诊室加热恒温漂白对不同牙位自然牙漂白效果的临床评价

目的评价不同牙位的自然牙在诊室加热恒温漂白治疗后颜色改善的效果。方法按照纳入标准挑选6名受试者,采用隔天漂白操作3次,每次操作15 min的方式进行诊室加热恒温漂白,测量受试者右上中切牙、右上侧切牙和右上尖牙漂白操作前,第1、2、3次漂白操作后,以及术后1周和1月的L*、a*、b*颜色参数值,计算色差值和白度值。结果不同牙位漂白后的色差值及白度值差值不存在统计学差异(P>0.05),不同漂白阶段及术后1周、1月的色差值及白度值差值之间也不存在统计学差异(P>0.05)。结论不同牙位的自然牙在诊室加热恒温漂白治疗后颜色改善的效果无明显差异。     

椅旁操作次数对恒温漂白活体上中切牙疗效的影响

目的 本实验旨在研究不同椅旁操作次数对活体上中切牙恒温漂白疗效的影响。 方法 受试者接受连续3次（每次间隔1 d）、每次45 min的恒温漂白治疗,以比色仪测量每次漂白前后上中切牙的L*、a*、b*颜色参数值,分析变化,并记录比色板比色结果。所得数据以配对t检验进行统计分析。 结果 统计分析显示,所有受试者接受漂白后牙体的L*、W(Lab)增大,b*降低,即牙齿的亮度和白度值增加,颜色向蓝色转变,且随漂白次数增多幅度变大,差别有统计学差异（P<0.05）。每次漂白操作后牙体颜色变化的色差均大于1.7个NBS单位,说明每次漂白后的颜色变化均能被肉眼辨别。 结论 增加漂白次数能提高漂白疗效。     

Nd—YAG激光漂白四环素牙效果观察

目的：评价Nd-YAG激光漂白四环素牙的有效性及持续性。方法：采用Nd-YAG激光及漂白糊剂实施诊室漂白及2周家庭漂白。利用PR－560测色计CIEL^*a^*b^*表色系对漂白前术后1d，2周，3月及6月的牙齿分别测色，分析牙色的变化。结果：漂白牙齿的平均测色结果表示，术后复查各阶段L^*均高于术前，与术前比较均有显著性差异（P＜0．01）；b^*均低于术前，除6月，术后各阶段与术前比较均有显著性差异（P＜0．05）；a^*各阶段与术前比较均无显著性差异。色差△E值呈逐渐下降趋势。结论：Nd-YAG激光漂白四环素牙即刻效果卓越，短期效果明显。     

无髓变色牙内漂白术后1年临床效果观察

目的 探讨无髓变色牙内漂白临床效果及术后1年内颜色反弹情况，以期指导临床和提示预后。方法对20例无髓变色牙进行内漂白治疗，分别于漂白前、漂白后即刻、漂白后第1、3、6、9、12月使用电脑比色仪对变色牙进行颜色测量，获得不同时间点牙体颈、中、切各部位颜色的L^*、a^*、b^*值，计算出漂白前后颜色变化量ΔE^*、ΔL^*、Δa^*、Δb^*，并观察ΔE^*、ΔL^*、Δa^*、Δb^*在颈、中、切部随时间的变化情况，分析颜色反弹速度(V^*)以及反弹率(P^*)。结果 20例无髓变色牙内漂白后即刻颜色改变平均ΔE^*为14.99。漂白后牙体颈部和中部ΔE^*、ΔL^*在1、3、6、9、12月减小，差异有统计学意义，自漂白后第9个月起，牙体中部及颈部颜色的反弹速度较第1个月...     

分光光度比色仪对牙齿漂白效果的分析

目的 采用分光光度比色仪分析牙齿漂白后不同部位颜色CIE L*、a*、b*值的变化。方法 选择67个健康完整的上颌中切牙,颜色大于A3（Vita经典比色板）。分光光度比色仪比色,记录颈部、体部、切端牙色。进行诊室漂白治疗（35%H2O2协同冷光漂白仪）后再次记录各部位牙色,计算ΔE、ΔL*、Δa*、Δb*和治疗有效率。对数据进行方差分析、配对t检验和Pearson相关分析。结果 治疗有效率分别为：颈部86.6%,体部86.6%,切端85.1%。ΔE均值：颈部5.09,体部4.44,切端4.40。漂白后L*值升高,a*和b*值降低,均有统计学差异（P<0.01）。颈部和体部基线b*值与ΔE成正相关。结论 35%H2O2协同冷光漂白仪照射有较好的牙齿漂白效果,顺序为颈部>体部>切端。颈部黄色降低幅度最大,切端明度增加最多。基线b*值越高,色差越大。     

Beyond冷光牙齿美白仪漂白疗效观察

目的：观察Beyond冷光牙齿美白仪的漂白疗效及其副作用。方法：随机选取30名受试者，用Beyond冷光牙齿美白仪进行漂白治疗。术前和术后用VITA比色板进行比色，并用数字化疼痛评判法记录受试者术后牙齿的敏感度，术后1、3、6个月复查受试者牙齿的反色度。结果：Beyond冷光牙齿美白仪漂白的综合显效率为72．4％，综合有效率为96．6％，漂白后平均提高6个VITA色阶。追踪复查显示术后6个月内大多数病人的牙齿颜色保持稳定。术后病人均有不同程度的牙齿酸痛症状，但24h后都能缓解。结论：Beyond冷光牙齿美白仪具有较好的漂白效果，并能维持一定的时间。     

光活化漂白技术的临床应用

以往的诊室漂白技术通常采用35%的过氧化氢置于牙面后加热。近年来,诊室漂白技术的主要方法是光活化漂白,漂白剂成分是30%至37%过氧化脲或过氧化氢[1~4]。已证明卤素灯,等离子弧灯,蓝光发射器和激光等光源能提高漂白剂的活性[3,5]。光活化漂白具有缩短漂白时间并降低术后敏感的优越性[3,5,6]。本文所报告的四个临床病例均为光活化漂白改善牙色的病例,患者主诉为要求美白牙齿。一、临床资料病例1:男,30岁,牙自然黄色。用Vita Lumin Shade术前比色,切牙和尖牙分别为A3.5和A4(图1a)。选用含35%过氧化氢的EasyWhite Office(DeltaMed Friedberg,Germany)。橡皮障隔离并用Orabase(Brazil)行牙龈保护。将漂白剂粉(二氧化硅,氢氧化钠,赋色剂)与35%过氧化氢混合成黄色膏体,涂布牙齿唇面约1~2mm厚。用蓝光发射器(Brazil)照射每颗牙20秒,静置5分钟后用吸唾器吸走。重复三次后切牙和尖牙的颜色分别为A2和A1(图1b)。病例2:男,27岁,外源性着色牙。术前比色切牙A3,尖牙A3.5(图2a)。选用Lase Peroxide(DMC Equ...     

10％过氧化脲延长漂白四环素染色牙的临床研究

目的评价10％过氧化脲6个月延长期的临床漂白效果。材料与方法对34名中、重度四环素染色牙的患者,制作含贮药池的扇形上颌个别托盘,采用Opalesence10％过氧化脲凝胶进行6个月的家庭漂白治疗。分别于漂白治疗前,治疗后第1周,第2周,第1月、第3月和第6月,对照Vitalescence比色板,记录比较上前牙漂白颜色的改变并照相。结果漂白治疗前,治疗后第1、3、6月的牙齿颜色存在显著性差异。3个月漂白效果较1个月有显著改善;第6个月漂白效果较第3个月有显著改善。结论10％过氧化脲治疗四环素染色牙延长到6个月可显著提高漂白效果。     

三种牙齿漂白方案的短期效果比较研究

目的:体外评价三种漂白方案对人牙齿漂白的短期效果.方法:36颗刚拔除的人牙,沿唇(颊)舌方向中央剖开去髓后,随机分成三组,联合漂白组(A):38%HP45min/d×1+15%CP 8h/d×4;诊室漂白组(O):38%HP45min/2×2,家庭漂白组(H):15%CP 8h/d×14.分别于漂白前,漂白后即刻(0天),4天、7天、14天、21天用Crystaleye分光光度计电脑比色仪拍摄牙齿唇(颊)面照片,分析测量牙齿体部靠近中线区的漂白前后△E值.结果:疗程结束时,3组漂白效果无统计学差异(P>0.05);3组在漂白结束后4天时与漂白结束△E有统计学差异,但H组在7天后△E无统计学差异,而A、O组2周、3周时仍有统计学差异.结论:三种漂白方案短期内都有颜色回复,但回复量和持续时间不同.     

半导体激光漂白四环素牙的疗效观察

目的:评价半导体激光漂白四环素牙的临床效果和安全性。方法:采用自制漂白糊剂,对9例68个四环素活髓牙进行半导体激光漂白,分别于术前、术后、术后一周和术后一月进行牙髓敏感测试和测色,分析牙髓敏感性及牙色变化。结果:所有漂白的牙齿术后牙髓敏感程度均在正常范围内。术后牙齿增白明显,VITA比色板色级和色差值有显著性改变。结论:半导体激光漂白四环素牙是快速和安全的,短期漂白效果明显。     

冷光美白治疗氟斑牙的初步探讨

目的：观察Beyond牙齿冷光美白治疗氟斑牙的效果。方法：选取10名受试者,用Beyond牙齿冷光美白进行漂白治疗。术前和术后分别采用数码照像计算机色度分析系统对上颌中切牙进行比色,术后1年复查受试者牙齿的色度变化。结果：术前受试者上颌中切牙的平均L＊,a＊,b＊值为73.89±2.80,7.77±1.05和21.50±1.21,经过Beyond牙齿冷光美白三次治疗后上颌中切牙的平均L＊,a＊,b＊值为82.95±2.42,3.39±0.91和12.97±1.36,平均色差ΔE＊ab为13.18±1.53。术后1年复查受试者上颌中切牙的平均L＊,a＊,b＊值为81.50±2.10,3.69±0.76和13.66±1.32,平均色差ΔE＊ab为11.45±1.64。结论：Beyond牙齿冷光美白对氟斑牙具有较好的漂白效果,并能较长时间维持漂白效果。     

The efficiency of 10% carbamide peroxide gel on dental enamel

This study investigated the effect of 10% carbamide peroxide gel on human tooth color, vibrational mode, and mineral loss. The exposed enamels were bleached for two weeks (six hours' bleaching and 18 hours' storage in distilled water per day). Color change was calculated from the CIE L*a*b* color values. Vibrational mode in Fourier transform Raman spectrum and mineral content were also estimated. The bleached enamels showed an apparent color change (deltaE* = 5.35). Within the test period, their whiteness increased linearly as the period increased. A slight decrease in Raman peak at 1068 cm(-1)--compared with the peak at 430 cm(-1)--was observed after bleaching. The total mineral content was decreased from 90.39 to 86.01 after bleaching. Also, the calculated Ca/P ratio decreased from 2.10 to 2.07. However, these changes were negligibly different from the enamels stored in distilled water except for a color change.     

漂白后牙本质颜色改变对牙齿体部与颈部颜色变化不同的影响研究

目的:探讨漂白后牙齿体部与颈部颜色变化不同的原因。方法:将36个新鲜拔除的人前磨牙沿唇(颊)舌方向中央剖开、去髓,随机分成3组,联合漂白组(A):380 mL/L过氧化氢(HP)45 min/d×1次+150 g/L过氧化脲(CP)8 h/d×4次;诊室漂白组(O):380 mL/L过氧化氢(HP)45 min/d×2次;家庭漂白组(H):150 g/L过氧化脲(CP)8 h/d×14次。3组分别于漂白前、后用Crystaleye电脑比色仪测量牙齿唇(颊)面靠近剖面中线区体部、颈部及相对应剖面靠近釉牙本质界牙本质漂白前后的ΔE值。结果:3种漂白方案疗程结束后,体部、颈部牙齿颜色及与其对应的剖面牙本质均出现了颜色变浅(P﹤0.05),但体部牙齿颜色改变程度超过颈部(P<0.05)。体部、颈部牙本质颜色改变无显著性差异(P>0.05);体部、颈部牙齿表面与其分别对应的剖面牙本质颜色改变无显著性差异(P>0.05)。结论:漂白剂对牙本质的颜色改变不受釉质厚度的影响。牙本质颜色变化和漂白后体部、颈部牙齿表面颜色变化不相关。牙齿体部颜色改变慢于颈部可能是体部釉质厚度大于颈部及半透明性改变产生的。     

Efficacy and oral side effects of two highly concentrated tray-based bleaching systems

The aim of this study was to investigate the tooth-whitening efficacy and oral side effects of the two tray-based bleaching systems Visalys whitening (VW) and Opalescence PF (OP). A stratified, randomised distribution of the subjects (n = 60) to two treatment groups was performed according to baseline tooth brightness (L* values) as determined by colourimeter and to the criteria smoker/non-smoker. Tooth colour was evaluated by measuring L*a*b* values generated from standardised digital image analysis with Adobe Photoshop of the facial surfaces of the right central maxillary incisor. Tooth hypersensitivity, with intensity graded from 0 (no hypersensitivity) to 10 (high hypersensitivity), was assessed chair-side using an air syringe. After bleaching therapy, both treatment groups demonstrated significant improvements in tooth colour (p < or = 0.05). A shift towards less yellow (-Deltab*) and brighter (+DeltaL*) tooth colour was observed. Deltab* was significantly higher in the OP group in comparison to the VW group, DeltaL* showed no significant difference between the both treatment groups (p < or = 0.05). After bleaching, the intensity of tooth hypersensitivity was increased significantly compared to baseline in both groups (p < or = 0.05), with no significant difference between the both groups. Both highly concentrated bleaching systems are effective as tooth-whitening systems, with few reported side effects such as transient tooth hypersensitivity.     

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目的评价Opalescence PF家庭美白系统漂白牙齿的临床疗效。方法随机选择2007年8月至2010年12月在暨南大学附属惠州口腔医院治疗的着色牙患者60例(四环素牙组和氟斑牙组各30例),用含15%过氧化脲的Opalescence PF家庭美白套装进行牙齿漂白,用美能达接触式色彩色差计分析并比较治疗前后牙面色度的变化,记录受试者术中牙齿酸痛的发生率,并复查评价疗效稳定性。结果用含15%过氧化脲的Opalescence PF家庭美白系统漂白后,四环素牙组与氟斑牙组牙面平均L*,a*,b*值与治疗前比较差异均有统计学意义(均P<0.05),平均色差分别为3.89和4.21;术中2组均有部分患者出现不同程度牙齿酸痛症状,但停药后4～5h均能缓解;治疗后6个月,氟斑牙漂白有效率仍达90%(27/30),四环素牙的漂白有效率为86.7%(26/30),与治疗结束时(93.3%和96.7%)比较,差异均无统计学意义(均P>0.05)。结论 Opalescence PF家庭美白系统治疗着色牙效果显著并具有一定稳定性。     

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目的评价不同漂白方法对氟斑牙漂白的临床效果。方法轻中度氟斑牙患者30例随机分为3组,每组10例60颗牙。分别采用联合漂白、激光漂白、家庭漂白3种方法进行上前牙区漂白,在漂白前、漂白后即刻、漂白后1个月、漂白后1年记录其L＊a＊b＊值,比较3组漂白效果及颜色回复情况。应用统计学分析软件CS10.34对数据进行t’检验。结果 3组漂白后的L＊a＊b＊值与漂白前比较差异均有统计学意义（均P〈0.05）;漂白后1个月,联合组与激光组颜色有所回复（P〈0.05）;漂白后1年,联合组、激光组颜色与漂白后即刻相比有所回复（P〈0.05）,与漂白后1个月相比颜色回复差异无统计学意义（P〉0.05）;家庭组颜色回复差异无统计学意义,但1个月到1年期间颜色变化小于治疗后即刻到1个月的变化（P〈0.05）。结论 3种漂白方案治疗1个疗程都得到相似的美白效果,但短期内也出现漂白牙的颜色回复,家庭漂白颜色相对稳定,诊室漂白收效快,3种治疗方案各有其适应人群。     

Effectiveness of different carbamide peroxide concentrations used for tooth bleaching: an in vitro study

Objectives

This in vitro study evaluated the effectiveness of three carbamide peroxide concentrations used for tooth bleaching treatments.

Material and Methods

Sixty bovine dental slabs (6x6x3 mm) were obtained, sequentially polished, submitted to artificial staining (baseline) and randomized into four groups (n=15), according to the bleaching agent concentration: distilled water (control), 10% (CP10), 16% (CP16) or 37% (CP37) carbamide peroxide. CP10 and CP16 were covered with 0.2 mL of the respective bleaching gels, which were applied on enamel surface for 4 h/day during two weeks. Samples of CP37 were covered with 0.2 mL of the bleaching gel for 20 min. The gel was light activated by two 40-s applications spaced by 10-min intervals. The gel was renewed and applied 3 times per clinical session. This cycle was repeated at 3 sessions with 5 days of interval between them. Tooth shade evaluations were done with a digital spectrophotometer at T0 (baseline), T1 (after 1-week of treatment) and T2 (1-week post-bleaching). Tooth shade means were statistically analyzed by Kruskal-Wallis and Friedman''s tests and color parameters were analyzed by two-way ANOVA and Tukey''s test (p<0.05).

Results

At T1 and T2 evaluations, tooth shade was significantly lighter than at baseline for all treatment groups, considering the color parameters ΔL*, Δa*, Δb*, ΔE* (p<0.001) or tooth shade means (p<0.001). CP37 group showed lower shade mean change than CP10 and CP16 at T1 (p<0.01), but this difference was not statistically significant at T2 (p>0.05).

Conclusions

One week after the end of the treatment, all carbamide peroxide concentrations tested produced similar tooth color improvement.     

牙齿漂白颜色稳定性影响因素研究进展

牙齿的漂白治疗可以改善变色牙齿的颜色,这种治疗方法越来越受到病人的欢迎,但是由于多种因素的影响,医生与病人均发现随着时间的变化,漂白后的牙齿颜色发生了反弹现象,该文就牙齿漂白颜色稳定性的影响因素做一综述。     

Efficacy of different whitening modalities on bovine enamel and dentin

Previous studies have shown that bleaching treatment may be efficient in both enamel and dentin, but it is still unknown how much the subsurface dentin contributes to the color change of teeth. This in vitro study evaluated the whitening effect of different external bleaching agents on enamel-dentin slabs and subsurface dentin. Ninety bovine teeth were distributed among six groups (A, Opalescence 10%; B, Opalescence PF 15%; C, Opalescence Quick; D, Opalescence Extra Boost; E, Rapid White; F, Whitestrips). Two enamel-dentin specimens were prepared from the labial surface of each teeth. In one of the specimens enamel was removed, resulting in a dentin (CD) disc of 1 mm high. The labial and the pulpal sides of the second specimen were ground until the remaining enamel and dentin layers of the enamel-dentin sample (ED) were 1 mm each. Whitening treatment of the ED specimens was performed according to manufacturers instructions. Pre- and posttreatment Lab values of ED samples were analyzed using CIE-Lab. Baseline Lab values of dentin were analyzed by evaluation of the CD specimen. Finally, enamel of the ED specimens was removed and color change of the exposed dentin (D) was recorded. For all treatment agents significant color changes (E) were observed for enamel-dentin samples and subsurface dentin specimens compared to controls. In groups A–D E was significantly higher in dentin than enamel-dentin. Furthermore, L and b values of bleached enamel-dentin and subsurface dentin samples differed significantly from baseline. Treatment with the tested external whitening bleaching agents resulted in color change of both enamel-dentin and subsurface dentin samples. The results indicate that color change of treated teeth might be highly influenced by color change of the subsurface dentin.