牙科鈦植體表面細菌貼附及清創方式之研究

少有文獻探討鈦表面條件對細菌貼附的影響。本研究探討鈦植體表面結構與細菌貼附之間的關係，並評估不同方法，包括塑膠刮除，粉末噴除，Er：YAG雷射剝除，以及化學藥劑(去汙劑)等，對細菌感染的鈦植體的清創效能。尤其是研究新式次氯酸（HOCl）藥劑與牙科常用之次氯酸鈉（NaOCl）、氯己定（chlorhexidine）對去除革蘭氏陰性菌（大腸桿菌和牙齦卟啉菌）和革蘭氏陽性菌（糞腸球菌和血清葡萄球菌）的效度。實驗首先將鈦試片分成5組：＃1200砂粒砂紙拋光（Grit），50 μm（SB50），100 μm（SB100）和250 μm Al2O3噴砂（SB250），以及SLA(大顆粒噴砂和酸蝕）。分析細菌在不同鈦基材上的貼附及不同的清創處理。結果顯示表面粗糙度（Ra）值從Grit組的較低值0.2 μm顯著增加SB250組的2.7 μm，與SLA組（2.0 μm）顯著不同。在所有粗化組中，除了培養12小時的SB50和SB250組之外，在大腸桿菌細菌貼附試驗中沒有顯著差異。清創處理沒有改變基材表面。然而，與用塑膠刮除方式相比，粉末噴除和雷射剝除造成大腸桿菌貼附顯著減少。關於化學藥劑清創法，隨著處理時間延長，HOCl可達更大的滅菌功效，相較於NaOCl與氯己定，HOCl顯著降低了牙齦卟啉單胞菌的內毒素濃度。雷射剝除和HOCl藥劑清創技術可能有效治療牙周植體周圍炎。

There is limited information about the influence of the titanium surface conditions on bacterial adherence. This study is to identify the relationships between surface conditions of titanium implants and bacterial adhesion, and then to evaluate the effectiveness of different decontamination methods including the plastic curettage, air-powder abrasion, Er:YAG laser irradiation, chemotherapeutic agents for bacteria-infected titanium implants. In particular, the effectiveness of hypochlorous acid (HOCl), sodium hypochlorite (NaOCl), and chlorhexidine (CHX) at eliminating Gram-negative (E. coli and P. gingivalis) and Gram-positive (E. faecalis and S. sanguinis) bacteria was also evaluated. Titanium specimens were divided into 5 groups: #1200 grit sandpaper polishing (Grit), 50 µm (SB50), 100 µm (SB100), and 250 µm Al2O3 sandblasting (SB250), and sandblasting, large-grit and acid-etching (SLA). The adhesion of bacteria on the different substrates was assayed. Different cleaning treatments were applied on the specimens. The results showed that the surface roughness (Ra) value changed from the lower value of 0.2 µm for the Grit group to the significantly higher value of 2.7 µm for SB250 group, indicating a significantly different from the SLA group (2.0 µm). No significant difference in E. coli bacterial adhesion was found among the all roughened groups, except the SB50 and SB250 groups at 12 h of culture. The use of cleaning treatments did not induce significant surface alterations. However, the E. coli adhesion was significantly reduced in the air-powder abrasive system and laser debridement in comparison with that treated with the plastic curettage. Regarding chemotherapeutic agents, HOCl achieved greater antibacterial efficacy as treatment time was increased. HOCl significantly lowered the LPS concentration of P. gingivalis when compared with NaOCl and CHX. Conclusions: Laser debridement and HOCl antiseptic might be useful cleaning methods for peri-implantitis therapy.