定量光导荧光技术评价含氟牙膏抑制早期龋损效果的临床研究

目的评价定量光导荧光技术（QLF）用于纵向监测光滑面早期龋损矿物质含量变化的能力及用于评价不同氟化物抑制早期龋损效果差异的可能性。方法选取305名11～14岁上颌前牙有早期光滑面龋的中小学生,随机分为NaF组、MFP组和不含氟组,分别采用含NaF的牙膏、含Na2PO3F的牙膏（氟浓度均为1 450 mg/L）和不含氟的牙膏刷牙。拍摄受检者上颌前牙光滑面早期龋损基线、刷牙后3个月和6个月时的QLF照片并保存。使用软件QLF2.00g对病损进行分析,界定病损范围,得出每次检查的△F（荧光损失）、Area（病损面积）和△Q（总荧光损失量）。结果296名（97.05%）受检者完成了整个研究。QLF检查结果显示,3个月时,296名受检者上颌前牙光滑面早期龋损均出现不同程度的好转,3组光滑面早期龋损Area、△F和lg△Q的变化均无统计学差异（P>0.05）;6个月时,296名受检者上颌前牙光滑面早期龋损均较基线时出现明显的好转,NaF组、MFP组光滑面早期龋损Area、△F和lg△Q的变化有统计学差异（P<0.05）,而NaF组与MFP组之间无统计学差异（P>0.05）。结论QLF作为一种定量诊断方法,能够用于纵向病变跟踪监测和评价不同龋病干预措施效果。     

定量光导荧光技术评价光滑面早期龋损再矿化时间的临床研究

目的:检测上颌前牙光滑面早期龋损发生再矿化的时间.方法:选取符合纳入标准的成都市11~14 岁上颌前牙有早期光滑面龋的中小学生24 名参加研究.将其分为使用含单氟磷酸钠(F 1.45 g/L)牙膏和使用不含氟牙膏2 组.对受试者进行相同的口腔健康教育及刷牙方法的培训.拍摄基线前牙光滑面早期龋QLF照片,以后每周拍摄受检者前牙光滑面早期龋的定量光导荧光技术(QLF)照片,连续8 周.使用软件QLF 2.00g对病损进行分析,界定病损范围,得出每次检查的ΔF(荧光损失)、Area(病损面积)和ΔQ(总荧光损失量).结果:对24 名受检者共101 处上颌前牙光滑面早期龋损进行了为期8 周的临床研究,2 组受检者的早期龋损均出现不同程度的好转,但2 组之间的差异没有统计学意义(P>0.05).结论:QLF所能检测到的光滑面早期龋损发生再矿化的时间为3 周;QLF难以在短期内(8 周内)对2 种牙膏的效果是否存在差异做出判断,使用QLF作为诊断手段的临床研究需要更长的时间.     

干燥方法对定量光导荧光系统分析早期脱矿病损的影响

目的研究不同的干燥方法对定量光导荧光系统(guantitative light-induced fluorescence,QLF)分析病损脱矿程度的影响,探讨最适合QLF临床检查使用的干燥方法.方法选择新鲜拔除的人无龋前磨牙8个,颊面用指甲油封闭留窗口大约3mm×3mm,置于脱矿液中,37℃摇床中7d形成脱矿病损.标本分别采用三种不同的干燥方法放置于空气中使之自然干燥、压缩空气干燥30s和棉卷干燥30s,然后进行QLF检查并采用盲法分析病损脱矿的严重程度.设置△Q(荧光损失量)值变化5%为病损入口,得出的数据导入SPSS 11.5软件进行统计分析.结果釉质脱矿病损随着干燥程度的增加,在QLF荧光图像中均表现为脱矿严重程度的增加.病损放置自然干燥564.386(±87.542)s后,QLF能够检测到最大荧光损失,压缩空气干燥30s和棉卷干燥30s后,能检测最大荧光损失的时间分别为39.250(±7.778)s和139.375(±13.212)s.压缩空气吹干30s后,QLF图像中病损表现出明显的荧光损失,与其他两种干燥方法有统计学差异(P＝0.000).结论压缩空气干燥30s后,病损表现的荧光损失可以用来反映该病损的最大荧光损失值.临床使用压缩空气对早期病损吹干30s是达到可靠干燥效果的最快速而实用的方法.     

定量光导荧光技术在口腔医学中的应用

定量光导荧光技术（quantitative light—induced fluorescence，QLF）是一种能拍摄牙面的荧光图像并对图像龋损区矿物质丢失和病损范围大小进行定量分析的方法。该技术可以对未形成龋洞的早期釉质龋损牙面定量评价，也可对病损区脱矿和再矿化过程矿物质含量改变进行定量监测。现就QLF的技术背景、设备组成、技术优点、在龋病早期诊断和其他方面的临床应用，以及影响QLF技术的因素等方面综述。     

ǰ�������ӳ�������޸����϶�����״��Ӱ���о�

目的探讨前牙牙冠延长术后采用氧化锆全瓷和金属烤瓷（porcelainfusedtometal,PFM）冠修复对牙周的影响。方法选择2009--2011年惠州市口腔医院修复科收治的拟行牙冠延长术＋冠修复患者18例（共108颗上颌前牙）,分成两组（全瓷组和PFM组）,每组54颗,均行牙冠延长术;术后6个月,全瓷组行氧化锆全瓷冠修复,PFM组行钴铬合金烤瓷冠修复。随访8～32个月,评价两组冠修复后的牙周状况。结果PFM组有34颗（62．96％）修复后出现牙周病损,其中轻度病损25颗,中度病损5颗,重度病损4颗;而全瓷组仅2颗（3．70％）发生轻度牙周病损。经Ridit分析,两组间差异有统计学意义（P〈0．05）。结论前牙牙冠延长术后采用氧化锆全瓷冠修复的牙周状况明显优于PFM冠修复。     

不同龋敏感儿童第一恒磨牙早期脱矿定量分析

目的：通过对混合牙列上下颌第一恒磨牙龋易感部位脱矿程度的定量测定，分析乳牙列龋病情况与第一恒磨牙早期脱矿之间有无相关性。方法：随机抽取成都市6－7岁儿童169名，其中无龋儿童（dmft=0)84名，龋敏感儿童（dmft≥85)85名，采用KaVo DIAGNOdent激光光脱硫测定仪测定样本双侧上颌第一恒磨牙中央窝，舌沟以及双侧下颌第一恒磨牙中央窝，颊沟的脱矿程度，将所得数据进行统计分析。结果：龋敏感儿童第一恒磨牙的早期脱矿明显大于无龋儿童第一恒磨牙的早期脱矿（P＜0．01），两组儿童左右侧第一恒磨牙相同点位脱矿程度无显著性差异（P＞0．05），双下颌第一恒磨牙中央窝的脱矿测定值明显高于其它各点位（P＜0．001）。结论：激光荧光法是一种有价格的定量诊断早期龋的方法。乳牙列龋病情况与第一恒磨牙早期龋之间有显著正相关，应对乳牙龋敏感儿童的年轻恒牙，特别是双下颌第一磨牙及早采防龋措施。     

红色荧光定量分析法评价釉质早期龋的临床研究

目的采用定量光导荧光（QLF）技术的红色荧光分析法检测釉质早期龋,并监测含氟牙膏促进早期龋再矿化的效果,评价该技术诊断早期龋的能力。方法选择有上颌前牙光滑面釉质早期龋的96名小学生为研究对象,指导其在6个月的时间内使用含氟牙膏（氟离子质量分数为0.145%）刷牙。分析基线和6个月后的上颌前牙光滑面荧光图像,获得红色荧光变量（包括荧光面积Ar、平均荧光量△R、荧光总量R）,将其与绿色荧光变量（包括荧光面积Aw、平均荧光损失量△F、荧光损失总量△Q）进行比较,并通过配对t检验评价使用含氟牙膏后龋损的变化情况。结果红色荧光变量Ar、△R、lgR与对应的绿色荧光变量Aw、△F、lg△Q的Pearson相关系数分别为0.89、0.54、0.72（P<0.05）,具有高度相关性。使用含氟牙膏6个月后,红色和绿色荧光变量均较基线明显降低,其差异有统计学意义（P<0.05）。结论采用QLF技术的红色荧光分析法能够评价釉质早期龋的严重程度,并纵向监测病变,适用于评价龋损防治措施的效果。     

QLF法研究一种含氟涂料对离体牛牙釉质的抗酸性效果

目的：采用定量光导荧光系统观察含氟涂料对牛牙釉质的抗酸性效果。方法：20个新鲜拔除的牛前牙,于每个标本唇面建立4个2mm×2mm开窗,随机分为4组,分别用含氟涂料、含氟牙膏、1%氟化钠溶液、去离子水处理,然后浸泡在脱矿液中,分别于处理的第1,2,4,8d,采用QLF法检测各组标本的荧光损失量△F（%）和病变面积△P（mm2）,计算△Q（%,mm2）,并再次处理。结果：用含氟涂料处理的牛牙釉质龋标本,再矿化面积最多、△Q降低最大,且与其他处理组有显著差异（P〈0.05）。结论：同其它方法相比,含氟涂料有利于增进离体牛牙釉质的抗酸性。     

328颗上颌恒切牙异常萌出原因的临床分析

目的分析导致上颌恒切牙异常萌出的原因,为提高诊疗水平提供理论依据。方法收集上颌恒切牙异常萌出的患者239例,共计328颗上领恒切牙,记录并分析导致上颌恒切牙异常萌出的原因,对数据进行统计学分析。结果328颗异常萌出的上颌恒切牙中,阻生或弯曲牙者64颗;上颌恒切牙已萌出,但位置异常者264颗,其中唇侧异常萌出45颗,腭侧异常萌出187颗,远中异常萌出32颗。对异常萌出的原因进行分析,上颌乳前牙根尖感染患者92例（38．5％）,上颌乳前牙外伤患者30例（12．6％）,上颌乳前牙滞留患者（非感染和外伤所致）26例（10．9％）,多生牙患者18例（7．5％）,上唇系带肥厚患者11例（4．6％）,口腔不良习惯、骨量不足等其它原因患者19例（7．9％）,另有43例（18．0％）患者合并局部或全身多种相关疾病。结论乳前牙根尖周炎是导致上颌恒切牙异常萌出的主要病因,儿童口腔医生应积极治疗乳牙疾病,去除或减轻导致上颌恒切牙异常萌出的因素,诱导儿童牙列和咬合功能的正常发育。     

上颌前门牙即刻种植早期效果观察

目的：观察上颌前牙即刻种植的早期效果。方法：用GBR技术、转粘膜瓣等方法为26例患者在上颌前牙区即刻植入28颗种植体，修复二年后观察其缺牙区的丰满度、龈边缘的美观程度、X光显示种植体周骨质情况等。结果：术后九月X光显示种植体周无低密度透光区，新骨形成良好。修复二年后26例患者中有23例对的丰满度感到满意，满意率达88．85％，与刚修复时差异无显著性；24例对龈边缘的美观满意，满意度达92．31％，也与刚修复时无显著性差异；结论：上颌前牙即刻种植是一种可行的修复方法。     

Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors

Caries prevalence on the buccal surfaces of teeth in orthodontic patients was determined with QLF and visual examination immediately after removal of fixed appliances. The number of lesions found by QLF far outnumbered that found by visual examination, but the distribution pattern was similar. 97% of all subjects and on average 30% of the buccal surfaces in a person were affected. On average, in males 40% of surfaces and in females 22% showed white spots (p < 0.01). Caries prevalence was lower (p < 0.01) in incisors and cuspids than in molars and premolars. A positive correlation with caries prevalence was found for the bleeding scores 6 weeks after debonding and lactobacillus counts before debonding. Mutans streptococci counts, age, treatment duration, socioeconomic status and dietary habits showed no correlation with caries prevalence.     

Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: an in vivo comparison

The aim of this clinical study was to compare the outcome of quantitative laser/light-induced fluorescence (QLF) and visual inspection (VI) for the detection of initial caries lesions on all maxillary and mandibular smooth surfaces in caries-risk adolescents. The subjects were 34 students, mean age 15 yr. A total of 879 buccal and 882 lingual surfaces were air-dried and visually examined at a magnification of x3.5. Fluorescence images of each smooth surface were captured with QLF\clin equipment, and QLF software 2.00 was used to display, store, and analyse the images. Fluorescence loss (deltaF; %) and area of the lesion (A; mm2), and fluorescence loss integrated over the lesion area (deltaQ; deltaF x A; % x mm2), were determined. The presence or absence of initial caries lesions was scored using both VI and QLF. A total of 87.2% of all smooth surfaces were scored as sound or initially carious when assessed by VI + QLF in combination: 4.9% were detected by VI alone and 7.9% by QLF alone. The parameters DeltaF, A, and DeltaQ differed significantly between lesions registered with VI + QLF and QLF alone. It was concluded that (i) QLF seems to be a sensitive method that is suitable for the detection of visually undetected initial caries lesions; and (ii) that the clinical use of QLF is limited by several confounding factors in caries-risk adolescents.     

Quantitative light-induced fluorescence (QLF)--a potential method for the dental practitioner.

The quantitative light-induced fluorescence (QLF) method is based on the natural fluorescence of teeth. Currently, the method is predominantly used in vitro and in clinical studies for early detection of carious lesions and for monitoring of de- and remineralization of white spots by quantifying the mineral loss and the size of smooth surface lesions. The objective of this paper was to demonstrate the potential of QLF for application in routine dental care. Experience with QLF was reported by selected cases, which enlightened the advantages of the method for caries detection and for evaluation of preventive interventions in caries-prone patients in daily practice.     

Assessing caries removal by undergraduate dental students using quantitative light-induced fluorescence

The purpose of this study was to compare detection of enamel and dentinal caries by dental students' and faculty members' visual inspection and by quantitative light-induced fluorescence (QLF). The overall aim was to determine whether QLF is an appropriate technique for use in clinical skills laboratories as a teaching aid for dental undergraduates to detect and assess the removal of enamel and dentinal caries. Sixty students who had no clinical experience with dental caries were asked to select . suitably decayed teeth and mount them in plaster. After recording baseline QLF images, students removed caries according to instructions given by the clinical tutor. On completion of the exercise, the teeth were visually determined to be caries-free by the student, then confirmed by the clinical tutor. A fluorescein in alcohol solution was injected into the cavity for two minutes, rinsed, and dried before QLF images were captured. The images were visually analyzed by two examiners for the presence or absence of caries. From seventy-four images recorded, seventeen were excluded due to exposure of the pulp chamber. The remaining fifty-seven teeth, which by clinical visual examination were judged to be caries-free, were examined using QLF. Fifty-three percent were found to be caries-free, while 47 percent were carious. In this sample of fifty-seven teeth judged to be caries-free by both dental students and faculty members, QLF thus detected caries in almost half of these teeth. These findings suggest that QLF is a useful, noninvasive, nondestructive technique for the detection of caries and can serve as an adjunct to chair-side diagnosis and management of dental caries, which is typically accomplished by visual inspection. QLF may be useful and appropriate as an objective clinical teaching aid for the assessment of dental caries.     

Comparison of QLF and DIAGNOdent for quantification of smooth surface caries

The aim was to compare the detection and quantification of smooth surface caries by KaVo DIAGNOdent and quantitative laser/light-induced fluorescence (QLF) using a laser and a lamp as two different light sources. On 40 premolar teeth extracted from adolescents, 71 non-cavitated approximal surfaces were assessed. For QLF, both mean and maximum fluorescence losses were registered. To provide a gold standard for verification, the teeth were then sectioned and lesion depth, stratified on a five-point scale, was determined by histopathology and microradiography. The correlation between the gold standard and the two methods was assessed by Spearman's rank correlation coefficient. The sensitivity and specificity of the methods for detection of smooth surface caries at D(3) level were also assessed. For lesion depth, correlation with the gold standard was similar for QLF and DIAGNOdent: about 0.85. With respect to dentinal caries detection, sensitivity for DIAGNOdent was 0.75 and specificity 0.96, with a cut-off point of 9. The corresponding values for QLF were 0.94 and 1, with a cut-off value of 20% of fluorescence loss. Spearman's rank correlation coefficients for enamel mineral loss and QLF and DIAGNOdent, respectively, were 0.76 and 0.67. It was concluded that for quantification of smooth surface caries, the methods are of equal merit, but for scientific purposes, QLF offers the advantage of closer correlation with changes in mineral content.     

A clinical study of a laser fluorescence device for the detection of approximal caries in primary molars

International Journal of Paediatric Dentistry 2012; 22: 132–138 Objective. To evaluate the efficacy of laser fluorescence (LF) device in detecting approximal caries in primary molars. Methods. Two hundred and sixteen primary molars from 96 children were inspected visually to identify possible caries with contact approximal surfaces. Target molars and their contralateral molars were examined using bitewing radiographs (BR) and LF. Depending on the examination findings, invasive treatments were performed on molars to identify the presence of cavitation. Results. Of 256 surfaces evaluated from 216 primary molars, 128 were intact, 39 had white spots, and 89 had cavities. At the white‐spot threshold, sensitivity and specificity, respectively, were 2.56% and 94.87% for visual inspection (VI); 64.10% and 97.43% for BR; and 56.41% and 94.87% for LF. At the cavity threshold, sensitivity and specificity, respectively, were 70.79% and 95.51% for VI; 97.75% and 93.26% for BR; and 92.14% and 97.75% for LF. Significant differences between intact surfaces and white spots, and white spots and cavities were shown through LF readings. Conclusions. Both LF and BR can detect cavitations on approximal surfaces of primary molars. LF could be an alternative to radiographs in detecting approximal caries in primary molars.     

Comparison of quantitative light-induced fluorescence (QLF) and digital imaging applied for the detection and quantification of staining and stain removal on teeth

OBJECTIVES: This study compares the use of QLF with digital imaging in the detection and quantification of the development and removal of stain on teeth. METHODS: Two experimental phases, tooth staining and tooth whitening, conducted in vitro on labial 12 mm(2) enamel windows made on ten extracted bovine teeth, developed stains in 6-min cycles (2 min in each solution) using artificial saliva, chlorhexidine and tea solutions and removed them using sodium perborate monohydrate in 2-min cycle monitored at the end of each cycle with QLF (Inspektor Research Systems, NL) and digital photography (Fuji, Japan). The stain values were quantified as DeltaQ derived from QLF and DeltaE from digital imaging. This was observed by the two methods correlated with Pearson correlation coefficient (r). Regression equations (R(2)) were also obtained. RESULTS: For both staining and stain removal there was a statistically significant (p<0.01) reverse correlation between DeltaQ values for QLF (r=-0.924, R(2)=85.4%) and DeltaE values for digital imaging (r=-0.994, R(2)=98.8%), respectively. CONCLUSION: QLF showed a high correlation with digital imaging as a technique for detecting and monitoring tooth stains and tooth whitening in vitro. The potential for QLF with further development as a tool for monitoring staining and whitening of teeth may be possible in vivo in addition to the diagnostic ability for caries detection.     

Ability of quantitative light-induced fluorescence (QLF) to assess the activity of white spot lesions during dehydration

PURPOSE: To determine the ability of QLF to assess the activity of white spots using visual examination (VE) as the gold standard. METHODS: Thirty-four specimens were prepared from extracted human permanent posterior teeth presenting natural white spots on the approximal surface. Fluorescence images were acquired at 1-second intervals for the first 10 seconds and every 5 seconds thereafter to 45 seconds. During image acquisition, specimens were dehydrated with compressed air. QLF variables of fluorescence loss (deltaF [%]), lesion size (S [mm2]), and deltaQ (deltaFxS [% x mm2]), were determined. Change in QLF variables per second (deltaQLF(D): deltaF(D), deltaS(D), deltaQ(D)) was determined using the following equation: (subsequent QLF-variables--baseline QLF-variables)/dehydration time. Five experienced dentists independently conducted VE under standardized conditions using a dental unit's light, compressed air, with an explorer, used only to check surface structure. Prior to VE, examiners had participated in a half-day training seminar on VE. After drying the specimens, examiners graded the lesions according to dullness of surface, roughness and presence of microcavitation. Agreement by at least three of them determined the activity status of lesions. RESULTS: deltaQLF(D) values of Active white spot group (n = 7) were compared with those of Inactive white spot group (n = 27) using a two-sample t-test. In general, the active group presented larger values of deltaQLF(D) than the inactive group; however, there were no differences in deltaF(D) and deltaS(D). There were significant differences in deltaQ(D) up to 6 seconds of dehydration (P < 0.05), and no differences after 7 seconds. The results suggest that deltaQ(D) can differentiate between active and inactive white spot lesions using QLF during the first few seconds of dehydration.     

西安市唐代遗址出土人颅骨标本的龋病研究

调查唐代遗址出土的人颅骨标本的龋病流行状况,为认识龋病在人类进化过程中的演化规律提供相关依据.方法同一研究者采用同样的判断标准,观察并记录了西安市长安区唐代遗址出土的62具人颅骨全部631颗牙齿(均为恒牙)的龋病状况.计算了总患龋率及不同年龄组、不同性别组、不同牙位组研究对象的患龋率,并对不同研究对象患龋率的差异进行统计学分析.结果本组共有39例标本患龋,患龋率为62.9%,龋齿率为14.6%.从龋患在牙面上的分布看,牙根面(颈部)龋最多,占全部龋患牙面的33.3%;其次为(牙合)面龋,占28.7%.从龋患在牙位上的分布看,龋齿率:第三磨牙>第二磨牙>第一磨牙.不同年龄组中男性与女性的龋齿率及总体龋齿率差异均无统计学意义(P>0.05).结论龋病在唐代已相当普遍,但其患龋率低于现代人.龋病患病率随着人类进化及社会生产力的提高而不断增高.     

Use of a ranked scoring system to detect occlusal caries in primary molars

OBJECTIVE: The available literature concerning systems for occlusal caries detection in primary teeth is limited. The aim of this study was to compare in vitro a ranked scoring system for occlusal caries detection in primary molar teeth with bitewing radiography and to investigate the most accurate cut-off point for dentine caries detection when using this ranked scoring system. METHODS: Sixty primary molar teeth were examined in vitro visually and by bitewing radiography (two examiners) using Ekstrand' criteria. RESULTS: Histological examination revealed that 13% were sound, 38% had enamel caries and the remainder had dentine caries. Similar accuracy was seen when comparing bitewing radiographs and visual examination for caries detection at the d3 threshold, while visual examination was more accurate at the d1 threshold. The most suitable cut-off for diagnosing caries at the d1 threshold was V1 (no/slight change in enamel translucency after air drying). Either V2 (opacity/discoloration visible without air drying) or V3 (enamel breakdown in opaque/discoloured enamel and/or greyish discoloration) were suitable cut-off points at the d3 threshold. CONCLUSION: Visual examination was more accurate than bitewing radiographs for detection at the d1 threshold (the cut-off point of V1). Either V2 or V3 can be used for caries detection at the d3 threshold.