ドックズベストセメント（Doc's Best Cement）とは、アメリカ合衆国テキサス州<ヒューストンに本社を置くCooley & Cooley社から発売されている歯科医療のう蝕治療で用いられるセメントの事、またそれを用いた治療法の事。銅の殺菌力により、従来であれば抜髄（神経をとる治療）になる症例で、神経を残すことができると期待される治療法であるヒールオゾンと同様にミニマムインターベーションをコンセプトとする治療法である。2011年現在、日本では薬事法の認可を受けていない。
Doc's Best Cements（ドックズベストセメント）の原型は19世紀後半フィラデルフィアのDr.John Henry Holiday(通称 ドック・ホリディー)が抗菌力とミネラル分が豊富で、深い虫歯から歯髄（歯の神経）を守り、虫歯の再発を起こさせないセメントとして作製されました。その後、抗菌力を増加するために初期の処方からかけ離れたものに改良したために虫歯の再発防止力や歯髄保護効果が失われてしまい、使われないセメントになってしまったのです。
Thneibat A,Moore BK,Matis BA,Anticariogenic and antibacterial properties of a copper varnish using an in vitro microbial caries model.Oper Dent 142-148,2008.
The antimicrobial and anticariogenic properties of a copper varnish (experimental mixture of Doc’s Best Red Copper cement and Copalite varnish,Cooley and Cooley, Ltd, Houston, TX, USA:designated in this study as “Copper Seal”) on the root surface were evaluated in an in vitro microbial caries model. Fifty-six human root specimens were prepared from anterior teeth and randomly divided into four groups: Groups 1 and 3— Copper Seal; Group 2—chlorhexidine varnish, the positive control (Cervitec, Ivolcar Vivadent, Schaan, Liechtenstein) and Group 4—a negative control that received no treatment. The varnishes were painted in Groups 1, 2 and 3, then visually removed after 24 hours in Group 1. The specimens were demineralized in a microbial caries model for five days. Plaque was collected from the specimens to obtain bacterial colonization numbers, then the specimens were sectioned and analyzed for lesion extent using Confocal Laser Scanning microscopy. There were no significant differences (p>0.05) among the four groups in terms of bacterial count. Regarding caries lesion development, the group with copper varnish visually removed (Group 1) and the non-treated group (Group 4) had significantly greater total area caries lesions and total lesion fluorescence than the copper varnish without removal group (Group 3) and the chlorhexidine group (Group 2). Therefore, it was concluded that copper and chlorhexidine varnishes have anticariogenic effects on root surfaces, as tested in this model.
in vitroでのカリエスモデルを使用してドックベストセメントの歯根面での抗菌、抗カリエスについて評価した。 56名の人の前歯を用いた。 グループ1と3がDoc’s Best Red Copper cement and Copalite varnish→通称カッパーシール グループ1は24時間後にカッパーシールを除去 グループ2がクロルヘキシジンバーニッシュ グループ4は無処置(コントロール） 5日間脱灰処理 グループ1～4で今回用いた細菌の数は有意差がなかった。 グループ1と4のカリエス領域は２，３よりも有意に大きい 今回の様な実験系ではカッパーシールとクロルヘキシジンバーニッシュ群は歯根において抗カリエス効果がある。
Copper ions have been reported to have an antibacterial effect both in vitro6-11 and in vivo.12 Copper reduces the number of bacteria on tooth surfaces. The suggested mode of the action of copper is the limitation of bacterial growth and the inhibition of glycolysis, leading to a decrease in acid production.13-14 Copper has also been found to interfere with glucan formation by glucosyl transferase. Such a process may contribute to reduced plaque accumulation.15
Foley and others16-17 suggested the use of copper cement as a liner under a less soluble material to take advantage of copper cement’s cariostatic properties. Afseth and others18 found a reduction in caries development in rats after adding 65 ppm copper in the drinking water. Rosalen and others13 found that copper,which was co-crystallized with sucrose was an effective cariostatic agent in rats. In another in vivo study, Foley and Blackwell12 compared the effect of copper cement with glass ionomer cement (GIC) on carious dentin that remained under restorations. These authors sampled the dentin microbiologically at one and six months and found that copper cement demonstrated a significant effect on the total anaerobic bacterial count over one month. Over six months, copper cement caused a significantly greater reduction in mutans streptococci than GIC.
Cooley and Cooley (Houston, TX, USA), the manufacturer of copper cement (Doc’s Best Red Copper cement) and copalite varnish, have recently proposed mixing copper cement powder with copalite varnish (Copper Seal) to serve as an antibacterial varnish to be painted on tooth surfaces. This preparation could have many potential uses, especially considering that there is no approved antibacterial varnish currently on the US market. The topical application of an antibacterial agent may have the potential of decreasing the severity of existing root caries lesions or preventing the development of new lesions.
The teeth were required to have apical closure and root surface areas without any visible damage or demineralization.
An acid resistant varnish (red fluoride-free nail varnish) was applied, leaving an approximate 4 mm x 4 mm window on the buccal root surface (about 2 mm apical to the CEJ).
Copper varnish is still new, and the manufacturer has not specified how many pplications are needed for this particular use. In the current study, only one application was used. Also, the amount of copper released was not specified by the manufacturer. It is possible that the amount released was not sufficient to demonstrate a prolonged antibacterial effect after five days.
Duguid7 measured the bacterial inhibition effect of different copper concentrations and found that 10-3 M copper inhibited the rate of growth, whereas 10-4 M and lower concentrations had little or no effect. In a more recent study, Foley and Blackwell10 measured the amount of copper released from copper cements at 2, 7 and 28 days and at six months and found that the highest amount was released after two days, with the majority of the decrease measured at day seven. Thus, it is possible that the varnish had an initial effect on S mutans numbers, but the effect was lost after longer incubation. A similar explanation may apply to the CHX varnish.
In 1996, Van Loveren and others21 compared the effect of different CHX varnishes in a bacterial demineralization model and found CHX to be antibacterial and, in their experiment, the varnishes were applied adjacent to the specimens. The experiment extended over three serial 22-hour demineralization periods with fresh S mutans suspensions used for each period. The bacterial count in their study was higher in the second and the third applications of the bacterial suspension when compared to the first 22 hours. Therefore, it is possible that both CHX and copper varnishes did have an antibacterial effect at the early stages of the experiment, but that the measurable effect was lost after five days. In the current study,although most of the copper varnish was still at the tooth surface after completing the experiment, the active ingredient could have been released. This is in agreement with Foley and others.17,28
Chlorhexidine and copper varnishes have anticariogenic effects on root surfaces. However, based on the results of the current study, it was unclear whether the effect was due to the release of antibacterial agents and/or to the mechanical coverage of tooth structure. As long as the varnish stayed on the surface, caries development was slowed down. The application regimen and long-term caries effects of a copper varnish need further investigation before clinical protocols can be recommended.
Foley J & Blackwell A (2003) In vivo cariostatic effect of black copper cement on carious dentine Caries Research 37(4) 254-260.
This study compared the effect of a copper phosphate cement (BCC) and a conventional glass ionomer cement (GIC) on carious dentine that remains under restorations in vivo. Using a split-mouth design, 45 primary molar pairs with dentine caries were sampled microbiologically. Without further removal of carious dentine, the molar pairs were randomly allocated to three restorative groups: (1) one cavity was lined with BCC and restored with GIC and the other was kept under review as an untreated control; (2) one cavity was restored with GIC, whilst the other was kept under review; (3) one cavity was lined with BCC and restored with GIC, whilst the other was filled with GIC. The dentine was re-sampled microbiologically at 1 month (30 pairs) and 6 months (15 pairs). BCC demonstrated a significant effect on the total anaerobic count over 1 month, when paired with both the control and GIC, whereas the antibacterial effects of GIC compared with no treatment were not statistically significant. In addition, BCC performed significantly better than no treatment in reducing mutans streptococci and lactobacilli over 1 month. Over 6 months, BCC caused a significantly greater reduction in mutans streptococci than GIC. In conclusion, BCC demonstrated a significant antibacterial effect on carious dentine in vivo.