Co.; 202. p Schwartz IS. A review of methods and techniques to improve the fit of cast restoration. J Prosthet Dent 986;56: Pilo R, Cardash HS, Baharav H, Helft M. Incomplete seating of cemented crowns: a literature review. J Prosthet Dent 988;59: White SN, Yu Z. Film thickness of new adhesive luting agents. J Prosthet Dent 992;67: Rosenstiel SF, Land MF, Crispin BJ. Dental luting agents: A review of the current literature. J Prosthet Dent 998;80: White SN, Yu Z, Kipnis V. Effect of seating force on film thickness of new adhesive luting agents. J Prosthet Dent 992; 68: Oilo G, Evje DM. Film thickness of dental luting cements. Dent Mater 986;2: Manhart J, Scheibenbogen-Fuchsbrunner A, Chen HY, Hickel R. A 2-year clinical study of composite and ceramic inlays. Clin Oral Investig 2000;4: Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G. Porcelain veneers: a review of the literature. J Dent 2000;28: Mitchell CA, Abbariki M, Orr JF. The influence of luting cement on the probabilities of survival and modes of failure of cast fullcoverage crowns. Dent Mater 2000;6: Knox J, Kralj B, Hübsch PF, Middleton J, Jones ML. An evaluation of the influence of orthodontic adhesive on the stresses generated in a bonded bracket finite element model. Am J Orthod Dentofacial Orthop 200;9: el-mowafy O, Rubo MH. Retention of a posterior resin-bonded fixed partial denture with a modified design: an in vitro study. Int J Prosthodont 2000;3: Kious AR, Roberts HW, Brackett WW. Film thicknesses of recently introduced luting cements. J Prosthet Dent 2009;0: Windeler AS. The use of film thickness to measure working time of zinc phosphate cements. J Dent Res 978;57: ISO Dentistry - Polymer-based filling, restorative and luting materials. International Organization for Standardization, Geneva, Switzerland, Zortuk M, Bolpaca P, Kilic K, Ozdemir E, Aguloglu S. Effects of Finger Pressure Applied By Dentists during Cementation of All-Ceramic Crowns. Eur J Dent 200;4: Smith DC. Dental cements. Dent Clin North Am 97;5: 대한치과보철학회지 53 권 4 호, 205 년 0 월
5 ORIGINAL ARTICLE 이유승 김성훈 2 * 이재봉 2 한중석 2 여인성 2 하승룡 3 김희경 4 서울대학교치의학대학원, 2 서울대학교치의학대학원치과보철학교실, 3 아주대학교의과대학치의학과, 4 중앙보훈병원치과병원치과보철과 목적 : 본연구에서는임상에서사용되는몇가지레진시멘트의혼합후부하를가하기까지의시간에따른피막도의변화를비교하고, 혼합후작업시간과레진시멘트의피막도의관계를알아보고자하였다. 재료및방법 : 네종류의레진시멘트 (Panavia F2.0, Clearfil SA Luting, Zirconite, RelyX U200) 를제조사의지시대로혼합한후두장의투명한 Mylar matrix strip 사이에소량의시멘트를넣고다양한시간간격 (20, 40, 60, 80, 00, 20, 40, 60, 80, 200 초 ) 후에 50 N 의부하를가하고광중합을시행하였다. 각시점에서의피막도는 μm단위까지측정가능한디지털피막도측정기를이용하여각시편당세번씩측정하여평균값을구하였으며, 선형회귀분석을통하여시간에따른측정값의변화를알아보았다. 또한 Wilcoxon 검정을사용하여각측정값과제조사에서제시한작업시간을유의수준 0.05 로비교분석하였다 (α=.05). 결과 : 본연구에사용된모든레진시멘트에서혼합후부하를가하기까지걸린시간과피막도는선형회귀분석결과양의상관관계를갖는일차함수적패턴을보였다. ISO 기준에따라피막도가 50 μm가되는시점까지의시간은각레진시멘트의제조사가제시한작업시간과차이가있었으나통계적인유의성은없었다. 결론 : 레진시멘트의피막도는작업시간의증가에따라증가한다. 임상에서의레진시멘트의작업시간은제조사에서제시한작업시간과차이가있을수있다. ( 대한치과보철학회지 205;53:325-9) 주요단어 : 레진시멘트 ; 피막도 ; 작업시간 * 교신저자 : 김성훈 서울시종로구대학로 0 서울대학교치의학대학원치과보철학교실 : , ksh250@snu.ac.kr 원고접수일 : 205 년 7 월 22 일 / 원고최종수정일 : 205 년 8 월 3 일 / 원고채택일 : 205 년 9 월 3 일 c 205 대한치과보철학회 cc 이글은크리에이티브커먼즈코리아저작자표시-비영리 3.0 대한민국라이선스에따라이용하실수있습니다. 대한치과보철학회지 53 권 4 호, 205 년 0 월 329
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