止血性歯肉退縮剤とその補綴治療ステップへの影響。ナラティブ・レビュー

Hemostatic gingival retraction agents and their impact on prosthodontic treatment steps: A narrative review.

抄録

このトピックの目的は、歯科補綴治療中に使用される歯肉退縮剤の一般的な概要と、歯科医師が直面する可能性のあるそれらに関連した困難を与えることです。止血剤は、歯肉退縮を成功させ、止血を行う上で重要である。しかし，これらの薬剤は歯科補綴治療や口腔組織に多くの悪影響を及ぼす可能性があり，実践する歯科医師はそれらを認識しておく必要があり，本レビューではそれらを明らかにする。PubMedおよびGoogle Scholarデータベースを用いて，2017年までの論文を検索した。以下のキーワードを異なる組み合わせで使用した。"hemostatic agent", "astringent", "agstringency", "epinephrine", "ferric sulfate", "aluminum chloride", "hemorrhage control", "soft tissue", "hard dental tissue", "self-etch adhesive", "total-etch adhesive", "bond strength", "impression", "gypsum", "plaster cast", "dental cast "です。ここ30年の間に、歯科医師が使用する止血剤はエピネフリンから収れん剤へと変化し、現在ではAlCl3とFe2(SO4)3が主流となっています。現在知られているすべての止血剤は、局所的かつ一時的に歯肉組織にダメージを与えるが、全身に悪影響を及ぼすことが知られているのはエピネフリンのみである。印象材に対する止血剤の影響に関する研究では、止血剤の重合阻害特性に関して、おそらく方法論の標準化がなされていないために、非常に矛盾した結果が示されている。止血剤は象牙質の表面性状を変化させ，酸によるエッチングに対する耐性を高めるようである。そのため、トータルエッチシステムと比較してセルフエッチ接着剤の酸性度が比較的低い場合、より抵抗性の高い象牙質表面を十分にエッチングするには十分ではなく、結果的に接着強度が低くなる可能性がある。

The purpose of this topic review is to give a general overview of gingival retraction agents used during prosthodontic treatment, and the possible difficulties connected to them that may be faced by the dentist. Hemostatic agents are important for successful gingival retraction and in achieving hemostasis. However, these agents may show numerous negative effects on the prosthodontic treatment and oral tissues of which the practicing dentist must be aware, and which will be elucidated in this review. PubMed and Google Scholar databases were searched for publications up to and including 2017. The following key words were used in different combinations: "hemostatic agent," "astringent," "astringency," "epinephrine," "ferric sulfate," "aluminum chloride," "hemorrhage control," "soft tissue," "hard dental tissue," "self-etch adhesive," "total-etch adhesive," "bond strength," "impression," "gypsum," "plaster cast," and "dental cast." In the last three decades the hemostatic agents used by practicing dentists have changed from epinephrine towards astringents, with AlCl3 and Fe2(SO4)3 now the most popular. All of the currently known hemostatic agents cause some local, temporary gingival tissue damage, but only epinephrine is known to elicit negative systemic effects. Studies concerning the influence of hemostatic agents on impression materials show highly contradictory results regarding the possible polymerization-inhibiting properties of hemostatic agents, probably due to the lack of standardization of methodology. Hemostatic agents seem to alter the dentinal surface properties making it more resistant to acid etching. Therefore the relatively low acidity of self-etch adhesives when compared to total-etch systems may not be strong enough to sufficiently etch a more resistant dentinal surface, and consequently may result in lower adhesive bond strengths.