Journal of Korean Academy of Oral Health 2019 December 43(4): Original Article 불소바니시 5 종의불소이온용출량비교

Journal of Korean Academy of Oral Health 2019 December 43(4):184-190 https://doi.org/10.11149/jkaoh.2019.43.4.184 Original Article 불소바니시 5 종의불소이온용출량비교 : 실험실연구 김지수, 변민지, 남용태, 김진범, 정승화 부산대학교치의학전문대학원예방과사회치의학교실 In vitro fluoride release from five different fluoride varnishes Ji-Soo Kim, Min-Ji Byon, Yong-Tae Nam, Jin-Bom Kim, Seung-Hwa Jeong Department of Preventive & Community Dentistry, School of Dentistry, Pusan National University, Yangsan, Korea Received: November 25, 2019 Revised: November 28, 2019 Accepted: December 1, 2019 Corresponding Author: Seung-Hwa Jeong Department of Preventive & Community Dentistry, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8222 Fax: +82-51-510-8221 E-mail: jsh0917@pusan.ac.kr https://orcid.org/0000-0001-5173-2859 *This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1F1A1061836). Objectives: This study aims to compare the fluoride-release between different fluorine varnish under in vitro experimental conditions. Methods: In this study, 5 fluoride varnish products distributed in Korea were selected. V-varnish TM (Vericom, Korea: VV), CavityShield TM (3M ESPE, USA: CS), Clinpro TM White varnish TM (3M ESPE, USA: CP), MI Varnish TM (GC, Japan: MI), and Fluor Protector (Ivoclar Vivadent, Liechtenstein: FP). For the in vitro study, 10 mg of each fluoride varnish was thinly applied to the same area of the specimen. The specimen was then immersed in 3 ml of distilled water at consistent intervals to confirm fluoride release. Nine specimens per group were used. Fluoride ion electrodes were used to measure the fluoride concentration of the solution. The Kruskal-Wallis nonparametric test was performed to compare between each experimental group, and the Wilcoxon signed-rank nonparametric test was performed to compare experimental groups over time. The significance level for a Type I error was set at 0.05. All statistical analyses were performed using SPSS 25.0 (IBM Co., Armonk, NY, USA). Results: In vitro experiments showed that the amount of fluoride released from MI was higher than the other groups during the first 12 hours after application. However, the amount of fluoride released from CP and CS was higher than MI as the immersion time increased over 12 and 20 hours, respectively. The fluoride release from FP was the lowest at all measurement points. Conclusions: The results of this study showed that the remaining fluoride effect from rosin type fluoride varnishes was higher than liquid type fluoride varnishes. There were differences in the residual fluoride concentrations despite each fluoride varnish having the same fluoride content. Key Words: Dental caries, Fluoride release, Fluoride varnish, In vitro study 서론 치아우식을예방하는것은치료보다더효율적인처치이며치과치료에서최우선적으로고려되어야할사항이다. 현재까지알려진우식병소의발생과진행을막는대표적인물질은불소 (Fluoride) 이다. 구강내에서불소는치면세균막에축적되거나분비된타액내에일정농도이상으로유지되면서미생물의산생성과관련한대사작용을억제하고치아우식예방효과를나타낸다 1-3). 치아표면에침착된불소는법랑질치질과결합하여수산화인회석을불화인회석으로바꾸어법랑질 의내산성을증가시키며, 치면세균막에서형성된산에의한탈회를억제한다. 또한, 저농도의불소이온은타액내무기질성분에의해탈회된치아의재광화를촉진시킨다 1-3). 다양한불소제재중한가지인불소바니시 (Fluoride Varnish: FV) 는 1960년대에소개된이후유럽뿐만아니라캐나다, 미국등에서널리사용된전문가국소도포불소제제 (Professionally applied topical fluoride) 이다 4). FV는치아법랑질표면에얇게도포되어치아표면에오랫동안부착되고접촉시간을증가시킬뿐만아니라불소가천천히방출하도록하는저장고역할을한다 5). FV는치면세마후작은 Copyright 2019 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/4.0/), 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

185 김지수외 불소바니시 5종의불소이온용출량비교 : 실험실연구 브러시를이용하여도포하고환자에따라일년에 2-4회도포할수있다. 도포되는양은 0.5 ml 정도로소량이기때문에불소섭취에따른부작용은적으며, 치아우식예방효과는크고진료실에서비교적간편하게도포할수있다는장점이있어어린이들에게유용하게활용이되고있는불소제제이다 6). 영구치를가진어린이또는청소년을대상으로조사한연구에서 FV를도포한사람들에게서우식, 상실, 치료된치아가평균 46% 감소한것으로나타났으며, 유치에서는 33% 감소한것으로나타났다 6). 구강내불소농도가일정수준이상으로유지되면치아우식의진행을늦추고법랑질의재광화를유도하는것으로알려져있다 7). Featherstone은 in vitro 및 in vivo 연구에서타액의불소농도가 0.1 ppm 이상이면우식위험도가높은사람들에게항우식효과가있다고보고하였다 8). 그러므로오랜시간구강내불소농도를유효수준이상으로유지하는 FV는항우식및재광화에유용한불소도포제재라할수있다. FV의성분조합은불소농도의지속성에영향을준다는연구도있다. 동일한실험실조건이라도제품마다부가적으로첨가한성분에따라도포직후짧은시간동안다량의불소를방출하기도하고, 다량의불소를방출하지는못하지만오랜시간동안불소를서서히방출하는등시간에따른불소방출량과불소농도의지속시간에차이를보고하였다 9). 칼슘, 무기인산염등이함유된 4종의 FV (MI varnish TM, Clinpro TM white, Enamel Pro TM, Bifluorid TM ) 불소이온방출량을평가한연구에따르면 Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) 를함유한 MI varnish TM 가칼슘과불소이온을가장많이방출하였다 10). 또한, 인공타액내에서 3종류의 FV (Clinpro-XT TM, Fluoritop SR TM, Fluor Protector) 의불소방출효과를연구한결과에따르면도포 1주일후에는 Fluoritop SR TM 이가장많은방출량을보였으나 1개월만에방출량이급격하게감소하였고, Clinpro-XT TM 는다른 FV제품에비해초기부터 6개월까지지속적으로불소를방출하는양상을보여제품마다불소방출의지속성에차이가있음을확인하였다 11). FV는성분에따라 22,600 ppm의불소이온이포함되어있는 5% sodium fluoride (NaF) 제품 (Duraphat TM, MI varnish TM, CavityShield TM 등 ) 과 1,000 ppm의불소이온이포함되어있는 0.9% difluorosilane을주성분으로하는 Fluor Protector로분류할수있다. 앞서 FV의불소이온용출량을평가한연구가수행되었으나 12,13), 연구방법을어떻게설계하느냐에따라상이한결과가나타날수있기때문에여러가지실험방법으로 FV를평가하여다양한정보를임상전문가들에게제공할필요가있을것으로생각된다. 이에이번연구의목적은국내에서시판되고있는 5종의 FV를이용하여 in vitro 연구를통해용출되는불소이온양을비교, 평가하는것이다. 1. 연구재료 연구대상및방법 1.1. 불소바니시의선정이번연구에서는국내에서유통중인 FV 중, 선행연구고찰과시장인지도를고려하여최종적으로 5종을선정하였다. CavityShield TM (3M ESPE, USA: CS), V-Varnish TM Premium clear (Vericom, Korea: VV), Clinpro TM White Varnish (3M ESPE, USA: CP), MI Varnish TM (GC, Japan: MI), Fluor Protector (Ivoclar Vivadent, Liechtenstein: FP). FP는액상형으로 0.9% difluorosilane ( 불소함량 1,000 ppm) 를함유하고있으며, 다른바니시들은송진형으로 5% NaF ( 불소함량 22,600 ppm) 를함유하고있다. 송진형바니시는불소화합물이외에제조사가강조하는주요성분으로자일리톨, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), tricalcium phosphate (TCP) 등이있다 (Table 1). 1.2. 불소바니시도포단면의직경이 5 mm인원기둥모양의아크릴봉 2개의단면 ( 총도포된단면적 39.25 mm 2 ) 에각불소바니시를도포하였다. 각 FV 군당 9개의시편을준비하였다. 10 mg (0.010 g) 의 FV를시편표면에브러시를이용하여얇게도포하였다. FV 도포량을정확히측정하기위해, 소수점넷째자리단위 (g) 까지표기되는전자저울 (ANALYTICAL Plus Electronic Balances AP-210, OHAUS, Morris, NJ, USA) 을사용하였다. 시편을저울에올려놓은뒤 0점조정하였으며, FV가도포된최종무게가 0.010 g이되도록하였다. FP는액상형 FV이기때문에마이크로피펫을이용하여시편표면에 0.010 g을도포하였으며, 도포즉시휘발성의성질을나타내어약 10분간상온에서휘발을유도후, 증류수에담갔다. 2. 불소용출량평가 FV가도포된아크릴시편을 3 ml의증류수에특정시간동안담금후불소용출량을평가하였다. 담금에사용된증류수는담금전과담금시간동안 37 항온기에보관되었다. 증류수의담금프로토콜은 Table 2와같았다. FV 도포직후초기 1분동안 3 ml의증류수에담갔으며이후새로운증류수에 1시간동안담갔다. 이과정을도포후 4 시간이될때까지반복수행하였다. 1시간담금이전 1분동안증류수에담그는이유는단기간에용출되는불소용출량을평가하기위함이었다. 도포후 4시간후부터는 20시간까지 4시간마다증류수를교체하였으며 1분증류수담금은수행하지않았다. 도포후 20시간이후는 72시간까지증류수에담갔다. 3. 불소이온농도측정불소가용출된증류수의농도를측정하기위해불소이온전극 (Orion ionplus Fluoride Electrode 9609, Orion Research, Beverly, MA, USA) 과 ph/ise Meter를활용하였다. 100 ppm 불소이온용액 (ORION 940911) 을증류수에희석하여 0.1, 0.2, 1, 2, 5, 10

186 J Korean Acad Oral Health 2019;43:184-190 Table 1. Information on fluoride varnishes evaluated in this study CavityShield TM V-varnish TM Premium clear Clinpro TM White varnish MI Varnish TM Fluor Protector Main content in 5% sodium fluoride 5% sodium fluoride 5% sodium fluoride 5% sodium fluoride 0.9% Difluorosilane* label Other cotents in - TCP, Xylitol TCP CPP-ACP - label Lot number A43203 VM7401B0 N981520 1901071 XZ1046 Components Colophony 20-70% Polyamide resin 20-70% Ethyl alcohol 4-30% Sodium fluoride 4-6% Hydrogenated rosin 30-60% Pentaerythritol glycerol ester of colophony Resin 30-75% n-hexane 10-15% Ethyl alcohol 25-50% Sodium fluoride 1-5% Ethyl acetate 50-100% Isopentyl propionate 10-25% Polyisocyanate 10-25% Flavor <5% Ethanol 1-5% Sodium fluoride 1-5% Modified Tricalcium phosphate <5% Odor Colophony odor Bubblegum, strawberry, Mint, cherry or melon Product specific Fruit-like melon or mint odour Color Orange Pale yellow Light yellow liquid White Clear Issue date 12/29/2017 10/30/2012 18/11/2016 14/08/2015 30/04/2015 Permit number 수인 07-485호 제인 15-10호 수인 13-3583호 수인 17-4228호 수인 08-229호 Manufacturer 3M ESPE, USA Vericom, Korea 3M ESPE, USA GC, Japan Ivoclar Vivadent, Liechtenstein *Difluorosilane: Bis {4-[2-(difluorohydroxysilyl)ethyl]-2-methoxycyclohexyl} [N,N-(trimethylhexan-1,6-diyl) dicarbamate]. Source from the Material Safety Data sheet (MSDS) of manufacturer. Source from the Ministry of Food and Drug Safety (MFDS), South Korea. Table 2. Immersing process of fluoride varnish applied specimens Elapsed time after fluoride varnish application ppm 표준용액을제조하였고 TISAB Ⅲ 를 10:1 (V/V) 비율로첨가하 였다. 0.1, 1, 10 ppm 용액을이용하여검량선을작성하였고, 0.2, 2, 5 ppm 으로검량선을확인하였다. 측정시점간의시간간격이 1 시간 이상일때마다표준용액을이용하여검량선을수시로확인하였으며 ±3% 이상의오차가나타날경우새롭게검량선을작성하였다. 측정 값의오차가능성을고려하여결과값이 0.01 ppm 이하인경우에는 0 ppm 로기록하였으며, 0.01 ppm 이상의값은소수점셋째자리에서 반올림하여소수점둘째자리까지기록하였다. Immersion period Immediately after 1 minute - 1 hour 1minute - 2 hours 1minute - 3 hours 1minute - 4 hours 1minute 4-8 hour - 4 hours 8-12 hour - 4 hours 12-16 hour - 4 hours 16-20 hour - 4 hours 20-72 hour - 52 hours 4. 통계분석각군당 9 개의시편으로부터얻어진자료가최종통계분석에활 용되었다. 각측정시점에서, FV 제품간용출된불소농도의차이를확 인하기위해비모수검정인 Kruskall-Wallis test 를시행하였으며, 사 후검정은 Bonferroni s method 로유의수준을보정한 Mann-Whitney test 를시행하였다. 동일 FV 군안에서두측정시점간에따른불 소농도의차이를비교하기위해 Wilcoxon signed rank test 를시행 하였다. 제 1 종오류에대한유의수준은 0.05 로판정하였으며, 모든통 계분석은 SPSS 25.0 (IBM SPSS statistics for Windows, Armonk, NY, USA) 을이용하였다. 연구성적 1. 도포후 0-4 시간동안 1 분담금불소용출량평가 FV 도포직후, 1 시간, 2 시간, 3 시간, 4 시간후시점에서각 FV 군 간 1 분담금불소용출량의차이가확인되었다 (P<0.05). 도포직후 1 분담금불소용출량은 CP (0.27 ppm), CS (0.19 ppm), MI (0.15 ppm), FP (0.15 ppm) 순으로나타났으며, 군간유의한차이는없었 다. VV (0.10 ppm) 는 CP 보다유의하게낮은불소용출량을나타냈 다 (P<0.05). 1 시간증류수담금후, 1 분담금불소용출량은 MI (0.53 ppm) 가다른군에비해유의하게가장많았으며, CP (0.19 ppm) 가 다음으로높게나타났다. CS, VV, FP 간의유의한차이는없었다. 2 시 간증류수담금후, 1 분담금불소용출량은 MI (0.34 ppm) 가다른군 에비해유의하게가장높았으며, FP (0.03 ppm) 와 VV (0.00 ppm) 가 가장적었으며두군간유의한차이는없었다. 3 시간증류수담금후,

187 김지수외 불소바니시 5종의불소이온용출량비교 : 실험실연구 1 분담금불소용출량은 MI (0.28 ppm) 가다른군에비해유의하게가 장많았으며, CP (0.08 ppm), CS (0.02 ppm) 순으로나타났다. FP 와 VV 가가장적었으며 (0.00 ppm), 두군간유의한차이는없었다. 4 시 간증류수담금후, 1 분담금불소용출량은 MI 군 (0.22 ppm) 이가장 많았으며, CP (0.05 ppm) 가다음으로높게나타났다. CS, FP, VV 군 간의유의한차이는없었다. 1 분담금불소용출량은 MI 를제외한모든 군에서담금시간이길어질수록감소하는것으로나타났다. MI 군은 도포직후 (0.15 ppm) 보다 1 시간담금후 (0.53 ppm) 용출량이증가한 뒤, 감소하였다 (Table 3, Fig. 1). 2. 도포후 0-4 시간동안 1 시간담금불소용출량평가 FV 도포후 0-1 시간, 1-2 시간, 2-3 시간, 3-4 시간시점에서각 FV 군간 1 시간담금불소용출량의차이가확인되었다 (P<0.05). 0-1 시 간, 1 시간담금불소용출량은 MI (23.54 ppm) 가다른군과비교시 유의하게가장많았으며, CS (0.32 ppm) 가유의하게가장적었다. 1-2 시간, 1 시간담금불소용출량은 MI (12.64 ppm) 가다른군과비 교시유의하게가장많았으며, CP (0.49 ppm) 가다음으로높게나타 났다. VV (0.10) 와 CS (0.09) 가가장적게나타났다. 2-3 시간, 1 시간 담금불소용출량은 MI (10.44 ppm) 가다른군과비교시유의하게 가장많았으며, CP (0.45 ppm) 가다음으로높게나타났다. FP (0.09), VV (0.09), CS (0.06) 가가장적게나타났다. 3-4 시간, 1 시간담금불 소용출량은 MI (8.01 ppm) 가다른군과비교시유의하게가장많 았으며, CP (0.38 ppm) 가다음으로높게나타났다. VV (0.07), FP (0.05), CS (0.04) 가가장적게나타났다. 1 시간담금불소용출량은모 든군에서담금시간이길어질수록감소하는것으로나타났다. 도포 직후 1 시간담금불소용출량과 3 시간후 1 시간담금불소용출량을비 교 (A/B ratio) 한결과, CP 는 2.63, MI, 2.93 인데반해, CS 는 8.0 배, FP 는 18.6, VV 는 23.7 로나타나서담금시간이증가함에따라불소용출 량변화량이매우큰것을알수있었다 (Table 4, Fig. 2). 3. 도포후 4-20 시간동안 4 시간간격불소용출량비교 4 시간단위불소용출량을비교한결과, 처음 4-8 시간불소용출 량은 MI (18.14 ppm) 가월등히많았으며, CP (2.95 ppm) 가다음으 로많았다. VV (0.70 ppm) 와 FP (0.27 ppm) 가가장낮게나타났다. 8-12 시간불소용출량은 MI 는 3.69 ppm 으로이전보다급격히감소 Fluoride release (ppm) 0.6 0.5 0.4 0.3 0.2 0.1 0.0 Immediately after CavityShield V varnish Clinpro White varnish MI Varnish Fluor Protector 1 hour 2 hours 3 hours 4 hours Fig. 1. Fluoride release after 1 minute immersion over time (0-4 hours). Table 3. Fluoride release after 1 minute immersion over time (0-4 hours) N Immediately after 1 hour 2 hours 3 hours 4 hours CS 9 0.19 (0.06) ab 0.03 (0.03) a 0.03 (0.01) a 0.02 (0.01) a 0.02 (0.01) a VV 9 0.10 (0.08) a 0.02 (0.04) a 0.00 (0.01) b 0.00 (0.01) b 0.00 (0.00) a CP 9 0.27 (0.15) b 0.19 (0.19) b 0.10 (0.07) c 0.08 (0.07) c 0.05 (0.02) b MI 9 0.15 (0.07) ab 0.53 (0.16) c 0.34 (0.10) d 0.28 (0.04) d 0.22 (0.03) c FP 9 0.15 (0.05) ab 0.01 (0.01) a 0.03 (0.05) abc 0.00 (0.00) b 0.00 (0.00) a Values are presented as mean (SD) of fluoride concentration (ppm). The time indicated the time after fluoride varnish application. CS, CavityShield TM ; VV, V-varnish TM Premium clear; CP, Clinpro TM White varnish; MI, MI Varnish TM ; FP, Fluor Protector. a,b,c,d Data in column with the same letter are not significantly different. Table 4. Fluoride release after 1 hour immersion over time (0-4 hours) N 0-1 hour 1-2 hour 2-3 hour 3-4 hour A/B ratio CS 9 0.32 (0.13) a 0.09 (0.03) a 0.06 (0.03) a 0.04 (0.02) a 8.0 VV 9 1.66 (2.25) ab 0.10 (0.14) ab 0.09 (0.12) a 0.07 (0.09) a 23.7 CP 9 1.00 (0.29) b 0.49 (0.14) c 0.45 (0.14) b 0.38 (0.09) b 2.63 MI 9 23.54 (3.47) c 12.64 (2.50) d 10.44 (1.48) c 8.01 (1.15) c 2.93 FP 9 0.93 (0.26) b 0.25 (0.21) b 0.09 (0.02) a 0.05 (0.01) a 18.6 Values are presented as mean (SD) of fluoride concentration (ppm). The time indicated the time after fluoride varnish application. A/B ratio=0-1 hour/3-4 hour. CS, CavityShield TM ; VV, V-varnish TM Premium clear; CP, Clinpro TM White varnish; MI, MI Varnish TM ; FP, Fluor Protector. a,b,c,d Data in column with the same letter are not significantly different.

188 J Korean Acad Oral Health 2019;43:184-190 하였으나, CP 와함께가장많은불소용출량을보였다. 12-16 시간불 소용출량은 CP (2.36 ppm) 가 MI (1.21 ppm) 보다많았으나, 두군 간의유의한차이는없었다. 16-20 시간불소용출량역시 CP (1.75 ppm) 가 MI (1.44 ppm) 보다많았으나, 두군간의유의한차이는없 었다. 4-8 시간대비 16-20 시간불소용출량의비는 MI 가 12.6, FP 가 3.0, VV 가 2.8, CP 가 1.7, CS 가 1.1 로나타나, 4-20 시간사이에서 MI 는불소용출속도가급격히감소하는성질이있는반면, CS 와 CP 는비 록낮은농도이지만, 안정적인속도로불소를지속방출하는것을알 수있었다 (Table 5, Fig. 3). 4. 도포후 20-72 시간담금불소용출량비교도포후 20 시간동안증류수에담갔던시편을새로운증류수에도 포후 72 시간이될때까지계속담근결과, 불소이온은계속용출되었 다. CP (12.69±4.37 ppm) 의불소용출량이가장많았으며, CS (3.82 ±0.42 ppm), MI (2.16±0.62 ppm), VV (1.73±1.75 ppm), FP (0.55±0.11 ppm) 순으로나타났다. 고안 이번연구결과도포후담금 1 시간부터담금 12 시간까지가장높 은불소이온용출량을보여준불소바니시는 MI 이었다. 담금시간이 12 시간이넘어서면서부터는 MI 의불소용출량은 CP 보다감소하였고, 20-72시간담금동안에도 CP, CS보다는적게나타나, 초기불소방출효과는우수하지만, 지속방출능력은낮은것으로생각된다. Kim 등 12), Cochrane 등 10), Lee 등 13) 의 in vitro 실험연구에서도 MI의우수한불소방출효과는보고된바있다. 임상적으로더많은불소의방출이우식예방및치아재광화에얼마나효과적인지는추후임상연구가필요하지만, 불소바니시가고농도의불소함유를표방하는만큼, 도포후구강내에서이용가능한불소의양이많다는것은술자와환자입장에서충분한가치가있다. 또한, 임상에서는불소바니시도포후, 식사나칫솔질등물리, 화학적인자극으로인해도포된대부분 24시간이내에제거되는만큼 14), 불소바니시의초기방출능력은중요한평가지표가될것이다. 담금시간이 4시간넘게지속됨에따라, MI는불소방출량이감소하였지만, CS와 CP는지속적인불소방출능력을나타냈다. 특히 20-72시간담금동안에는 CP가가장많은불소를방출했다 (CP 12.69 ppm, CS 3.82 ppm, MI 2.16 ppm). CP와 CS는 3M ESPE에서제조되는제품으로지속능력에관한기술력을공유하는것으로생각된다. CS는국내에 2007년에처음소개된, 천연송진성분을함유한제품으로알려져있으며, CP 역시 CS와유사한송진성분이함유된것으로확인된다 (Table 1). 만약불소바니시의대부분을차지하는송진성분이구강내에오래잔류한다면, 불소의지속방출가능성은높아진다. 하지만, 칫솔질과식사등의외부자극에의해불소바니시의송진성분을쉽게제거될것이다. Fluoride release (ppm) 25 20 15 10 5 CavityShield V varnish Clinpro White varnish MI Varnish Fluor Protector Fluoride release (ppm) 18 16 14 12 10 8 6 4 2 4 8 hour 8 12 hour 12 16 hour 16 20 hour 0 0 1 hour 1 2 hour 2 3 hour 3 4 hour 0 CavityShield V varnish Clinpro White MI Varnish varnish Fluor Protector Fig. 2. Fluoride release after 1 hour immersion over time (0-4 hours). Fig. 3. Four hour fluoride release from 4 to 20 hours. Table 5. Four hour fluoride release from 4 to 20 hours N 4-8 hour 8-12 hour 12-16 hour 16-20 hour C/D ratio CS 9 0.56 (0.08) a1 0.65 (0.06) a2 0.63 (0.10) ad12 0.51 (0.27) ab12 1.1 VV 9 0.70 (0.65) ad1 0.41 (0.44) ac2 0.27 (0.28) ac2 0.25 (0.33) a12 2.8 CP 9 2.95 (0.73) b1 2.31 (0.68) b2 2.36 (0.96) b12 1.75 (1.41) b12 1.7 MI 9 18.14 (1.46) c1 3.69 (1.32) b2 1.21 (0.44) bd3 1.44 (0.82) b3 12.6 FP 9 0.27 (0.05) d1 0.17 (0.03) c2 0.15 (0.03) c23 0.09 (0.11) a3 3.0 Values are presented as mean (SD) of fluoride concentration (ppm). The time indicated the time after fluoride varnish application. C/D ratio=4-8 hour/16-20 hour. CS, CavityShield TM ; VV, V-varnish TM Premium clear; CP, Clinpro TM White varnish; MI, MI Varnish TM ; FP, Fluor Protector. a,b,c,d Data in column with the same letter are not significantly different. 1,2,3 Data in row with the same number are not significantly different.

189 김지수외 불소바니시 5종의불소이온용출량비교 : 실험실연구 액상형의에탄올베이스휘발성바니시인 FP는도포후 1시간에서최대농도에도달한뒤, 4시간뒤에는초기수준으로감소하여, 불소의지속방출효과가매우낮음을확인하였다. Virupaxi 등 11) 의 in vitro 연구도유사한결과를보고하였다. 이번연구에사용된다른 FV제품의불소함량은 22,600 ppm인데반해, FP는 1,000 ppm이었다. FP 는불소함량이타실험군에비해 1/20 수준이고바니시성상이다르기때문에타실험군과절대적인비교를통해불소용출량의많고적음을비교하는것은신중하게접근할필요가있다. 하지만, 이러한차이를감안하더라도, 도포후 2시간이후에는불소가측정되거나방출되지않은것은 FV의불소지속방출능력이라는기본목적에부합하지않는다. FP는 1975년에개발되었으며, 1987년에 0.9% difluorosilane 을함유하여 1,000 ppm의불소함량을표방하는제품으로널리알려져있다 6). Petersson 등 15) 은연간 2회 FP를도포한 4-5세미취학아동들의인접면치아우식의발생은감소하였다고보고하였다. 하지만 Duraphat TM 과 FP를평가한연구에따르면 Duraphat TM 이보다더효과적이라보고된바가있으며 16,17), 연간 1회 FP를적용하였을때큰효과를보여주지못하였다는결과도보고되었다 18). 임상적으로저농도의불소를함유한액상형바니시의활용성이존재하는만큼, 불소지속방출능력을향상시키기위한관련연구가수행될필요가있을것이다. 이번연구를수행하는데있어한계점이있었다. 첫번째, 불소이온용출량을평가한다수의연구에서인공타액을이용하였으나 19,20), 이번연구에서는증류수를활용하였다. 하지만 Comar 등 21) 의연구에서증류수, 인공타액모두사용한결과제품간의용출량은증류수에서더큰차이를보였다고보고되었다. 점도와 ph 등다수의변수가존재하긴하지만제품간불소이온용출량을평가하는데무리가없을것으로사료된다. 두번째, 이번연구에서불소이온용출량을평가하였지만그결과를치아재광화 (Remineralization) 효과로간주하기에는한계가있다. 치아재광화는저농도의불소농도로도가능하다는선행연구가있기때문이다 3). 계속되는연구에서는불소농도측정뿐만아니라치면재광화평가가동반되어야할것으로생각된다. 이러한제한점에도불구하고이번연구를통해국내에서시판되고있는 5종의 FV를이용하여불소이온용출량을비교, 평가하였고의미있는결과를도출하였다. 결론 이번연구는국내에서시판되고있는 5종의불소바니시를 in vitro 실험조건하에서아크릴시편에도포한후증류수에서용출되는불소이온용출량을비교, 평가하였고다음과같은결과를얻을수있었다. 1. 도포직후를제외한 1분담금부터담금 12시간까지가장높은불소이온용출량을보여준불소바니시는 MI이었다. 2. 12-16시간, 20-72시간이후부터는 CP와 CS가 MI보다많은양의불소를방출하였다. 3. 송진형바니시가액상형바니시보다불소를더오랫동안방출했다. 이번연구를통해불소바니시성상에따라불소이온용출량에차이가있었고, 동일한불소함량을가진불소바니시라하더라도제품간 용출량차이가존재하고용출시점에도차이가있음을확인하였다. 구 강내불소바니시도포효과를극대화하기위하여, 치아우식예방에유 효한농도의불소를지속적으로용출하는불소바니시의개발이필요 할것이다. ORCID Ji-Soo Kim, https://orcid.org/0000-0003-1571-4762 Min-Ji Byon, https://orcid.org/0000-0003-0359-9234 Yong-Tae Nam, https://orcid.org/0000-0002-2377-4151 Jin-Bom Kim, https://orcid.org/0000-0001-8619-2741 References 1. Fejerskov O, Cury JA, Tenuta LM, Marinho VC. Fluorides in caries control. In: Fejerskov O, Nyvad B, Kidd E. Dental caries: the disease and its clinical management. 3rd ed. Oxford:Wiley Blackwell;2015:245-276. 2. Featherstone JDB, Ten Cate JM. Physicochemical aspects of fluoride-enamel interactions. In: Ekstrand J, Fejerskov O, Silverstone LM. Fluoride in dentistry. 2nd ed. Copenhagen:Munksgaa rd;1988:125-149. 3. Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol 1999;27:31-40. 4. Beltrán-Aguilar ED, Goldstein JW, Lockwood SA. Fluoride varnishes. A review of their clinical use, cariostatic mechanism, efficacy and safety. J Am Dent Assoc 2000;131:589-596. 5. Øgard B, Seppä L, Rølla G. Professional topical fluoride applications-clinical efficacy and mechanism of action. Adv Dent Res 1994;8:190-201. 6. Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2013;7:CD002279. DOI: 10.1002/14651858.CD002279.pub2. 7. ten Cate JM, Featherstone JD. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol Med 1991;2:283-296. 8. Featherstone JD. Delivery challenges for fluoride, chlorhexidine and xylitol. BMC Oral Health 2006;6 Suppl 1:S8. 9. Ritwik P, Aubel JD, Xu X, Fan Y, Hagan J. Evaluation of shortterm fluoride release from fluoride varnishes. J Clin Pediatr Dent 2012;36:275-278. 10. Cochrane NJ, Shen P, Yuan Y, Reynolds EC. Ion release from calcium and fluoride containing dental varnishes. Aust Dent J 2014;59:100-105. 11. Virupaxi SG, Roshan NM, Poornima P, Nagaveni NB, Neena IE, Bharath KP. Comparative evaluation of longevity of fluoride release from three different fluoride varnishes an in vitro study. J Clin Diagn Res 2016;10:ZC33-ZC36. 12. Kim HN, Jeong MS, Kim SY, Kim JB, Jeong SH. Evaluation of release of fluoride from dental varnishes marketed in Korea. J Korean Acad Oral Health 2014;38:131-137. 13. Lee K, Lee S, Lee N, Jih M. A comparison of the amount of fluoride ion released and remineralization effect on the initial caries lesion of the various fluoride varnishes. J Korean Acad Pediatr Dent 2016;43:443-451. 14. Al Dehailan L, Lippert F, González-Cabezas C, Eckert GJ, Martinez- Mier EA. Fluoride concentration in saliva and biofilm fluid following the application of three fluoride varnishes. J Dent 2017;60:87-93.

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