Journal of Korean Academy of Oral Health 2014 September 38(3):131-137 http://dx.doi.org/10.11149/jkaoh.2014.38.3.131 Original Article 일부시판불소바니쉬의불소이온유리량비교 김한나, 정명수, 김세연, 김진범, 정승화 부산대학교치의학전문대학원예방치과학교실 Evaluation of release of fluoride from dental varnishes marketed in Korea Han-Na Kim, Myung-Su Jeong, Se-Yeon Kim, Jin-Bom Kim, Seung-Hwa Jeong Department of Preventive and Community Dentistry, Pusan National University School of Dentistry, Yangsan, Korea Received: May 23, 2014 Revised: July 21, 2014 Accepted: August 21, 2014 Corresponding Author: Seung-Hwa Jeong Department of Preventive and Community Dentistry, Pusan National University School of Dentistry, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea Tel: +82-51-510-8222 Fax: +82-51-510-8221 E-mail: jsh0917@pusan.ac.kr * 이논문은 2014 년도부산대학교기초과학연구원기초과학연구지원사업비에의하여연구되었음 (RIBS-PNU-2014-302). Objectives: The purpose of this study was to compare the amount and rate of cumulative fluoride released over a period of 4 h from several varnishes marketed in Korea. Methods: The following six commercial products were studied: cavity shield (CS, ppm F), V varnish (VV, ppm F), enamel pro varnish (EP, ppm F), MI varnish (MI, 22600 ppm F), fluorine care (FC, 22600 ppm F), and fluor protector N (FP, 7700 ppm F). Five samples were collected from each varnish. Further, 10 mg of each varnish were applied onto an acrylic surface (diameter, 5 mm) and then immersed in 20 ml of distilled water at 37 o C. The fluoride concentration in each sample was then analyzed after 30 min, 1, 2, 3, and 4 h, and after 4 days of exposure. Results: The cumulative amount of fluoride released by FC (5.64±1.10 ppm) was significantly higher than that released by other products after 30 min. FC (8.55±1.85 ppm) and MI (8.21±0.81 ppm) released a significantly higher cumulative amount of fluoride after 4 h. The cumulative rate of fluoride released by FC (47.80±9.35%) was significantly higher than that of other products after 30 min. FC (72.44±15.68%) and MI (69.54±6.88%) showed a higher cumulative fluoride release rate after 4 h. MI sustainably released fluoride after 4 h and demonstrated a high fluoride release rate of 95.76%. Conclusions: The cumulative amount and rate of fluoride released by several varnishes were statistically significant at each time point. This data can be used by clinicians prior to selection of dental products. Key Words: Fluoride release, Fluoride varnish 서론 1940년대미국에서음용수에포함된불소가치아우식증을감소시킨다는사실 1) 이증명된이후, 다양한불소화합물제품이예방술식으로사용되고있다. 치아우식증예방을위한불소활용법중에서불소복용법으로수돗물불소농도조정사업, 불소가첨가된소금과우유의섭취가있다. 자가국소도포법으로불소치약, 불소용액양치등이있고, 전문가국소도포법으로불소젤, 불소폼, 불소바니쉬도포등이있다. 불소의치아우식예방기전은불소의 높은이온친화력으로탈회된치아주변의무기질이온을끌어들여, 치아에침착시킴으로써치아의재광화를증가시키며, 치아표면에결합되어서치아의구조인수산화인회석 (OH-apatite) 을불화인회석 (F-apatitie) 구조로전환시켜법랑질의격자구조를더욱치밀하게함으로써치질의강도를높이고산 (acid) 에대한저항성을증가시킨다 2). 치아우식증원인균의대사과정에관여하여, 미생물의해당작용을억제함으로써, 미생물에의한산생성을억제한다 3). 불소바니쉬 (Fluoride varnish) 는치아에도포후, 얇은막을 Copyright 2014 by Journal of Korean Academy of Oral Health 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. JKAOH is available at http://www.jkaoh.org pissn 1225-388X / eissn 2093-7784
132 J Korean Acad Oral Health 2014;38:131-137 형성하여치아에오랫동안잔류하면서불소를지속적으로방출하기위한목적으로개발된제품으로 4), 유럽에서 1964년처음으로소개되었고그뒤로 25년동안수많은임상연구를통해안전하고효과적인불소도포법으로인정받았다 5). 불소바니쉬는구강내에도포후저농도의불소가제품에따라 1-7일동안유지되어며다른고농도의도포용불화물이 10-15분이후에구강내에서소실되는점을감안할때, 비교적오랫동안치아에부착되어있는장점이있다 5). Tray를이용해야하는 APF gel과달리치면에붓을이용해단순도포하는방식으로사용이간단하고 6), 전처치없이바로도포가가능하며, 불소섭취에대한안정성도다른제품에비해높다 7). 최근에는농도와물성이다양한형태의제품이소개되고있다. 불소바니쉬의치아우식증예방효과를평가한많은연구가보고되었으며 8), 이들을체계적으로고찰한 Marinho 등 9) 의 Cochran 리뷰에따르면, 불소바니쉬는어린이와청소년의유치및영구치의우식감소에효과가있으며, 영구치와유치우식감소율이각각 46%, 33% 이라고보고하였다. 또한불소바니쉬평가를위한 in vitro 실험연구에따르면, 5% NaF를주원료로하는 4종류의불소바니쉬 (Premier Enamel ProVarnish, Colgate Previ- Dent, Omni Vanish, Omni Vanish XT) 를도포한후인공타액에 48시간동안침척시켜, 용액에유리되는불소이온농도를측정하였다. 그결과에서 Premier Enamel ProVarnish가가장높은불소이온을유리하여, 불소이온유리량이제품에따라차이가있음을제시하기도하였다 10). Shen과 Autio-Gold 12) 의연구에서는 Duraphat, Duraflor, CavityShiled 3종류의불소바니쉬를플라스틱바에도포한뒤인공타액에서불소이온유리량을측정하고도포량대비유리량을기준으로제품에동질성에대한평가를시행하였다. 그결과천연수지가함유된 CavityShiled가가장낮은불소이온을유리하였고튜브형태제품이동질성이낮게평가되었다. 또다른선행연구로는불소를함유한 resin composit의불소유리량평가에관한연구는보고되고 13), 유사한국내연구로치과용수복재의불소이온유리를평가한연구로시간에따른유리량의감소가제품에따라차이가있음을제시하였다 14). 불소가함유된고분자테잎을이용한불소유리량을측정한연구가시행되었지만 15), 4시간동안구강내에유지하도록하는제조자의권고사항을고려한불소바니쉬의불소유리량에대한연구는소수이거나과거의연구로국한되어있다. 다른국소불소도포제제와대비되는불소바니쉬의대표적인장점은구강내도포후, 일정기간동안지속적으로불소가구강내에유리됨으로써치아의재광화를촉진시키는것이다. 따라서불소를얼마나지속적으로유리할수있는가는임상에서술자가불소바니쉬를선택하는주요한기준이된다. 최근예방치과진료의요구가증가함에따라, 사용이간편하고우식예방에효과적인불소바니쉬도포가증가하고있으며, 국내에도다양한국내외제품들이소개되어임상에서활용되고있다. 비록대부분의제품들이동일한농도의불소화합물 (5% NaF) 을함유하고있지만, 제품간물성의차이가존재할뿐만아니라, 구성성분의차이가존재하기 때문에, 각제품간불소유리능력의차이가존재할것으로예상된다. 일부선행연구에서몇몇제품의불소유리능력을보고한바있으나, 최근국내에출시된일부제품들에대해서는보고된바없다. 시판중인다양한제품을동일한실험환경에서비교, 평가함으로써임상에서불소바니쉬선택시고려해야할정보를지속적으로제공할필요가있다. 따라서본연구의목적은국내에서시판되고있는일부불소바니쉬제품의시간에따른불소유리능력을비교하는것이다. 대상및방법 1. 연구재료불소바니쉬는국내에서판매되고있는 6가지제품을연구재료로하였다. Cavity shield (CS, 3M ESPE c, USA), V varnish (VV, Vericom c, Korea), Enamel pro varnish (EP, Premier Dental Products c, USA), MI varnish (MI, GC c, Japan), Fluorine care (FC, Hearim Dental c, Korea), and Fluor protector N (FP, Ivoclar Vivadent c, Liechtenstein). 국내에서시판되고있는국산바니쉬 2종 (VV, FC) 과외산바니쉬 4 종 (CS, EP, FP, MI) 을연구재료로하였다. 시판되는바니쉬중에서국내제품과의비교를위해서최근출시된 2가지의국내제품을연구대상에포함시켰다. FP의불소농도는 7,700 ppm이었고이제품을제외한나머지 5가지제품의불소농도는 ppm 이었다 (Table 1). FP는액상, FC는 flowable resin와유사하게점도가낮고광조사후단단하게경화되는형태였고나머지제품들은일반적인불소바니쉬의물리적성상을띄고있었다. 2. 연구방법 2.1. 불소바니쉬샘플의준비와불소이온의유리 각불소바니쉬제품당 Lot 번호가동일하지않은 5개의샘플을이용하였다. 모든제품은실험 24시간전에상온에보관한뒤도포직전에개봉하여사용하였다. 일회용량으로포장된제품은제조사의권고에따라제품을충분히혼합한후도포하였고 FP( 용기에담긴제품 ) 은내용물이충분히혼합될수있도록흔들어준뒤, 제품을수직으로세워내용물을한방울씩떨어뜨려초반에나오는 5방울까지의내용물은버리고, 그이후의내용물을사용하였다. FC (Syringe 형태 ) 는개봉하여처음 50 mg정도는짜서버리고그이후내용물을사용하였다. 6가지제품의 10 mg의바니쉬를 5 mm 지름의원기둥모양의아크릴봉에도포하였다. 바니쉬도포량의오차를 10% 미만으로유지하기위해서소수점넷째자리가표기되는전자저울을이용하여영점조절을하고 Micropipet을이용하여 0.01 ml를골고루도포하였다. 0.01 ml의소량의바니쉬를 5 mm라는한정된범위에도포하였기에제품간두께차이는감지하지못할정도였다. Fluorine- Care는제조사의지시에따라도포후광중합기를이용하여 15초씩광조사하였다. 바니쉬가도포된아크릴봉끝부분을증류수 20 ml에침적후
133 김한나외 일부시판불소바니쉬의불소이온유리량비교 Table 1. Tested fluoride varnishes Product name Manufacturer Type of packing Main contents CavityShield Enamel Pro V varnish Fluorine- Care MI varnish Fluor protector N 3M ESPE, USA Premier Dental Products, USA Vericom, Korea Hearim Dental, Korea GC, Japan Ivoclar Vivadent, Liechtenstein Single dose of 0.40 ml or 0.25 ml Single dose of 0.4 ml Single dose of 0.4 ml 3 g in syringe (Light cured type) Single dose of 0.5 ml 7 g in the bottle 5% NaF, Rosin, Xylitol. 5% NaF, ACP. 5% NaF, TCP, Rosin, Xylitol. 5% NaF, Calcium Glycerophosphate 5% NaF, CPP-ACP. 1.5% Ammonium fluoride, Film formers Fluoride concentration 7,700 37 항온기에서보관되었다. 시간에따른누적된불소이온유리량은 30분간격으로 4시간동안그리고마지막 4일째측정하여총 9회측정하였다. 유리된불소이온농도은아크릴봉을침적시킨 20 ml의 0.5% 에해당하는 0.1 ml를분리한후 0.01 ml의 TISAB III를첨가하여불소이온전극을이용하여측정하였고측정에사용된용량의새증류수는첨가하지않았다. 2.2. 유리된불소이온농도측정불소바니쉬의불소유리량을측정하기위해불소이온전극을사용하였다. 매측정시마다표준검량선 (Standard curve) 을작성하였다. 100 ppm 농도의불소이온표준원액 (Fluoride standard 100 ppm F, Orion, USA) 를증류수에희석하여 0.01, 0.1, 1.0, 5.0, 10.0, 15.0 ppm의불소이온표준용액을준비하였다. 준비된표준용액 5 ml와 TISAB III (Total Ionic Strength Buffer III) 용액 0.5 ml을 10:1 비율이되도록혼합한뒤, 불소이온전극 (Orion Fluoride Electrode 9609, Orion Research Inc, MA, USA) 을용액에침지시켜이온분석기 (Expandable ion Analyzer 940, Orion, Boston, MA, USA) 를이용하여표준검량선을작성하였다. 불소이온전극의제조사의지시사항을참고하여작성된 표준검량선의 slope는 56-60 mv/dec에포함되도록하여적정 slope를유지하였다. 6가지불소바니쉬제품마다 5개씩제작된샘플의불소이온은 3번반복측정되었고, 마지막측정값을사용하였다. 불소이온농도양과전체도포량대비유리되는비율이제시되었다. 3. 분석방법시간에따라측정된불소이온농도는제품간평균분석을통해나온결과값을평균과표준편차로제시하고도포된총불소함량대비유리된불소의비율을산출하였다. FP의불소함유량은나머지 5가지제품보다낮아, 통계학적유의성을확인하는제품간의비교에서는제외하였다. FP를제외한불소바니쉬제품에따른불소이온농도와유리된불소이온의비율의차이는비모수검정인 Kruskal-Wallis를이용하여검증하였고사후분석으로는 Mann- Whitney를이용하였다. Kruskal-Wallis 통계분석의제1종오류에대한유의수준은 0.05, 사후검정의유의수준은본페로니조정을고려한 0.1로판정하였으며, PASW 통계패키지버전 21.0 (SPSS Inc., Chicago, IL, USA) 을이용하였다. 연구성적 1. 불소이온농도의차이각제품의샘플들을침적하여유리되는시간에따른누적불소이온농도는다음과같았다 (Table 2). 30분침적시에는 FC (5.64 ±1.10 ppm) 가다른 4가지제품에비해서통계학적으로유의한가장높은불소이온농도를나타냈고, CS (0.04±0.01) 가가장낮은불소이온농도를나타냈다. 4시간침적후에는 FC (8.55±1.85 ppm), MI (8.21±0.81 ppm), VV (5.26±0.34 ppm), EP (5.10±0.76 ppm), FP (0.92 ±0.10 ppm), CS (0.26±0.04 ppm) 의순서로불소이온유리량을보였고, MI와 FC 그룹이다른제품들에비해통계적으로유의하게가장높은불소이온농도가측정되었고, CS는통계적으로유의하게가장낮은불소이온농도를나타냈다. 4일동안샘플을침적시킨후측정시, MI (11.30±0.43 ppm), EP (11.10±1.17 ppm), FC (9.59±1.57 ppm), VV (7.49±1.40 ppm), FP (3.35±0.47 ppm), CS (1.17±0.57 ppm) 가순으로불소이온농도를나타냈고, EP와 MI 그리고 FC 그룹이다른제품들에비해통계적으로유의하게가장높은불소이온농도가측정되었고, CS는통계적으로유의하게가장낮은불소이온농도를나타냈다. 시간에따른유리되는불소이온농도는 FC가가장많았지만, 1시간 30분이후에는그증가량이적었으며, MI, EP와 VV는초기유리되는불소이온량은적었지만시간에따라불소이온이지속적으로유리되었다. 2. 불소이온농도비율의차이각제품의샘플에함유된총불소함량대비유리된불소이온농도비율은다음과같았다 (Table 3, Fig. 1). 30분침적시에는 FC (47.80±9.35%), FP (15.16±7.01%), MI (8.76±2.55%), EP (2.49±0.70%), VV (1.39±0.34%), CS (0.38±0.10%) 의순으로불소이온농도비율을나타냈다. FC가다른 4가지제품에비해서통계학적으로유의한가장높은불소이온농도비율이였고, CS가통계학적으로유의한가장낮은불소이온농도로나타났다. 4시간침적후에는 FC (72.44±15.68%), MI (69.54± 6.88%), VV (44.61±2.88%), EP (43.20±6.47%), FP (23.91 ±2.64%), CS (2.16±0.34%) 의순으로불소이온농도비율을나
134 J Korean Acad Oral Health 2014;38:131-137 Table 2. Cumulative amount of fluoride release (ppm) from 6 fluoride varnishes (Mean±SD) Time CS VV EP MI FC FP 30 min 1 h 1 h 30 min 2 h 2 h 30 min 3 h 3 h 30 min 4 h 4 days 0.04±0.01 a 0.08±0.02 a 0.12±0.05 a 0.14±0.04 a 0.19±0.04 a 0.21±0.04 a 0.27±0.08 a 0.26±0.04 a 1.17±0.57 a 0.16±0.04 b 0.35±0.09 b 0.86±0.35 b 1.92±0.80 b 3.01±0.69 b 4.15±0.48 b 5.04±0.37 b 5.26±0.34 bd 7.49±1.40 b 0.29±0.08 b 1.46±1.14 bc 2.36±0.80 c 3.34±0.61 bc 3.92±0.70 bc 4.57±0.93 bcd 4.60±0.69 b 5.10±0.76 b 11.10±1.17 c 1.03±0.30 c 2.97±0.39 c 4.49±0.55 d 4.77±0.65 c 5.73±1.00 cd 6.67±0.83 cd 7.50±0.97 cd 8.21±0.81 cd 11.30±0.43 c 5.64±1.10 d 7.28±1.70 d 7.85±1.98 e 8.16±1.29 d 8.06±1.63 d 7.81±1.47 d 8.27±0.73 d 8.55±1.85 d 9.59±1.57 d 0.58±0.27 0.65±0.24 0.68±0.26 0.79±0.27 0.80±0.19 0.90±0.16 0.93±0.11 0.92±0.10 3.35±0.47 CS, CavityShield; VV, V varnish; EP, Enamel Pro varnish; MI, MI Varnish; FC, Fluorine- Care; FP, Fluor Protector N. Five samples were tested from each fluoride varnish. Values are presented as mean±sd of fluoride concentration (ppm). FP was not included Kruskal-Wallis signed rank test and Mann-Whitney. Kruskal-Wallis signed rank test was used to compare the differences. Different superscript letter denote values that are significantly different one another for 5 varnishes in same time (P<0.05) by Mann-Whitney U test using Benfenoni Correction. Table 3. Cumulative fluoride release percent of total amounts from 6 fluoride varnishes (Mean±SD) Time CS VV EP MI FC FP 30 min 1 h 1 h 30 min 2 h 2 h 30 min 3 h 3 h 30 min 4 h 4 days 0.38±0.10 a 0.68±0.21 a 1.05±0.40 a 1.22±0.37 a 1.63±0.31 a 1.77±0.32 a 2.29±0.70 a 2.16±0.34 a 9.90±4.83 a 1.39±0.34 bc 3.00±0.80 bc 7.33±2.99 b 16.27±6.81 bc 25.53±5.82 bc 35.20±4.07 bc 42.71±3.09 bc 44.61±2.88 bce 63.51±11.86 b 2.49±0.70 c 12.38±9.69 cd 20.02±6.80 c 28.27±5.18 cd 33.19±5.93 bcd 38.69±7.92 cd 39.00±5.81 c 43.20±6.47 c 94.50±9.95 c 8.76±2.55 d 25.17±3.33 d 38.07±4.64 d 40.39±5.54 d 48.52±8.46 de 56.51±7.06 d 63.54±8.18 d 69.54±6.88 d 95.76±3.65 c 47.80±9.35 e 61.69±14.40 e 66.54±16.74 e 69.17±10.91 e 68.32±13.84 e 66.15±12.49 d 70.07±6.20 d 72.44±15.68 de 81.31±13.29 d 15.16±7.01 16.91±6.20 17.74±6.77 20.40±7.02 20.78±5.06 23.44±4.15 24.22±2.86 23.91±2.64 86.91±12.23 CS, CavityShield; VV, V varnish; EP, Enamel Pro varnish; MI, MI Varnish; FC, Fluorine- Care; FP, Fluor Protector N. Five samples were tested from each fluoride varnish. Values are presented as mean±sd of fluoride concentration (%). FP was not included Kruskal-Wallis' signed rank test and Mann-Whitney. Kruskal-Wallis' signed rank test was used to compare the differences. Different superscript letter denote values that are significantly different one another for 5 varnishes in same time (P<0.05) by Mann-Whitney U test using Benfenoni Correction. Fig. 1. Percent of cumulative fluoride release during 4 hours. Fig. 2. Percent of cumulative fluoride release after 96 h.
135 김한나외 일부시판불소바니쉬의불소이온유리량비교 타냈고, MI와 FC 그룹이다른제품들에비해통계학적으로유의하게높은불소이온농도비율이었으며, CS가제품간의유리되는불소이온농도비율비교에서통계학적으로유의하게가장낮은순위였다. 4일동안샘플을침적시킨후측정시, MI (95.76±3.65%), EP (94.50±9.95%), FP (86.91±12.23%), FC (81.31± 13.29%), VV (63.51±11.86%), CS (9.90±4.83%) 가순으로불소이온유리비율을나타냈으며, EP, MI, FC 그룹이다른제품들에비해통계학적으로유의하게높은불소이온농도비율이었으며, CS는통계학적으로유의하게가장낮은불소이온농도비율이었다 (Fig. 2). 고안 구강내의타액과치태에서낮은농도이지만서서히유리되는불소이온은치아우식예방에효과적이므로 16) 저농도의불소이온이구강내에서장기간존재하는것은불소이온의항우식효과의중요한요인중에하나이다. 도포된불소바니쉬에서유리되는불소이온의양은이온이포함된용액의불소농도로측정되고불소이온의지속력은시간의간격을두고측정하여서서히유리되는지여부로판단된다. 치아우식의재광화가가능할수있는농도가유지되어야하고, 치과임상에서예방처치를위한내원이대부분 1-2회 / 년인것을감안한다면저농도의불소이온이장기간지속되는것이권장된다. 본연구에서는불소바니쉬의불소이온유리량과그지속여부비교를목적으로시간에따른유리량을측정하고제품간비교를시행하였다. 본연구에서사용되었던불소이온전극은화합물과결합되어있지않은불소이온에반응하므로이온강도조절이필요하며측정한계가 10 6 M (0.02 ppm F ) 정도이기때문에이보다높은농도가요구된다 17). 본실험의불소이온농도결과는 0.02 ppm 이상의값으로결과에신뢰성을부여할수있다. 이온강도조절액 (TISAB solution) 의첨가는측정용액의 ph를 5-6정도로유지시켜준다. Comar 등 18) 의연구에서샘플을침적시킨용액으로증류수와인공타액을사용하였고용액에따른실험결과의유의한차이는제시하지않았으나, 제품간의유리량은인공타액보다는증류수에서더큰차이를보였다. 본연구에서증류수를이용하여실제타액의점도와 ph 등의변수를충족하지는못했으나동일조건을고려하였을때, 제품간비교하기에는무리가없었을거라사료되었다. FP를제외한나머지 5가지제품 ( ppm) 은도포된불소바니쉬가모두유리된다고가정하여, 0.01 g의불소바니쉬가도포된샘플을 20 ml의증류수에침적시키면 11.8 ppm 농도의불소가유리된다. FP (7,000 ppm) 는다른제품과동일한양을도포하였을때, 3.85 ppm의농도가유리된다. 따라서도포된총불소량대비유리된불소의비율을각불소바니쉬의유리능력을비교하는데이용하였다. 불소이온농도는측정 4시간동안 FC는가장높은유리량 을, CS가가장낮은유리량을보였다 (Table 2). Shen과 Autio- Gold 12) 의연구에서는 Duraphat, Duraflor 그리고 CS를사용하여인공타액에침적후유리되는누적불소이온농도를측정한결과 CS가가장낮은농도의불소이온을유리되는결과를보여본연구에서 CS가가장낮은유리률을보인결과와유사하였다. FC의불소이온유리비율은측정 30분에 40% 이상유리되었지만그이후시간에따른유리량은비교적적은편이었고 4일침적시에는약 81% 로 MI, EP 보다낮은유리비율을나타냈다. 본실험에서 FC가측정초기 1시간 30분안에타제품에비해유리되는불소이온량은많았으나, 표준편차가다른제품에상대적큰것으로보아지속력과제품의안정성은그리높지않은것으로사료되었다. Shen과 Autio-Gold 12) 의불소바니쉬의동질성 (uniformity) 에대한평가에서튜브형태로되어짜서쓰는제품이동질성이낮게, 즉제작된샘플에서유리되는불소이온의편차가크게나타났다. FC는치과용 flow-able resin처럼 syringe형태로제작되어있어튜브형태로제작된불소바니쉬처럼여러번사용할수있게포장되어있다. 일회용사용으로포장되어있는제품은거의모든제품이내용물을섞어사용하여동질성문제는적었다. 동질성에대한연구결과를참고하여샘플제작시충분히혼합하여사용하여야하거나튜브제품은내용물이균일하게배출되기시작한이후에샘플을제작해서사용해야할것이다. 또한제품내에불소이온이고르게분포하여도포시동질성을확보될수있도록상품생산시더많은기술투입이필요하다고사료되었다. MI는불소이온유리측정 4시간동안지속적인불소이온을유리하였고 4일째측정시에는불소이온유리비율이 95% 이상으로총도포된용량대비유리되는비율도양호한결과였다. EP는 MI 에비해서시간당유리되는불소이온의양은적었지만타제품에비해지속적인불소이온이유리되었으며 4일째측정시 94% 이상유리되었다. 4일동안침적시킨후결과에서, FP를제외한나머지제품들은모두 5% NaF를함유하고있음에도불구하고 CS가가장낮은농도의불소이온을유리하였다. MI, EP, FC, FP는거의 85% 이상의총량대비불소이온을유리하였지만, VV와 CS는상대적으로낮은불소이온유리비율이측정되었다. VV와 CS는 Rosin과 Xylitol을주요성분중하나로함유하고있었다. Xylitol는단독또는불소와함께치약을포함한다양한치과용항우식제품에주요한성분으로사용되고있다 19). 항우식효과증대를위해함유된주요한성분과불소이온간의상호작용이본실험의측정결과에유의한영향을주었는지여부는본실험에서는밝힐수없었으나추후연구가필요할것이다. 본실험에사용된 6가지제품들은일부중복되는성분이있기는하나주성분이제품별로상의함을알수있었고제품마다유리되는불소이온의양에차이를보였다. 포함된성분과제품의성상에따라유리정도에차이를보였다고추측할수있었다. Cochrane 등 20) 의연구에서 calcium이함유된바니쉬가대조군에비해유사하거나더높은불소유리를보고하여 calcium이불소이온유리를방해하지않는요소임을확인하였다. 본연구에서 EP,
136 J Korean Acad Oral Health 2014;38:131-137 VV, FC 그리고 MI의제품에 calcium성분이함유되어있었고, 그렇지않은 CS보다는유리량과유리비율이높았다. 하지만지속적이며상대적으로높은유리를보인 MI와 EP가다른제품과의차이를본연구에서는밝힐수는없었다. 실제바니쉬의치아우식증예방효과평가에서는 calcium과 phosphate ion의측정도주요한변수로고려되어야할것이다. 또한, 본연구에서사용된불소바니쉬에포함된주요한성분인 TCP, Calcium Glycerphosphate, CPP-ACP은주로칼슘이포함된화합물로이들에의한불화칼슘생성여부로인해불소이온농도가저측정되었을가능성이있다. 이러한성분이불소이온의유리에미치는영향에대한고려및포함되는성분에따른항우식효과에대한추가적인연구가필요하다. 법랑질과상아질표면에불화칼슘형성의차이에관한연구에서탈회된상아질에서불화칼슘이더많이형성되었고그이유를탈회시상아세관과세관간상아질에형성된미세균열의침투성증가로보고하였다 21). 본연구에서는아크릴봉을이용하였으므로치아시편이나실제구강내치아에서관찰되는미세균열이재현되기어려워불화칼슘의형성에차이가있었을거라사료된다. 초기도포시에바니쉬와치면의접착도도중요한요소로판단된다. 불소가함유된제품과그제품을도포한개인에따라타액내에 0.03-0.1 ppm의불소농도가 26시간정도유지된다 22). 일반적으로도포 4시간동안을바니쉬가도포된상태를유지하도록권고하는것은초기불소이온이충분히유리될수있는시간을제공할것으로사료된다. 점조도가거의없는액상제품이나점조도가낮아타액에의해치면에서쉽게씻겨없어질경우에는불소이온유리시간이상대적으로짧아질것이다. CS의경우본연구에서는낮은농도의불소이온을유리하였지만, Rosin을함유하여점조도가높아실제구강내의불소이온의측정결과가본실험연구결과와동일하지않을수도있을거라사료된다. 또한비록일부불소바니쉬가본연구에서다른제품과의비교에서상대적으로낮은불소이온유리량을보였지만, 그결과를불소바니쉬의항우식및재광화효과정도를판단하기에는신중한고려가필요하다. 불소가추후연구에서는바니쉬를이용한탈회된치면의재광화평가가필요하다. 본연구의한계점으로는불소이온농도는누적용출량으로실제구강내에서지속적으로배출되는타액의환경을재현하기에는한계가있었다. 인공타액과의반응이나실제구강내의타액용출을고려한추후연구가필요할것이다. 불소바니쉬제품의불소이온유리정도를평가하고자용액에바니쉬를바른샘플을침적시키고그용액의불소농도를측정하였기때문에불소바니쉬도포의최종효과인치아우식예방효과에직접적용하기에는한계가있다. 비록 in vitro 상의연구이지만, 불소농도가다른 5가지제품에비해낮은 FP가일부바니쉬보다높은불소유리가되었다는점을고려해본다면, 실제임상적용시불소농도와제품의성상을고려함에본연구가일부분도움이될거라사료된다. 다양한종류의불소바니쉬제품을기존의제품들과비교한것으로임상가의재료선택에있어유용한정보제공에기여하였다고판단된다. 결론 본연구는국내시판되는불소바니쉬 6가지제품의불소이온유리를평가하기위해불소바니쉬가도포된아크릴봉을 4시간동안증류수에침적시킨후시간에따른누적불소유리량과도포된전체량대비누적불소유리비율을비교하였다. 1. 5가지제품의불소이온유리량은유의한차이가있었고 (P<0.001), 30분에서는 FC (5.64±1.10 ppm), 4시간에서 FC (8.55±1.85 ppm) 와 MI (8.21±.81 ppm) 가가장많은유리량을보였다. 2. 5가지제품의불소이온유리비율은유의한차이가있었고 (P<0.001), 30분에서 FC (47.80±9.35%), 4시간에서 FC (72.44±15.68%), MI (69.54±6.88%) 로제품들중에서높은유리률을보였다. 3. MI는 4시간동안지속적인불소이온을유리하였고, 4일동안유리한불소이온비율이 95.76% 으로가장높은유리비율이었다. 5% NaF를주원료로만들어진불소바니쉬간에도불소유리량의차이를보였고, 제품에함유된성분이나성상에따른차이가발생되었으리라사료된다. 임상가의재료선택에있어유용한정보제공에기여하였다고판단된다. References 1. Mckay C. A dental epidemiological study in a high fluoride area of County Fermanagh. Ulster Med J 1974;43:41-44. 2. Ogaard B, Seppa L, Rolla G. Professional topical fluoride applications-clinical efficacy and mechanism of action. Advances in Dental Research 1994;8:190-201. 3. Baek DI, Kim HD, Jin BH, Park YD, Shin SC, Jo JW at el. Clinical preventive dentistry 5th ed. Seoul:Komoonsa;2012:221. 4. Autio-Gold JT, Courts F. Assessing the effect of fluoride varnish on early enamel carious lesion in the primary dentition. J Am Dent Assoc 2000;131:589-596. 5. Bawden JW. Fluoride Varnish: A useful new tool for public health dentistry. J Public Health Dent 1998;58:266-269. 6. Jin BH. Clinical use of fluoride varnish. Korean Dent Assoc 2008; 46:146-149. 7. Eugenio D, Jonathan W. Fluoride varnishes. JADA 2000;13:589-596. 8. Weyant RJ, Tracy SL, Anselmo TT, Beltrán-Aguilar ED, Donly KJ, Frese WA, et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144:1279-1291. 9. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;3:CD002279. 10. Riwik P, Aubel JD, Xu X, Fan Y, Hagan J. Evaluation of short term fluoride release from fluoride varnishes. Pediatr Dent 2012;36: 275-278. 11. Park SE, Yi KW, Kim HY, Son HH, Chang JH. Elemental analysis of the fluoride varnish effects on root caries initiation. JKACD 2011;36:290-299. 12. Shen C, Autio-Gold JT. Assessing fluoride concentration uniformity and fluoride release from three varnishes. JADA 2002;133:
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