ORIGINAL ARTICLE http://dx.doi.org/10.4047/jkap.2013.51.1.20 백철우 1 박철우 1 박준섭 2 류재준 1 * 1 고려대학교임상치의학대학원심미수복학과, 2 굿윌치과병원 Shear bond strength of the three different kinds of resin cement on CAD/CAM ceramic inlay Chul-Woo Baek 1, DDS, MSD, Cheol-Woo Park 1, DDS, MSD, Jun-Sub Park 2, DDS, MSD, PhD, Jae-Jun Ryu 1 *, DDS, MSD, PhD 1 Department of Esthetic Restorative Dentistry, Graduate School of Clinical Dentistry, Korea University, Seoul, Korea, 2 Goodwill Dental Hospital, Pusan, Korea Purpose: The purpose of this study was to evaluate the bond strengths between the latest CAD/CAM ceramic inlay and various resin cements which are used primarily for esthetic restoration. Materials and methods: Cylindrical ceramic blocks(height: 5 mm, diameter: 3 mm) were fabricated by using Cerec3 and bonded on the dentin of the ninety extracted caries-free molars using three different kinds of resin cement(unicem, Biscem, and Variolink II ) according to the manufacturer's instructions. Ninety specimens were divided into 3 groups according to three different kinds of resin cement. Half of each group were conducted thermocycling under the conditions of the 5-55, 5,000 cycle but the other half of them weren't. All specimens were kept in normal saline 37, for 24 hours before measuring the bond strength. The shear bond strength was measured by Universal testing machine with a cross head speed of 0.5 mm/min. The results were analyzed statistically by t-test and one-way ANOVA. Results: Unicem group showed the highest shear bond strength despite a slight decline by thermocycling. The shear bond strength of Unicem group and ValiolinkII group were significantly influenced by thermocycling, whereas Biscem group was not influenced (P<.05). There were no significant differences in the bond strength between the three groups without thermocycling, but there was significant differences between Unicem group and Valiolink II group with thermocycling(p<.05). Conclusion: It has been shown to be clinically effective when the self-adhesive resin cements Unicem and Biscem were used instead of the etch-and-rinse resin cement Valiolink II during the bonding of CAD/CAM ceramic inlay restorations with teeth. (J Korean Acad Prosthodont 2013;51:20-6) Key words: Resin cement; Cerec3; Ceramic inlay; Shear bond strength; Thermocycling 서론 최근치과치료에대한심미적인요구가높아짐에따라구치부수복시전통적인아말감및골드인레이대신치아색수복을원하는환자들이많아지고있다. 이러한심미수복방법에는복합레진을이용한직접법과인레이를이용한간접법이있다. 구강내의와동에복합레진을직접충전할경우에는재료자체의특성상여러임상적문제점들이나타날수있는데, 중 합수축으로인한미세누출, 이차우식증, 술후지각과민증등이가장큰문제이고, 낮은마모저항성과수분에의한가수분해붕괴를일으키는결함이있다. 1 복합레진직접충전법의문제점을극복하기위해서대두된간접법에의한인레이수복중, 세라믹인레이는레진인레이에비해강도가우수하며색조도보다투명하여자연치아와자연스러운조화를이룬다. 세라믹인레이수복은여러논문을통해치아수복시훌륭한임상결과를보여주며, 2,3 Computer-aided design and computer-aided *Corresponding Author: Jae-Jun Ryu Korea University Ansan Hospital, Gojan 1-dong, Danwon-gu, Ansan, Gyeonggi-do, 425-707, Korea +82 31 412 5370: e-mail, koprosth@unitel.co.kr Article history: Received October 10, 2012 / Last Revision December 8, 2012 / Accepted January 5, 2013 c cc 2013 The Korean Academy of Prosthodontics This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. These authors contributed equally to this work. 20 대한치과보철학회지 2013 년 51 권 1 호
manufacturing (CAD/CAM) 시스템의발전으로치과기공소를거치지않고당일수복이가능하게되어빠른치료를원하는환자들의높은관심을받고있다. Cerec 시스템을이용한세라믹수복물의제작은그과정을단순화시킴으로써효율적일뿐만아니라신뢰할만한결과를보여준다. 4 E.max CAD HT block 은 400 MPa 이상의굽힘강도를가지며투명도가높아심미성이아주뛰어나다. 5 세라믹인레이의임상적성공은치질과의접착강도가중요하기때문에접착제의선택과접착과정에크게영향을받는다. 6 여러연구에서세라믹인레이의접착시글래스아이오노머시멘트나인산아연시멘트를사용한경우보다레진시멘트를사용한경우에더높은결합강도를보였다고보고하였다. 7,8 하지만레진시멘트를사용하기위해서는통상의산부식과프라이머, 본딩과정을거쳐야하기때문에불편하다. 최근에이러한불편함을해결하기위해서개발된 self-adhesive 레진시멘트는자가접착기능을갖고있기때문에기존의산부식과프라이머, 본딩과정을거쳐야하는복잡함을없애고접착과정을한번으로압축시켰으며상아질의전처리없이도상아질과의접착을가능하게하였다. 9 대표적인 self-adhesive 레진시멘트의제품으로 Unicem (3M ESPE, Seefeld, Germany) 과 Biscem (BISCO, Schaumberg, USA) 등이있다. 따라서 CAD/CAM 세라믹인레이를수복할때임상에서자주사용되는 self-adhesive 레진시멘트와전통적인 etch-and-rinse 레진시멘트사이의전단결합강도를측정해봄으로써, 보다적합한레진시멘트가무엇인지를알아보고자하였다. 초간 silane (Ultradent, USA) 처리를시행하였다. 상아질이노출된 90 개의치아를 3 개의군으로나누고, 각각세라믹블록을치아면에접착하기위해서 2 개의 self-adhesive 레진시멘트 (Unicem, Biscem ) 와통상적인 etch-and-rinse 레진시멘트 (Variolink II ) 를사용하였다 (Table 1). Self-adhesive 레진시멘트의경우치아면에는특별한처치를하지않았고, 레진시멘트를세라믹블록의부착면에고르게펴서바르고한명의실험자가손가락의최대힘을이용하여수직방향으로 20 초간압력을가하였다. 잉여시멘트는브러쉬로제거하고광중합기 (Bluephase, Ivoclar Vivadent, Liechtenstein) 를사용하여 4 면에서각각 20 초씩광조사하였다. Etch-and rinse resin cement 은치아면에 etching 과 bonding 제를제조사의지시대로적용하였다 (Fig. 1). 2. 열순환처리 구강내온도변화를재현하기위해서각군마다세라믹블록이접착된 30 개의시편을절반으로나눠서절반은 5-55, 5,000 cycle 조건하에서 thermocycling 을시행하였고다른절반은 thermocycling 을시행하지않았다. Thermocycling 과정은 5 와 55 water bath 에각각 30 초씩, 이동시간은 5 초의조건하에서이루어졌고, 열자극이외의시간에는시편을 37, 100% 습도의 incubator 에보관하였다. 연구재료및방법 1. 시편제작 Cylindrical ceramic block (D: 3 mm H: 5 mm) Exposed dentine surface 발거된우식이없는 90 개의건전한대구치를준비하여생리식염수에보관한후 fine grit diamond bur 를사용하여상아질이노출되도록교합면중심와에서상아법랑질경계의직하방까지수평으로삭제하고 600 grit sand paper 로매끈하게연마하였다. 직경 3 mm, 높이 5 mm 철사를복제한균일한원기둥모양의세라믹블록을제작하기위해서 CAD/CAM 시스템 (Cerec3, Sirona, Germany) 장비를이용하여전용세라믹블록 (Ivoclar e.max CAD HT block A2 shade, Ivoclar Vivadent, Liechtenstein) 을절삭하였다. 세라믹블록의부착면은 5% 불산으로 20 초간산부식및 60 Embedded tooth Fig. 1. Cementation of ceramic and prepared specimen. Embedding dental sone Table 1. Composition of resin cements used in this study Resin cement Main composition Manufacturer Unicem methacrylate monomers containing phosphoric acid groups, silanated fillers 3M ESPE, USA Biscem Bis (hydroxyethyl methacrylate) phosphate (base); tetraethylene glycol dimethacrylate; dental glass Bisco, USA Variolink II Bis-GMA +, TEGDMA ++, UDMA +++ Ivoclar Vivadent, Liechtenstein + Bis-GMA: bisphenol A-glycidyl methacrylate, ++ TEGDMA: triethyleneglycol dimethacrylate, +++ UDMA: urethane dimethacrylate. 대한치과보철학회지 51 권 1 호, 2013 년 1 월 21
Boxplot of Resin cement vs Thermocycling biscem unicem variolink 22.5 Metal Zig Embedding dental stone Instron cross head (0.5 mm/min) Cylindrical ceramic block (D: 3 mm H: 5 mm) Tooth Shear bond strength (MPa) 20.0 17.5 15.0 Instron 12.5 No Yes No Yes No Yes Thermocycling Fig. 2. Shear bond test in universal testing machine. Fig. 3. Shear bond strength values of all groups with/without thermocycling. 3. 전단결합강도의측정 상아질면에세라믹블록이접착된시편을석고매몰후 Universal testing machine (Instron, MA, USA) 에수직으로고정하고 0.5 mm/min 의전단속도로파절되는순간의힘 (N/mm 2 = MPa) 을기록하여전단결합강도를측정하였다 (Fig. 2). 4. 통계분석 SAS Ver. 9.2 (SAS Institute, Cary, NC, USA) 프로그램으로각군을단측검정 t-test 를이용하여유의수준 0.05 로검증하였다. 세개의군을비교시 one-way ANOVA 를사용하고 Tukey's test 를이용하여사후검정을실시하였다. 결과 1. 세군의전단결합강도값을 thermocycling 시행여부에따라비교하였을때다음과같은결과를얻었다 (Fig. 3, Tables 2, 3) (1) Unicem 군은 thermocycling 을시행하지않은경우의평균은 20.67 이고시행한경우의평균은 18.93 으로통계적으로접착강도에유의한차이가있었다 (P<.05). (2) Biscem 군은 thermocycling 을시행하지않은경우의평균은 18.93 이고시행한경우의평균은 17.85 로통계적으로접착강도에유의한차이가없었다 (P<.05). (3) Variolink II 군은 thermocycling 을시행하지않은경우의평균은 18.91 이고시행한경우의평균은 16.43 으로통계적으로접착강도에유의한차이가있었다 (P<.05). 2. 세군을동시에비교하였을때다음과같은결과를얻었다. (1) Thermocycling 을시행하지않은경우 one-way ANOVA 분석결과 3 개의군사이에통계적으로유의한차이가없었다 (P<.05)(Table 4). (2) Thermocycling 을시행한경우 one-way ANOVA 분석결과 3 개의군사이에통계학적으로유의한차이가있었기때문에다중비교검토하였다 (P<.05)(Table 5). Biscem 군과 Unicem 군은유의한차이가없었고 Biscem 군과 Variolink II 군도유의한차이가없었다. 그러나 Unicem 군과 Variolink II 군은유의할만한차이가있었다 (Table 6). Table 2. Mean and Standard variation of the shear bond strength (MPa) of all groups with/without thermocycling (Mean ± SD) Thermocycling Resin cement Unicem Biscem Variolink II No 20.67 ± 1.98 18.93 ± 2.09 18.91 ± 2.69 Yes 18.93 ± 2.40 17.85 ± 1.91 16.43 ± 2.01 Table 3. T-test of Unicem, Biscem, and Variolink II with/without thermocycling Group t value P-value* Unicem 2.17.039 Biscem 1.47.153 Variolink II 2.86.008 22 대한치과보철학회지 51 권 1 호, 2013 년 1 월
Table 4. One-way ANOVA for shear bond strength without thermocycling Source DF Sum of squares Mean square F value P-value Resin cement 2 30.779 15.389 2.98.062 Error 42 217.140 5.170 Total 44 247.919 Table 5. One-way ANOVA for shear bond strength with thermocycling Source DF Sum of squares Mean square F value P-value Resin cement 2 47.269 23.634 5.28.009 Error 42 187.828 4.472 Total 44 235.097 Table 6. Result of Tukey multiple comparisons for shear bond strength with thermocycling Resin cement N Mean SD F value P-value Tukey Unicem 15 18.932 2.397 A Biscem 15 17.852 1.908 5.28.009 A,B Variolink II 15 16.429 2.007 B Thermocycling 시행여부와상관없이 Unicem 군은접착강도의평균이 20.67 MPa 와 18.93 MPa 로다른레진시멘트와근소한차이지만가장높았다. 고찰 본연구는최근각광받고있는 CAD/CAM 시스템인 Cerec3 장비를사용하여심미수복에많이사용되는 Ivoclar e.max CAD HT block 과 3 종의레진시멘트 (Unicem, Biscem, Variolink II ) 간의전단결합강도를비교하여세라믹수복물을접착하기에적절한레진시멘트를알아보고, 기존의 etch-and-rinse 레진시멘트대신 self-adhesive 레진시멘트를사용하였을때접착강도에문제가없는지를알아보고자하였다. Etch-and-rinse 레진시멘트의경우여러단계의과정을거치며, 성공적인접착을위해서는전처리제및본딩제의 film thickness 가중요하다. 만약균일한두께를얻지못하거나적절한 wet bonding 을얻지못할경우에는결합력이감소한다. 반면, selfadhesive 레진시멘트는치아를위한산성모노머를포함하고있기때문에추가적인표면전처리과정없이사용가능하고치면의수분조절에덜민감하다. 10,11 또한여러논문에서 self-adhesive 레진시멘트는기존의 etch-and-rinse 레진시멘트에서의접착계면을보이지는않지만변형된 smear layer 를이용하여상아질과법랑질에서훌륭한접착력과변연적합성을보여주었다. 12-17 두종류의레진시멘트간의결합강도에대하여상반된결과를보고한여러문헌을살펴보면, 전단결합강도에관한실험논문중 Variolink II 가 Unicem 보다강한접착을보인다는결과가있는반면에, 18,19 Variolink II 가 Unicem 과비슷하거나낮은값 을보인다는결과도있었다. 20,21 De Munck 등 12 과 Flury 등 22 은상아질에대한미세인장결합강도실험에서통계학적으로유의한차이를나타내지않으며, 주사전자현미경관찰을통해 selfadhesive 레진시멘트가상아질에아주얕은접착을이루고있음을보고하였다. 한편 self-adhesive 레진시멘트에관한연구에서 Unicem 은통계적으로다른접착제들과유사한접착강도를보이거나, 19,21 다른자가접착레진시멘트보다항상높은결합강도값을보고하는연구가있어혼란스럽다. 23,24 이처럼서로다양한연구결과를보이는이유는결합강도가실험매개변수의적용뿐만아니라실험방법에도크게영향을받기때문이다. 법랑질접착에대한 self-adhesive 레진시멘트의적용방법에관해서도논란이있기때문에본연구에서는법랑질을모두삭제하고상아질표면만을접착대상으로삼았다. 또한보다실제적인비교가되도록과거 Unicem 연구에서주로쓰던 mixing machine 을이용한혼합방식이아니라다른 self-adhesive 레진시멘트와동일한 Unicem clicker type 을선택하였다. Self-adhesive 레진시멘트의장기적인작용에관하여알아보기위해서 thermocycling 을시행한기존연구가많지않았다. Brunzel 등 25 은 RelyX Unicem 의접합력에관한연구에서 "soft" thermocycling (37,500 cycle, 20-40 ) 및 "hard" thermocycling (37,500 cycle, 5-55 ) 간에통계적으로유의한차이가없음을보고하였고, Holderegger 등 26 은 5-55 에서 1,500 cycle thermocycling 후모든 luting 시멘트의접착력은감소하였는데, 그중 RelyX Unicem 의변화가최소였다고보고하였다. 본연구에서는 5-55 에서 5,000 cycle thermocycling 을시행하였다. 이전연구에서 ISO TR 11450 표준에의한 5-55 에서 500 cycle thermocycling 이장기 대한치과보철학회지 51 권 1 호, 2013 년 1 월 23
간상아질결합의효율성을검증하기에는부족한것으로평가되었다. 27 Ernst 등 28 은 5 와 55 의온도가통상적인열순환의조건으로사용되기에적절한온도범위라고하였고, Yap 등 29 이 5,000 cycle 은임상적으로약 6 개월정도의기간과비슷하다고하였다. 이상의연구결과를토대로 CAD/CAM 을이용하여세라믹인레이를당일수복할때기존의 etch-and-rinse 레진시멘트대신 self-adhesive 레진시멘트를사용하더라도결합강도에는문제가없음을확인하였다. 그러나이번연구에서다른사람의발치된치아를사용하였기때문에구강상태를완벽하게재현하거나완전히동일한실험조건을이루기에한계가있었다. 또한이번에 3 종의레진시멘트만사용되었는데더정확한비교실험을위해서보다많은종류의레진시멘트와시편을대상으로추가연구가필요하리라생각된다. 향후연구에서는 thermocycling 을더많은 cycle 조건하에서인공노화과정을더욱세분화하거나기계적응력측정 ( 씹는시뮬레이션형태의예 ) 방법및세라믹과상아질계면에서발생하는레진시멘트의파절면분석을포함한다면더욱의미있는연구가되리라사료된다. 결론 Self-adhesive 레진시멘트인 Unicem 과 Biscem 을사용하여 CAD/CAM 세라믹인레이를접착하면그과정이간략할뿐만아니라접착강도면에서도우수하여 etch-and-rinse 레진시멘트인 Valiolink II 를충분히대체할수있으며, 이는임상적으로유용하다. 참고문헌 1. Irie M, Suzuki K. Current luting cements: marginal gap formation of composite inlay and their mechanical properties. Dent Mater 2001;17:347-53. 2. Hayashi M, Tsuchitani Y, Kawamura Y, Miura M, Takeshige F, Ebisu S. Eight-year clinical evaluation of fired ceramic inlays. Oper Dent 2000;25:473-81. 3. Hayashi M, Tsuchitani Y, Miura M, Takeshige F, Ebisu S. 6-year clinical evaluation of fired ceramic inlays. Oper Dent 1998;23: 318-26. 4. Fasbinder DJ, Dennison JB, Heys D, Neiva G. A clinical evaluation of chairside lithium disilicate CAD/CAM crowns: a two-year report. J Am Dent Assoc 2010;141:10S-4S. 5. Wiedhahn K. From blue to white: new high-strength material for Cerec-IPS e.max CAD LT. Int J Comput Dent 2007;10:79-91. 6. Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. J Prosthet Dent 1999;81:135-41. 7. Tjan AH, Dunn JR, Grant BE. Marginal leakage of cast gold crowns luted with an adhesive resin cement. J Prosthet Dent 1992;67:11-5. 8. White SN, Sorensen JA, Kang SK, Caputo AA. Microleakage of new crown and fixed partial denture luting agents. J Prosthet Dent 1992;67:156-61. 9. Han L, Okamoto A, Fukushima M, Okiji T. Evaluation of physical properties and surface degradation of self-adhesive resin cements. Dent Mater J 2007;26:906-14. 10. Mazzitelli C, Monticelli F, Osorio R, Casucci A, Toledano M, Ferrari M. Effect of simulated pulpal pressure on self-adhesive cements bonding to dentin. Dent Mater 2008;24:1156-63. 11. Moszner N, Salz U, Zimmermann J. Chemical aspects of selfetching enamel-dentin adhesives: a systematic review. Dent Mater 2005;21:895-910. 12. De Munck J, Vargas M, Van Landuyt K, Hikita K, Lambrechts P, Van Meerbeek B. Bonding of an auto-adhesive luting material to enamel and dentin. Dent Mater 2004;20:963-71. 13. Monticelli F, Osorio R, Mazzitelli C, Ferrari M, Toledano M. Limited decalcification/diffusion of self-adhesive cements into dentin. J Dent Res 2008;87:974-9. 14. Behr M, Hansmann M, Rosentritt M, Handel G. Marginal adaptation of three self-adhesive resin cements vs. a well-tried adhesive luting agent. Clin Oral Investig 2009;13:459-64. 15. D'Arcangelo C, De Angelis F, D'Amario M, Zazzeroni S, Ciampoli C, Caputi S. The influence of luting systems on the microtensile bond strength of dentin to indirect resin-based composite and ceramic restorations. Oper Dent 2009;34:328-36. 16. Mörmann W, Wolf D, Ender A, Bindl A, Göhring T, Attin T. Effect of two self-adhesive cements on marginal adaptation and strength of esthetic ceramic CAD/CAM molar crowns. J Prosthodont 2009;18:403-10. 17. Sarr M, Mine A, De Munck J, Cardoso MV, Kane AW, Vreven J, Van Meerbeek B, Van Landuyt KL. Immediate bonding effectiveness of contemporary composite cements to dentin. Clin Oral Investig 2010;14:569-77. 18. Piwowarczyk A, Bender R, Ottl P, Lauer HC. Long-term bond between dual-polymerizing cementing agents and human hard dental tissue. Dent Mater 2007;23:211-7. 19. Lührs AK, Guhr S, Günay H, Geurtsen W. Shear bond strength of self-adhesive resins compared to resin cements with etch and rinse adhesives to enamel and dentin in vitro. Clin Oral Investig 2010;14:193-9. 20. Bitter K, Paris S, Pfuertner C, Neumann K, Kielbassa AM. Morphological and bond strength evaluation of different resin cements to root dentin. Eur J Oral Sci 2009;117:326-33. 21. Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K, Maida T, Lambrechts P, Peumans M. Bonding effectiveness of adhesive luting agents to enamel and dentin. Dent Mater 2007;23:71-80. 22. Flury S, Lussi A, Peutzfeldt A, Zimmerli B. Push-out bond strength of CAD/CAM-ceramic luted to dentin with self-adhesive resin cements. Dent Mater 2010;26:855-63. 23. Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M. Selfadhesive resin cements: a literature review. J Adhes Dent 2008;10:251-8. 24. Viotti RG, Kasaz A, Pena CE, Alexandre RS, Arrais CA, Reis AF. Microtensile bond strength of new self-adhesive luting agents and conventional multistep systems. J Prosthet Dent 2009;102:306-12. 24 대한치과보철학회지 51 권 1 호, 2013 년 1 월
25. Brunzel S, Yang B, Wolfart S, Kern M. Tensile bond strength of a so-called self-adhesive luting resin cement to dentin. J Adhes Dent 2010;12:143-50. 26. Holderegger C, Sailer I, Schuhmacher C, Schläpfer R, Hämmerle C, Fischer J. Shear bond strength of resin cements to human dentin. Dent Mater 2008;24:944-50. 27. Gale MS, Darvell BW. Thermal cycling procedures for laboratory testing of dental restorations. J Dent 1999;27:89-99. 28. Ernst CF, Euler T, Willershausen B. Approximal temperature increase and decrease during thermocycling in vivo. J Dent Res 1997; Special Issue, Abstr 231:42. 29. Yap AU, Wang X, Wu X, Chung SM. Comparative hardness and modulus of tooth-colored restoratives: a depth-sensing microindentation study. Biomaterials 2004;25:2179-85. 대한치과보철학회지 51 권 1 호, 2013 년 1 월 25
ORIGINAL ARTICLE 백철우 1 박철우 1 박준섭 2 류재준 1 * 1 고려대학교임상치의학대학원심미수복학과, 2 굿윌치과병원 연구목적 : 본연구는최근심미수복에주로사용되는 CAD/CAM 세라믹인레이와각종레진시멘트간의결합강도를알아보고자하였다. 연구재료및방법 : 원기둥모양의세라믹블록 ( 높이 : 5 mm, 직경 : 3 mm) 을 Cerec3 로제작하고, 총 90 개의우식이없는대구치의상아질표면에세종류의레진시멘트 (Unicem, Biscem, Variolink II ) 를사용하여각각제조업체의지시에따라접착했다. 90 개의시편을레진시멘트의종류에따라 3 개의군으로나누고, 각군의절반은 5-55, 5,000 cycle 조건하에서 thermocycling 을시행하였고, 다른절반은시행하지않았다. 모든시편은결합강도를측정하기전에 37 생리식염수에 24 시간동안보관되었다. 전단결합강도는만능시험기를이용하여 0.5 mm/min 의 cross head speed 로측정하였다. 결과값은 t-test 및 one-way ANOVA 를사용하여통계분석하였다. 결과 :Unicem 군의전단결합강도가 thermocycling 후에약간감소했으나 3 개의군중가장높은결합강도를보였다. Unicem 및 Valiolink II 군의전단결합강도가 thermocycling 에영향을받았지만 Biscem 은영향을받지않았다 (P<.05). Thermocyling 전에는 3 개의군간의결합강도에유의한차이가없었지만, thermocyling 후에는 Unicem 과 Valiolink II 군간에유의한차이가있었다 (P<.05). 결론 : CAD/CAM 세라믹인레이수복물을치아에접착할때, etch-and-rinse 레진시멘트인 Valiolink II 대신 self-adhesive 레진시멘트인 Unicem 과 Biscem 을사용해도임상적으로유용하다. ( 대한치과보철학회지 2013;51:20-6) 주요단어 : 레진시멘트 ; Cerec3; 세라믹인레이 ; 전단결합강도 ; 열순환 * 교신저자 : 류재준 425-707 경기안산시단원구고잔1동 516 고려대학교의료원안산병원치과 031-412-5370: e-mail, koprosth@unitel.co.kr 원고접수일 : 2012년 10월 10일 / 원고최종수정일 : 2012년 12월 8일 / 원고채택일 : 2013년 1월 5일 c 2013 대한치과보철학회 cc 이글은크리에이티브커먼즈코리아저작자표시-비영리 3.0 대한민국라이선스에따라이용하실수있습니다. 이저자들은본연구에동일한기여를하였음. 26 대한치과보철학회지 2013 년 51 권 1 호