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대한치주과학회지 2009;39:17-26 비우식성치경부병소와 5 급와동수복물이치주조직에미치는영향 김현주, 김성조, 최점일, 이주연 * 부산대학교치의학전문대학원치주과학교실 Effects of non-carious cervical lesions and class Ⅴ restorations on periodontal conditions Hyun-Joo Kim, Seong-Jo Kim, Jeom-Il Choi, Ju-Youn Lee * Department of Periodontology, School of Dentistry, Pusan National University ABSTRACT Purpose: The non-carious cervical lesion(nccl) is a loss of tooth structure at the neck of affected teeth that is unrelated to tooth caries. The reported prevalence of NCCL varies from 5% to 85%. Prevalence and severity of lesions have been found to increase with age. They are becoming more significant as people live longer and become more aware of the importance of oral health. The purposes of this study were first, to examine the periodontal conditions associated with NCCL, and second, to investigate the clinical effects of class Ⅴ restorations of NCCL on periodontal tissues. Materials and methods: The sample size was 982 teeth of 50 subjects(25 male, mean age 52±7) who were seen at the Department of Periodontology, Pusan National University Hospital. At the baseline examination, clinical periodontal parameters were measured. After the initial examination, 24 patients who were absent from hypersensitivity were selected. The teeth with NCCL were randomly divided into the test and control groups. The teeth in the test group were restored with flowable resin; the control teeth were not restored. Six months later, the clinical examinations were repeated. The data were analyzed using the SPSS program. Results: The results were as follows: 1) NCCL occurred on 45.8% of examined teeth. The percentage of affected teeth was higher in maxillary and premolar teeth. 2) The shallow saucer type was the most common. 3) Teeth with NCCL had more gingival recession, lower attachment level, and higher incidences of bleeding on probing(bop) and plaque than NCCL-free teeth. 4) Six months later, gingival recession, attachment level, the percentages of BOP and plaque in the test group were lower than in the control group(p<0.05). Conclusion: NCCLs were more found in maxillary teeth, especially in premolar teeth. The results suggest that the restoration of NCCL could affect some periodontal parameters favorably. (J Korean Acad Periodontol 2009;39:17-26) KEY WORDS: NCCL; class Ⅴ restoration; periodontal condition. 서론 비우식성치경부병소 (Non-carious cervical lesion; NCCL) 는치아우식증과무관하게치경부의백악법랑경계부위에서발생하는치아구조의상실을의미한다 1). 이는치아의지각과민, 치태의침착, 치아우식가능성및치수생활력 Correspondence: Dr. Ju-Youn Lee Department Periodontology, School of Dentistry, Pusan national University, 1-10, Ami-dong, Seo-gu, Pusan, 602-739, Korea. E-mail: heroine@pusan.ac.kr, Tel: 051-240-7459, Fax: 051-243-7606 * 이논문은부산대학교자유과제학술연구비 (2 년 ) 에의하여연구되었음. Received: Dec. 8, 2008; Accepted: Feb. 18, 2009 에영향을미칠수있다 2). 백악법랑경계에서의비우식성경조직상실은임상에서흔히접할수있는경우로다양한인종에서그유병률이 5~85% 범위로보고되고있다 3). 치열에서는주로견치부터제 1대구치에분포하며이중에서도특히소구치가가장잘이환되며 2,4,5), 고령자에서는치아위치에따른차이가없고연령에따라증가한다고보고되고있다 6,7). 평균연령의증가와함께최근구강관리에대한관심이높아지면서우식및다른원인에의한치아상실률이감소함에따라비우식성치경부병소의빈도가더증가할것으로생각해볼수있다. 비우식성치경부병소를유발하는주된원인으로마모, 17

김현주, 김성조, 최점일, 이주연 대한치주과학회지 2009 년 39 권 1 호 부식, 파절마모를들수있고, 여러가지원인이복합적으로작용한다 8). 따라서비우식성치경부병소의형태와원인은단정적으로연결지을수없는것이며이에대한치료역시다양한원인에대한고찰이필요하다 9). 병소의치료는수복, 교합조정, 올바른잇솔질교육, 식이습관개선및노출된치근면에대한치주외과적처치등으로다양하다 10-13). 이중수복은주로치아의강도를증가시키고하중의집중및굴곡을감소시키며병의진행을중지시키고자할때행하게된다. 또한지각과민을해결하고치수병변을예방하며, 치태조절을용이하게하여치은건강을개선하며심미성을증진시키기위한목적으로비우식성치경부병소에이환된치아를수복한다 1,12,13). 다양한수복재료중복합레진은치질보존이가능하며, 심미성이뛰어나며, 탄성계수가우수하다는물리적인특성으로인해비우식성치경부병소의수복재료로주로사용된다 10). 수복물의변연적합도가불량할경우치태가축적되어우식및치주질환의위험이증가하게되므로수복시수복물의치은측변연적합성에특히주의를기울여야한다 13). 의원성요인에의한치주조직의파괴가 1912 년 Black 에처음으로인식된이후로수복물과치주질환과의상관관계에대한연구가수년간이루어져왔다 14). 일부저자들은치은연하로수복물의변연을설정하면치은염증이유발된다고보고하였으나 15,16), 수복물의변연을잘마무리하고연마하면치은에대한영향은적다는보고도있었다 17,18). Paolantonio 등 14) 은다양한재료를이용하여치은연하변연을가진 5급와동을수복한다음이에의한임상적효과를관찰하였다. 이연구에의하면치은연하변연을가진다하더라도수복물의경계를잘마무리하고연마하면치주낭, 치은출혈, 치태축적에는주요한영향을미치지않는다고한다. 비우식성치경부병소는노년층의증가와구강건강에대한관심의증대로흔히볼수있는구강질환이되었고, 하방경계가치은과맞닿아있기때문에치주조직에영향을미칠수밖에없다. 현재치료법으로가장일반적으로사용되고있는수복치료역시수복물의하방경계가치은과맞닿아있거나치은아래에위치하기때문에치주조직에어떤방법으로든지영향을미치게된다. 그러나비우식성치경부병소의수복치료에대한이전의연구들은대부분수복물변연적합도나수복물의영구성에초점이맞추어져있으며비우식성치경부병소와연관된치주조직의변화나치경부병소의수복치료후의치주조직변화에대한장, 단기적인연구 는부족한실정이다. 이에본연구는여러치주임상지표를이용하여비우식성치경부병소에인접한치주조직의건강상태를평가하고이들병소에대한수복치료 6개월뒤의재평가를통해 5급와동수복물이치주조직에미치는영향을함께알아보고자하였다. 연구대상및방법 1. 연구대상 2008년 3월에서 9월까지부산대학교병원치주과에치주염과직접관련되지않은증상을주증상으로내원한 50명의환자 ( 남성 25 명, 평균연령 52±7세, 29세 ~65 세 ) 를대상으로하였다. 치주조직의염증이육안으로식별가능한경우와방사선사진상에서치주질환으로인한명백한골소실이관찰되는경우는연구대상에서제외하였다. 치근이개부의영향을배제하기위해대구치는제외하였다. 상, 하악제 2 소구치에서반대편제 2소구치까지를연구대상에포함시켰으며이중협면에비우식성치경부병소를가진치아가적어도하나이상존재하는환자를대상으로하였다. 특이한전신질환이없으며최근 6개월간치과치료를받은경험이없는환자를연구대상자로선정하였다. 대상치아는 982 개이었고환자 1인당평균대상치아는 19.6 개였다. 본연구는부산대학교병원임상연구윤리위원회의심의를통과하였다 ( 심의번호 2008007). 2. 연구방법연구시작단계에서연구대상조건을만족하는 50명에대해다음의임상검사를시행하였다. 병소와관련하여지각과민과같은특별한자각증상이없는환자 24명에대하여수복치료를시행한후수복 6개월이후에아래의임상검사를재실시하였다. 1) 비우식성치경부병소의형태육안으로검사하여형태를쐐기형 (wedge) 과접시형 (saucer) 으로나누었다 (Fig. 1). 병소의형태는 Aw와 Lepe 2) 의방법과동일하게비우식성치경부병소내측과외측의치면이이루는각도가작아예리한내외선각이관찰되는경우를쐐기형 (Fig. 1A), 내측과외측의치면이둔각을형성하 18

J Korean Acad Periodontol 2009;39(1) 비우식성치경부병소와 5 급와동수복물이치주조직에미치는영향 여내외선각이명확하지않은경우를접시형 (Fig. 1B) 으로분류하였다. 2) 비우식성치경부병소의깊이 Aw와 Lepe 2) 의방법을따라치주탐침자를이용하여병소의깊이를 mm 단위로측정하였다 (Fig. 2). 이환되지않은인접치혹은반대측치아를기준으로이상적인협측형태를예상한다음병소의가장깊은부위까지의깊이를측정하였다. 병소깊이에따른비교를위해 1 mm를기준으로얕음 (shallow) 과깊음 (deep) 으로분류하였다. 5) 치태 (Plaque) 육안과치주탐침자를이용하여각치아별협측치태의유무를확인하여백분율로조사하였다. 협측에치태존재하는치아수 Plaque(%)= 100 전체치아수 6) Biotype Seibert와 Lindhe 19) 의분류에따른 ʻʻflat-thickʼʼ type을 thick biotype으로 ʻʻscalloped-thinʼʼ type을 thin biotype 으로분류하였다. 3) 탐침치주낭깊이 (Probing depth; PD), 치은퇴축 (Gingival recession; GR) 및부착수준 (Attachment level; AL) 탐침치주낭깊이는치주탐침자를이용하여 mm 단위로측정하였으며, 각치아의협측면에서근심, 중앙, 원심의세지점을측정하였다. 치아의백악법랑경계를기준으로하여유리치은변연까지거리를측정하여치은퇴축량을측정하고부착수준을조사하였다. 보철물이장착되어있는경우는보철물변연을백악법랑경계로간주하였다. 비우식성치경부병소에대한수복치료후에는병소의하방경계와수복물의하방경계가동일하므로수복물의하방경계를기준점으로간주하였다. 4) 탐침시출혈 (Bleeding on probing: BOP) 치주탐침자로각치아협측의탐침시출혈여부를백분율로조사하였다. 협측탐침출혈존재하는치아수 BOP(%)= 100 전체치아수 7) 수복치료연구대상자중병소와관련한자각증상이없는환자 24 명에대하여치아정중선을경계로비우식성치경부병소를좌우측으로나누었다. 이중임의로선택한편측 ( 왼쪽혹은오른쪽 ) 의상, 하악비우식성치경부병소를흐름성이좋은레진 (Arabesk R, VOCO Co., Cuxhaven, Germany) 을이용하여술자 1인이수복하였으며이를실험군으로설정하였다. 부적절한수복물에의한영향을배제하기위해다이아몬드버 (DIA-BURS TC-12EF, MANI Inc., Tochigi-ken, Japan) 로마무리하고그린스톤 (Dura-Green R stone, Shofu Inc., Kyoto, Japan), 화이트스톤 (Dura-white R stone, Shofu Inc., Kyoto, Japan) 을차례로사용하여연마하였다. 치료를시행하지않은반대측의상, 하악에위치한비우식성치경부병소를가진치아를대조군으로설정하였다. 3. 통계분석통계처리는 SPSS(version 14.0K for windows, SPSS A B Figure 1. Angular shape of cervical lesion in buccolingual cross section. (A) Wedge shape, (B) Saucer shape Figure 2. Dimension of cervical lesion in buccolingual cross section; horizontal depth 19

김현주, 김성조, 최점일, 이주연 대한치주과학회지 2009 년 39 권 1 호 Inc., Chicago, USA) 를이용하였고통계적유의수준은 95% 신뢰구간으로설정하였다. 비우식성치경부병소유무, 형태에따른탐침치주낭깊이, 치은퇴축, 부착수준의비교는치아별로평균을구하여독립표본 t-검정을실시하였다. 비우식성치경부병소의유무, 형태에따른탐침시출혈, 치태존재의연관성은카이제곱검정으로살펴보았다. 치주조직에대한 biotype과비우식성치경부병소유무의상호연관성은이원배치분산분석법을사용하였다. 수복치료에대한평가에있어서측정시점에따른탐침치주낭깊이, 치은퇴축, 부착수준의그룹내비교를위해서는대응표본 t-검정을, 그룹간의비교를위해서는독립표본 t-검정을사용하였다. 실험군과대조군의탐침시출혈, 치태의존재는맥니마검정을사용하여유의성을검정하였다. 연구결과 1. 비우식성치경부병소의분포및특성비우식성치경부병소가있는치아는전체치아수 982 개중 450 개로 45.8% 로나타났다. 분포를살펴보면전체적으로하악보다상악에서더많이관찰되었다. 또한상, 하악모두소구치부에서비우식성치경부병소의빈도가높았다. 제 1소구치와제 2소구치의차이는크지않았다. 치아에따른병소의형태별분포는상악에서쐐기형이더많이관찰되었으며절치보다는소구치에서쐐기형의빈도가높았다 (Fig. 3). 비우식성치경부병소의특성을살펴보면전체적으로얕은접시형이가장많이관찰된반면깊은접시형의빈도가가장낮았다. 접시형과쐐기형모두병소의깊이가얕은경우가더많았다. 깊이에따라살펴보면얕은경우에서는접시형이, 깊은경우에서는쐐기형이더많이존재하였다 (Table 1). 2. 비우식성치경부병소와임상지표의연관성비우식성치경부병소의유무에따른탐침치주낭깊이는병소유무에관계없이거의유사하였다 (p>0.05). 치은퇴축량은비우식성치경부병소가있는치아에서는 1.27± 0.71 mm, 비우식성치경부병소가없는치아에서는 0.29± 0.72 mm로통계적인유의성이관찰되었으며 (p<0.05), 이 로인해부착수준의측정값역시비우식성치경부병소가있는치아에서유의성있게더크게나타났다 (p<0.05). 병소가있는치아에서탐침시출혈은 61.5%, 치태존재는 72.2% 로이는모두병소가없는치아에비해높은값을보였다 (p<0.05, Table 2). 치태와탐침시출혈을각치아의대표값의백분율로계산하였으므로다소높은결과를보였다. 비우식성치경부병소의형태와임상지표의관계를살펴보면탐침치주낭에서통계적으로유의한차이 (p<0.05) 가관찰되었으나평균약 0.1 mm 정도로임상적으로의미가없다고볼수있고, 부착수준에서통계적유의성이관찰되었다. 반면치은퇴축, 탐침시출혈및치태의존재는유의한차이가없었다 (p>0.05, Table 3). 3. Biotype 과비우식성치경부병소의유무에따른임상지표비교 전체환자중 thick biotype이 56% 였다. 탐침치주낭깊이, 치은퇴축, 부착수준에대하여 biotype과병소유무의효과를함께고려해보았다. 탐침치주낭깊이에대해서는 biotype과병소유무에따른상호작용효과는존재하지않았다 (p>0.05). Biotype의영향은유의하여 thick biotype은탐침치주낭깊이가 2.29±0.38mm, thin biotype 은 2.20± 0.29 mm이었지만임상적으로의미있는차이는아니었다 (Table 4). 반면치은퇴축및부착수준에대해서는 biotype 과병소유무에따른상호작용효과가존재하였다 (p<0.05, Table 5, 6). 즉 thin biotype이면서병소가존재하는경우치은퇴축이가장많았으며 (1.38±0.67 mm) 부착수준이가장낮게나타났다 (3.60±0.75 mm). 4. 수복에의한임상지표의변화 수복치료를시행하였던 24명의환자 ( 남성 14명 ) 는 44세에서 60세까지로평균연령 52±4세였다. 수복치료를시행한치아 ( 실험군 ) 와수복치료를시행하지않은치아 ( 대조군 ) 의수는각각 104개였다. 치료전양그룹간의임상지표에는통계적으로유의한차이가없었다. 치료에의한효과를임상지표별로살펴보면치은퇴축, 부착수준, 탐침시출혈, 치태의존재에있어서두그룹간에통계적으로유의한차이가있었다 (p<0.05). 탐침치주낭은양그룹모두에서치료전, 후에통계적으로유의한수준으 20

J Korean Acad Periodontol 2009;39(1) 비우식성치경부병소와 5 급와동수복물이치주조직에미치는영향 로감소하였으나 (p<0.05) 그룹간의차이는존재하지않았다 (p>0.05). 치은퇴축은실험군에서는시간에따라크게차이가나지않았으나 (p>0.05) 대조군에서는통계적으로유의한수준으로퇴축이더진행되었다 (p<0.05). 부착수준의변화를살펴보면실험군에서는시간에따라부착이획득되었으나 (p<0.05) 대조군에서는부착이소실되는경향을 보였다 (p<0.05). 탐침시출혈은실험군에서는치료후에크게개선되었으나 (p<0.05) 대조군에서는큰차이가없었다 (p>0.05). 양그룹모두에서치태조절이향상되었으나특히실험군에서개선의정도가컸으며이는통계적으로유의성있는결과였다 (p<0.05, Table 7). % 100 90 80 70 60 50 40 30 20 10 0 15 14 13 12 11 21 22 23 24 25 wedge saucer % 0 10 20 30 40 50 60 70 80 90 100 No. of tooth 45 44 43 42 41 31 32 33 34 35 wedge saucer Figure 3. The Distribution of the non-carious cervical lesions according to their location and shape. All the population had more than one non-carious cervical lesion. Table 1. The Characteristics of the Non-Carious Cervical Lesions according to the Shape and Depth Depth Shape of the Lesions Saucer(%) Wedge(%) Total(%) Shallow 315(70) 90(20) 405(90) Deep 15(3.3) 30(6.7) 45(10) Total 330(73.3) 120(26.7) 450(100) Table 2. Relationship between the Clinical Parameters and the Non-Carious Cervical Lesions(NCCL) Clinical Parameters without NCCL with NCCL p-value PD(mm) 2.25±0.38 2.26±0.31 0.818 GR(mm) 0.29±0.72 1.27±0.71 0.000 AL(mm) 2.54±0.80 3.52±0.73 0.000 BOP(%) 41.7 61.5 0.000 Plaque(%) 38.2 72.2 0.000 PD: Probing depth; GR: Gingival recession; AL: Attachment level; BOP: Bleeding on probing PD, GR, AL: Independent t-test was used to test statistically significant between groups(p<0.05). mean±sd BOP, Plaque: χ 2 test was used to test statistically significant between groups(p<0.05). 21

김현주, 김성조, 최점일, 이주연 대한치주과학회지 2009 년 39 권 1 호 Table 3. Relationship Between the Clinical Parameters and Shape of the Non-Carious Cervical Lesions(NCCL) Clinical Parameters Saucer NCCL Wedge p-value PD(mm) 2.22±0.29 2.35±0.32 0.000 GR(mm) 1.23±0.71 1.35±0.69 0.102 AL(mm) 3.45±0.74 3.70±0.65 0.001 BOP(%) 59.3 67.5 0.113 Plaque(%) 72.1 72.5 0.937 PD: Probing depth; GR: Gingival recession; AL: Attachment level; BOP: Bleeding on probing PD, GR, AL: Independent t-test was used to test statistically significant between groups(p<0.05). mean±sd BOP, Plaque: χ 2 test was used to test statistically significant between groups(p<0.05). Table 4. The Extent of Probing Depth by the Biotype and Non-Carious Cervical Lesions(NCCL) Biotype without NCCL with NCCL Sig. Thin 2.19±0.30 2.22±0.29 Thick 2.30±0.43 2.29±0.32 0.000 Sig. 0.806 0.416 Anova test was used to test statistically significant between groups(p<0.05). Table 5. The Extent of Gingival Recession by the Biotype and Non-Carious Cervical Lesions(NCCL) Biotype without NCCL with NCCL Sig. Thin 0.25±0.55 1.38±0.67 Thick 0.32±0.83 1.18±0.73 0.198 Sig. 0.000 0.003 Anova test was used to test statistically significant between groups(p<0.05). Table 6. The Extent of Attachment Level by the Biotype and Non-Carious Cervical Lesions(NCCL) Biotype without NCCL with NCCL Sig. Thin 2.44±0.63 3.60±0.75 Thick 2.62±0.90 3.47±0.70 0.563 Sig. 0.000 0.002 Anova test was used to test statistically significant between groups(p<0.05). 22

J Korean Acad Periodontol 2009;39(1) 비우식성치경부병소와 5 급와동수복물이치주조직에미치는영향 Table 7. Comparison of the Clinical Parameters Between the Test Group and the Control Group Clinical Parameters Test Group Control Group baseline 6M p-val. baseline 6M p-val. PD(mm) 2.30±0.30 2.20±0.27 0.00 2.42±0.32 2.34±0.31 0.00 GR(mm)* 1.36±0.62 1.36±0.63 0.92 1.22±0.85 1.33±0.86 0.00 AL(mm)* 3.67±0.67 3.57±0.67 0.02 3.63±0.85 3.67±0.89 0.02 BOP(%)* 59.2 36.9 0.00 62.1 64.1 0.85 Plaque(%)* 90.3 25.2 0.00 82.5 69.9 0.04 Test group: restorative treatment was done Control group: restorative treatment was not done PD: Probing depth; GR: Gingival recession; AL: Attachment level; BOP: Bleeding on probing PD, GR, AL: Paired t-test was used to test statistically significant change between baseline and 6month later(p<0.05). mean±sd Independent t-test was used to test statistically significant change between test and control group at 6month later(p<0.05). mean±sd BOP, Plaque: Mcnemar test was used to test statistically significant change between baseline and 6month later, as well as test and control group at 6 month later(p<0.05). *: Statistically significant difference between test and control group at 6month later(p<0.05). 고찰 본연구에서비우식성치경부병소는전체치아의 45.8% 로나타났다. 이는 Borcic 등 7) 이보고한 16.6% 보다높은비율이었다. Borcic 등의연구에서는다양한이유로치과를방문한환자를연구대상으로선정하였고, 본연구에서는하나이상의비우식성치경부병소를가진환자를연구대상으로선정하였기때문에비율이더높게나타난것으로생각된다. 치아의위치에따른비우식성치경부병소의분포를살펴보면상, 하악모두소구치부에서높은빈도로관찰되었으며, 이는앞서의여러연구들과일치한다 2,5,6). 제 1, 2 소구치에서큰차이는보이지않았으나, 다른연구들에서보고된바에따르면제 1소구치에서더많이관찰할수있다고한다 3,5). 제 1소구치는악궁의가운데위치하므로과도한교합하중을받게되며이로인해치경부에응력이집중되며 1,7,8) 치열궁에서상대적으로돌출되어있기때문에기계적인자극을다른치아보다더많이받게된다 2,5). Hong 등 5) 은비우식성치경부병소에이환된치아의비율이상악에서약간높게관찰되며, 동일악궁내에서좌, 우측의차이는거의없다고보고하였으며본연구에서도이를확인할수있었다. 병소의특성을형태, 깊이에따라살펴본결과얕은접시형이 70% 로가장많이관찰되었다. 비우식성치경부병소유무에따른임상지표의차이를비 교해보았다. 탐침치주낭깊이는차이가없었으나병소가있는치아에서치은퇴축이평균약 1 mm 정도더진행되었다. 이로인해부착수준역시비우식성치경부병소가있는치아에서 1 mm 정도더낮게나타났다. 이는 Piotrowski 등 9) 의임상연구에서도확인할수있었다. 비우식성치경부병소를가진치아의 66% 가 2 mm 이상의치은퇴축을보인반면병소에이환되지않은치아중 2 mm 이상의치은퇴축을보인치아는 16% 에불과하였다. 치은퇴축의정도에있어서는본연구와차이가있지만병소의유무에따른두그룹간의비교결과는동일하였다. 비우식성치경부병소가있는치아에서탐침시출혈, 치태존재가높은비율로관찰되었다. 비우식성치경부병소는치아의완전성이상실되는경조직소실이기때문에병소의형태로인해치태조절이어려울것으로생각된다. 이로인한치태축적으로경미한치은염증이존재하게되고따라서탐침시출혈빈도가높게측정되었다고생각되어진다. 비우식성치경부병소의형태에따라임상지표를비교해보았을때탐침치주낭깊이에서차이가관찰되었지만약 0.1 mm정도로임상적으로의미있는수준이아니었다. 이외에치은퇴축, 부착수준, 탐침시출혈및치태의존재에있어서는차이가없었다. 그러나 Piotrowski 등 9) 의연구결과에의하면접시형의 26% 에서치태가관찰되었던반면쐐기형에서는 47% 에서치태가관찰되었다. 이는접시형이쐐 23

김현주, 김성조, 최점일, 이주연 대한치주과학회지 2009 년 39 권 1 호 기형보다잇솔질로관리하기더쉬운형태이기때문이다. 또한칫솔에의한기계적인자극으로접시형의초기병소가형성된다음병이진행됨에따라쐐기형으로그형태가바뀌게되므로장기간에걸친병소의특성상치태가더많이관찰될것이라고생각해볼수있다. Seibert와 Lindhe 19) 에따르면치은염증에대하여 thin biotype에서는치은변연이퇴축되며 thick biotype에서는탐침치주낭이깊어진다고한다. 외부자극에대한치주조직의반응이 biotype에따라다르기때문에비우식성치경부병소가존재할경우이에대한치주조직의반응역시 biotype에따라다를것으로예상하였으며이에비우식성치경부병소와 biotype의연관성을확인할수있었다. Schätzle 등 20) 은수복물의변연이치주조직에미치는영향을 26년간관찰하고보고하였다. 결과를통해치은연하로수복물의변연을위치시킬경우치주조직에위해가된다는기존의개념을입증할수있었다. 그러나부착소실은매우느리게진행되어수복물을위치시킨후최소 1~3 년뒤에야이를임상적으로확인할수있었다. 본연구에서치료에의한효과를임상지표별로살펴보았을때치은퇴축, 부착수준, 탐침시출혈, 치태의존재에있어서실험군과대조군의차이를확인할수있었다. 치은퇴축은대조군에서더많이진행되었으며부착수준은대조군에서더낮게나타났으며탐침시출혈이나치태의존재는실험군에서개선을보였다. 수복치료를시행한경우와시행하지않은경우를비교해보았을때탐침치주낭깊이, 치은퇴축, 부착수준에서의차이는모두 0.1~0.2 mm 정도였으므로임상적인의미가없다고볼수도있으나, 수복후 6개월의결과임을감안할때장기적추적관찰이필요할것으로생각된다. 그러나비우식성치경부병소의수복치료를통해초기치주염증의지표가되는탐침시출혈및치태부착을개선할수있었다. 임상적치주상태가양호한대상자들임에도불구하고치태와탐침후출혈의백분율을각대표치아별로계산하여다소높은백분율을보여주었다. 그러나실험군과대조군모두임상적치은염증소견이나방사선사진상뚜렷한골소실이없는환자를대상으로하였고, 추가적치주치료를시행할필요성이없었음에도불구하고실험군에서의뚜렷한임상지표들의개선은수복치료자체의영향도있음을배제할수없을것으로본다. Paolantonio 등 14) 은치은연하변연을가진 5급와동을수복한다음 1년후보고에서치은연하에변연을위치시키더라도수복물의경계를잘마무리하고연마하면치 주낭, 치은출혈, 치태축적에주요한영향을미치지않는다는결론을얻을수있었다. 이는치은연하로수복물의변연을설정할경우치은건강에해가된다는이전의연구결과 20,21) 와반대된다. 저자들은적은수의연구대상, 높은구강위생수준, 모든수복물의협측위치로치태조절이용이한점과수복물변연을세밀하게마무리하고연마하여불량한수복물로인한영향을최소화한점등을원인으로언급하였다. 위의원인은본연구에서도동일하였다. 수복치료를한다음단기간에걸쳐그영향을평가해보았을때수복물의변연을잘마무리하고연마하면수복물에의한영향은거의없었으며오히려치태조절을하기더좋은환경을만들어줄수있었고이는이전의연구들과도일치하는것으로볼수있다 22,23). 수복물에의한부착소실은최소 1~3 년뒤에야임상적으로확인할수있다는이전의연구결과를고려해보았을때비우식성치경부병소의수복치료이후수복물에대한치주조직의반응을더정확히평가하기위해서는장기간에걸친연구가필요하다. 참고문헌 1. Osborne-Smith KL, Burke FJ, Wilson NH. The aetiology of the non-carious cervical lesion. Int Dent J 1999;49: 139-143. 2. Aw TC, Lepe X, Johnson GH, Mancl L. Characteristics of noncarious cervical lesions. A clinical investigation. J Am Dent Assoc 2002;133:725-733. 3. Levitch LC, Bader JD, Shugars DA, Heymann HO. Non-carious cervical lesions. J Dent 1994;22:195-207. 4. Sangnes G, Gjermo P. Prevalence of oral soft tissue and hard tissue lesions related to mechanical tooth cleansing procedures. Community Dent Oral Epidemiol 1976;4:77-83. 5. Hong FL, Nu ZY, Xie XM. Clinical classification and therapeutic design of dental cervical abrasion. Gerodontics 1988;4:101-103. 6. Donachie MA, Walls AW. Assessment of tooth wear in an ageing population. J Dent 1995;23:157-164. 7. Borcic J, Anic I, Urek MM, Ferreri S. The prevalence of non-carious cervical lesion in permanent dentition. J Oral Rehabil 2004;31:117-123. 8. Bader JD, McClure F, Scurria MS, Shugars DA, Heymann HO. Case-control study of non carious cervical lesions. 24

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