정량 광유도 형광법(QLF)과 광활성제를 이용한 초기 치아우식증의 진단
Diagnosis of Early Dental Caries with Dye-Enhancing Quantitative Light-Induced Fluorescence (QLF)
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본 연구의 목적은 건전 법랑질과 우식 병소의 형광 차이를 증진시켜 QLF의 영상학적인 진단강도를 높이고, QLF로 촬영한 이미지 상에서 착색과 우식병소를 감별하기 위해 형광 염색제인 플루오레세인나트륨을 접목하여 사람 치아의 법랑질 표면에 유발된 초기 우식병소를 평가하는데 있다. 치아우식증이나 균열이 없는 최근 발거된 소구치 및 제3대구치를 대상으로 하여 치아의 평활면을 6 mm × 3 mm × 3 mm 크기로 절단한 후 아크릴 주형에 매몰하였고, 시편 표면적의 1/2에 nail varnish를 도포하여 대조군으로 설정하였다. 시편은 무작위로 15개씩 총 6개 탈회그룹(6, 12, 24, 48, 72, 96시간)으로 나누었다. 시편을 각 시간에 맞게 탈회시키고 생리 식염수로 세척한 후 QLF-D를 이용하여 탈회 정도(ΔF)를 측정하고 0.075% 플루오레세인나트륨을 적용한 후 세척하고ΔF 값을 측정하여 그 값을 비교하였다. 시편의 중앙 부위를 삭제하고 연마하여 주사전자현미경 상으로 영상을 저장한 후 병소 깊이를 측정하였다. QLF를 이용하여 관찰한 우식병소는 건전 법랑질보다 어둡게, 플루오레세인나트륨을 도포한 후 QLF로 관찰한 우식병소는 건전 법랑질보다 밝게 관찰되었으며 탈회시간이 증가함에 따라 형광염료는 더 많이 침투하였다. 플루오레세인나트륨을 적용한 후 측정한 ΔF 값은 염색 전과 비교하여 모두 증가하였다(p < 0.05). QLF 수치와 병소 깊이는 높은 상관관계를 보였고 회귀분석을 통해 선형 방정식을 추출하였다. 따라서 플루오레세인나트륨을 접목시킨 QLF 측정은 임상적으로 초기우식을 감지하고 분류하는데 기여할 수 있을 것이며, QLF로 촬영한 이미지에서 우식병소와 착색을 감별하는데 도움을 줄 것이다.
Abstract
This study used sodium fluorescein to improve imaging diagnostic ability by increasing the fluorescence difference between sound enamel and caries lesions. It also made it easier to discriminate between stain and caries lesions using quantitative light-induced fluorescence (QLF). Half of the specimen surface was covered with nail varnish as a control. Specimens were divided randomly in six decalcification groups and decalcified for different lengths of time. Then, ΔF was measured using QLF-D. After applying 0.075% sodium fluorescein, we measured ΔF again and compared it with the initial value. After cutting the central portion of the specimen, we measured the lesion depth using scanning electron microscopy. The lesion surfaces observed with QLF were darker than normal enamel, whereas they were lighter than normal enamel after applying fluorescein. Longer decalcification time was associated with greater fluorescent dye penetration. The ΔF measured after applying fluorescein was higher than the initial value (p < 0.05). Due to QLF measurement using fluorescein being more sensitive for diagnosing early decalcification, this approach will enable early diagnosis of dental caries before the cavity formation stage, allowing the treatment of early caries lesions. With QLF and sodium fluorescein, we can easily discriminate between stain and caries lesions.
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