渗透树脂在早期釉质龋修复中的应用：颜色稳定性评价

 背景：采用渗透树脂微创技术治疗釉质脱矿的修复效果优于传统的再矿化治疗,但目前研究渗透树脂修复非实质性缺损龋病后颜色变化的文献很少。目的：通过体外研究评估渗透树脂修复早期釉质龋的颜色稳定性。方法：将具有完整釉质面的48颗人离体牙浸泡在脱矿液中4周,制作成人工龋模型,之后进行渗透树脂修复,再随机均分成4组,分别置于红酒、咖啡、茶和人工唾液中浸泡2,4周。采用分光光度仪对病损区的颜色进行检测,以渗透树脂治疗后的检测作为基准色,计算出色差数值。结果与结论：浸泡后,4组样本都有不同程度的颜色变化。浸泡2周后,颜色变化大小顺序为：红酒>咖啡>茶>人工唾液,4组间比较差异有显著性意义(P < 0.05);浸泡4周后,颜色变化大小顺序为：红酒≈咖啡>茶>人工唾液,红酒组与咖啡组比较差异无显著性意义(P > 0.05),其他组间比较差异有显著性意义(P < 0.05)。红酒组与咖啡组浸泡不同时间点的颜色变化比较差异有显著性意义(P < 0.05)。浸泡在红酒、咖啡和茶一定的时间后,均显示在临床上不可以接受的色彩改变(?E >3.7)。说明渗透树脂颜色的稳定性受浸泡时间长短和浸泡溶液种类的影响,其中红酒、咖啡对其颜色稳定性影响较大,在人工唾液中颜色稳定性最好。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

树脂渗透修复脱矿牙齿

背景：树脂渗透技术是一种治疗早期龋的新方法,为评估其治疗效果,与传统再矿化治疗方法进行比较。 目的：比较树脂渗透技术与氟化物再矿化治疗拮抗牙体组织脱矿的效果。 方法：将35颗牛牙样本的釉质表面各制备出3个相同大小的窗区,分别设为渗透区、氟化钠区、空白区,将样本制备为脱矿模型,渗透区行树脂渗透处理(Icon®),氟化钠区每天以0.1%NaF溶液涂布连续7 d(即氟化物再矿化治疗),空白区不作处理;将样本自底部垂直向表面二等分,一份设为脱矿组再次脱矿,一份设为对照组置于去离子水中保存,观察脱矿组与对照组相对应窗区脱矿深度的进展。 结果与结论：牛牙样本渗透区、氟化钠区脱矿深度的进展均小于空白区(P < 0.05),且渗透区脱矿深度的进展小于氟化钠区(P < 0.05)。提示树脂渗透技术和氟化物再矿化治疗均可抑制牙体组织进一步脱矿,树脂渗透技术拮抗脱矿效果可能更佳。     

Filtek Z350流动纳米树脂与Fuji Ⅸ玻璃离子应用于磨牙窝沟浅龋的效果比较

目的 比较3M ESPE Fihek Z350 Flowable纳米流动树脂(Filtek Z350流动纳米树脂)与而至富士Ⅸ GP玻璃离子水门汀(Fuji Ⅸ玻璃离子)应用于磨牙窝沟浅龋的临床效果,探讨更适合于预防和治疗磨牙窝沟浅龋的方法.方法 选择201例患者的356颗窝沟浅龋的患牙作为研究对象,随机分为两组,实验组101例患者178颗患牙,对照组100例患者178颗患牙,在彻底去除龋坏组织后,实验组用Fihek Z350流动纳米树脂充填龋坏部位并对未龋损的窝沟区域进行预防性充填封闭,对照组采用FUjiⅨ玻璃离子材料进行充填及封闭,观察两种材料4年中的保留情况和继发龋发生率.结果 术后第2～4年Filtek Z350流动纳米树脂的涂膜保留率高于对照组(P＜0.05),两组的继发龋发生率在第1、第2年均为0,在第3、第4年两组间无统计学差异(P＞0.05).结论 Filtek Z350流动纳米树脂是一种能有效预防和治疗磨牙窝沟龋的新方法,建议临床推广使用.     

流动纳米树脂预防性窝沟龋充填

背景：预防性树脂充填术由于不采用传统的预防性扩展,只去除少量的龋坏组织后即用复合树脂或玻璃离子材料充填龋洞,而未患龋的窝沟使用封闭剂保护。 目的：通过应用美国3M公司生产的Filtek Z350流动纳米树脂对窝沟可疑龋、初龋磨除后进行预防性充填,观察并评价其临床效果,探索预防性充填治疗早期窝沟龋的新方法。 方法：对196例6~25岁患者磨牙的牙合 面窝沟龋在去除龋坏的牙体组织后,采用Eadper prompt自酸蚀粘结技术,用Filtek Z350流动纳米树脂对整个牙面进行预防性充填术,并采用对侧同名牙或邻牙也有窝沟龋者用同一公司生产的ClinproTM可见光固化变色窝沟封闭剂充填作对照研究。 结果与结论：随治4年后发现该方法涂膜保留率高,能有效阻止龋病的进一步发展。实验组与对照组在术后1,2年时的涂膜保留率差异无显著性意义,而在第3,4年时差异有显著性意义(P < 0.01、P < 0.05)。龋病发生率在1,2年时差异无显著性意义,而在3,4年时差异有显著性意义(P < 0.05)。提示Filtek Z350流动纳米树脂预防性窝沟充填是一种有效阻止窝沟早期龋进一步发展的方法。     

FiltekTM Z 350纳米流动树脂微创修复细小窝沟龋

背景：传统的细小窝沟龋修复需要按Ⅰ类洞形进行预备,对牙体组织破坏较多。 目的：评价流动纳米树脂微创修复细小窝沟龋的临床效果。 方法：选择14~30岁磨牙有窝沟龋且对侧同名牙或邻牙也有窝沟龋患者167例,在一侧磨牙牙合面窝沟龋去除龋坏牙体组织后,采用Adper Single Bond 2全酸蚀黏结技术,用Filtek ^TM Z350流动纳米树脂充填整个微创窝洞作为实验组,对侧同名牙或邻牙窝沟龋用同一公司生产的Filtek ^TM Z350纳米树脂充填作对照。 结果与结论：随访2年后发现实验组Z350流动纳米树脂填充体保留率高,边缘完整性好,边缘着色率低,树脂保留率、边缘完整性及边缘着色率高于对照组(P < 0.05)。提示Filtek ^TM Z350流动纳米树脂微创窝沟充填可有效修复细小窝沟龋。     

两种牙体预备方法制作玻璃纤维夹板固定松动前牙5年临床观察

背景：研究发现采用舌侧凹槽加邻面流体树脂牙体预备方法制作玻璃纤维夹板,用其固定松动前牙可达到较为理想的临床固定修复效果。 目的：观察两种牙体预备方法制作玻璃纤维夹板固定松动前牙5年基牙与夹板脱黏率及固定修复效果。 方法：根据慢性牙周病诊断标准,并严格按照牙周夹板固定适应证选取经过牙周基础治疗后需纤维夹板固定的94例Ⅱ-Ⅲ度前牙松动患者,根据松动患牙间是否进行邻面固定分为2组,邻面未固定组采用舌侧凹槽牙体预备方法,邻面固定组采用舌侧凹槽加邻面流体树脂牙体预备方法进行纤维夹板固定。随后5年中定期临床复诊或电话随访,对固定修复效果进行评价。 结果与结论：5年中定期临床复诊或电话随访显示,邻面固定组76例基牙与夹板脱黏7例,邻面未固定组18例基牙与夹板脱黏12例,均已经进行再固定。与邻面未固定组相比,邻面固定组5年后两组患牙的探诊深度、附着丧失明显改善(P  < 0.05),牙槽骨高度占根长的百分比增加(P < 0.05),患者自觉舒适无异物感。结果证实,采用舌侧凹槽加邻面流体树脂牙体预备方法制作玻璃纤维夹板固定松动前牙的5年观察固定效果较好。     

正畸牙釉质脱矿与应用3种不同牙刷的比较

背景：近年来,有大量关于防正畸牙釉质脱矿方面的研究,但目前还未有学者对普通牙刷、正畸专用牙刷及牙间刷3者做过这方面的比较研究。 目的：比较分别使用普通牙刷、正畸牙刷及牙间刷对正畸牙釉质脱矿的影响。 方法：将12-17岁的青少年正畸患者按使用牙刷的种类不同,随机分成普通牙刷组、正畸专用牙刷组和牙间刷组。由同一正畸专科医生检查并计算矫治前和矫治1年后釉质脱矿指数和釉质脱矿增加指数。 结果与结论：正畸治疗前,3组患者的釉质脱矿指数差异无显著性意义(P > 0.05)。治疗1年后,各组患者的釉质脱矿指数均大于其矫治前(P < 0.05)。矫治1年后,3组间脱矿指数及脱矿增加指数的两两比较：正畸专用牙刷组< 普通牙刷组< 牙间刷组(P < 0.05)。结果证实,使用正畸专用牙刷对防治正畸治疗中的釉质脱矿效果更好,更适用于正畸人群;而单独使用牙间刷并不能起到很好的防止釉质脱矿的作用。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

生物活性玻璃对早期人工釉质龋的再矿化

背景：生物活性玻璃具有良好的生物相容性,且具有抑制口腔致龋细菌和牙周相关细菌及抗牙本质过敏的作用。 目的：评价生物活性玻璃促进早期人工釉质龋再矿化的作用。 方法：将新鲜拔除的30颗牛切牙制成人工龋模型,将标本在37 ℃人工脱矿液内脱矿72 h,用扫描电镜观察脱矿后釉质表面的平滑情况,用显微硬度仪测量脱矿后釉质的显微硬度。然后随机分为3组,每组10个。采用pH循环法模拟人口腔环境,将3组标本分别浸泡在生物活性玻璃溶液、氟化钠溶液及人工唾液内,3次/d,10 min/次,循环浸泡20 d,扫描电镜检测标本脱矿及再矿化情况,用显微硬度计检查牙釉质显微硬度。 结果与结论：浸泡在生物活性玻璃溶液中的牙釉质表面较浸泡在其他两溶液中的牙釉质表面光滑平整,无空隙存在;浸泡在生物活性玻璃溶液中的牙釉质表面显微硬度高于浸泡在其他两溶液中的牙釉质表面显微硬度(P < 0.05)。说明生物活性玻璃在体外实验中能促进早期釉质龋的再矿化。     

Varnish XT和ICON渗透树脂对釉质龋白斑微硬度的影响

背景:早期龋的治疗方法中,可以采用氟化物对龋白斑进行再矿化处理。长效释氟玻璃离子保护膜(Varnish XT)和ICON渗透树脂是两种新型的材料,Varnish XT是一种新型的树脂加强型玻璃离子,可以作为再矿化材料的新选择。ICON渗透树脂是一种流动性较好的高渗透系数树脂,借助毛细作用渗入到脱矿釉质的微孔中,利用低黏性的渗透树脂取代由于脱矿而丧失的硬组织并占据微孔的空间,填补釉质脱矿区并阻止病损的进一步发展。目的:观察Varnish XT和ICON渗透树脂两种微创治疗材料对釉质龋白斑微硬度的影响。方法:选择牛门齿100颗,将唇面向下作为观察面,环氧树脂包埋,打磨。暴露至少6 mm×10 mm的釉质牙面,由切端至颈部依次分A,B,C,D,E 5个区,E区用抗酸指甲油封闭。分别采用人工龋脱矿液后,A区不做处理,B区经Varnish XT处理,C区经ICON渗透树脂处理,D区经氟化物处理后,用韦氏硬度仪测量表面显微硬度值。结果与结论:脱矿样本经处理后A,B,C,D区的表面显微硬度值较E区均明显降低(P0.05),B,C,D区样本表面显微硬度值均较A区升高,且表面显微硬度值C区B区、D区(P0.05);B区的表面显微硬度值与D区相比,差异无显著性意义(P0.05)。说明ICON渗透树脂、Varnish XT和氟化物对龋白斑的微硬度都有明显的改善,ICON渗透树脂的改善较Varnish XT和氟化物明显,Varnish XT和氟化物之间无明显差异。     

玻璃纤维桩与金属桩核修复牙体缺损的比较

背景：当冠部牙体组织大面积缺损单纯充填、全冠及嵌体疗效不佳时,桩核系统使残根、残冠的修复成为可能。 目的：分析玻璃纤维桩和铸造金属桩在牙体缺损修复中的临床效果。 方法：将106例患者共160颗患牙随机分为2组,经完善的根管治疗后,分别采用玻璃纤维桩(n=80)和铸造金属桩(n=80)制作桩核,金瓷冠修复,随访9-33个月,评价两组临床修复效果。 结果与结论：玻璃纤维桩治疗成功78颗,桩松动2颗,治疗成功率98%;铸造金属桩治疗成功71颗,冠折1颗,根折4颗,桩脱落4颗,治疗成功率89%,两组治疗成功率比较差异有显著性意义(P < 0.05)。表明玻璃纤维桩在牙体缺损修复中具有操作方便、色泽好且不易造成根折等优点,治疗效果优于金属铸造桩核修复。     

酪蛋白磷酸多肽/无定形磷酸钙复合物与氟化钠预防正畸托槽周围的牙釉质脱矿

BACKGROUND: In clinical practice, both casein phosphopeptides/amorphous calcium phosphate compound and fluoride can effectively prevent the occurrence of enamel demineralization and caries. OBJECTIVE: To investigate the preventive effects of casein phosphopeptides/amorphous calcium phosphate compound and fluoride on enamel demineralization in the orthodontic treatment, so as to seek a remineralization agent with good effect. METHODS: Totally 40 human in vitro teeth which had been well bonded to brackets were randomly divided into four groups: control group (the surface was not coated with any substance), GC tooth mousse group (the surface was coated with casein phosphopeptides/amorphous calcium phosphate compound), duraphat group (the surface was coated with fluoride) and combined group (the surface was coated with casein phosphopeptides /amorphous calcium phosphate compound and fluoride). The enamel surface porosity was observed by scanning electron microscopy after the successive 14-day demineralization-remineralization experiments in these four groups. The change value of microhardness was measured before and after the experiment in each group. RESULTS AND CONCLUSION: There was obvious enamel demineralization in the control group, but not in the other three groups. The change value of microhardness in GC tooth mousse, duraphat and combined groups was lower than that in the control group (P < 0.05), and there was no significant difference between GC tooth mousse, duraphat and combined groups. These results demonstrate that fluoride, casein phosphopeptides/amorphous calcium phosphate compound and their combination can prevent enamel demineralization, promote remineralization; however, their combination does not improve the effect of preventing enamel demineralization.         

全光纤OCT量化检出早期釉质龋的研究

目的评价全光纤光学相干断层成像（全光纤OCT）检出早期牙釉质人工龋的敏感性。方法在新鲜拔除的7颗离体人恒牙釉质光滑面制备2mm×3mm实验窗．选用pH4．5的化学酸蚀液在开窗区制备0～120h早期脱矿人工龋模型．采用自行研发的口腔全光纤OCT系统检测离体人恒牙早期牙釉质人工龋,以同一牙齿样本的显微数码摄影和偏光显微镜检测作为对照．比较和检验OCT有效检出早期龋变的敏感性和可行性。结果全光纤口腔OCT装置可早期准确检测到脱矿12h以内牙釉质表面组织学水平的微观改变,早于裸眼和临床显微摄影的观察结果：开窗区釉质表面完整度随脱矿作用时间出现递减变化;而釉质脱矿深度随脱矿作用时间而出现递增性变化,不同时段脱矿深度的OCT量化数据与偏光显微镜检出结果相吻合．统计学分析结果表明2者间无显著性差异（P〉0．05）,证实OCT可早期、敏感、精确地检出组织学水平的早期牙釉质人工龋。结论全光纤口腔OCT系统可无创准确检出早期牙釉质表面和表层下人工龋变．获得的龋变深度量化测量数据与偏光显微镜下组织学水平的测量结果高度相关。系统进一步完善后有望作为一种新型光学手段用于口腔临床龋病的早期诊断、量化监控以及干预效果的有效评估。     

Quantitative light-induced fluorescence: a potential tool for general dental assessment

Current dental diagnostic methods can detect caries but cannot quantify the mineral status of a lesion. Quantitative light-induced fluorescence (QLF) measures the percentage of fluorescence change of demineralized enamel with respect to surrounding sound enamel, and relates it directly to the amount of mineral lost during demineralization. Development of caries-like lesions and subsequent remineralization of the lesions were monitored by QLF. The results showed that the percentage of fluorescence change (Delta Q) increased linearly with the demineralization time and decreased with increased remineralization time. Stained teeth were whitened with a bleaching agent and the change in stain intensity (Delta E) was quantified using QLF. The results showed that Delta E decreased linearly as the tooth regained its natural color. Factors that might affect the use of QLF to detect and quantify caries were also examined. It was concluded that QLF could be used to detect and longitudinally monitor the progression or remineralization of incipient caries, however lesion detection may be limited by the presence of saliva or plaque and enhanced by staining. The change in shade of discolored teeth by whitening agents could be quantitatively measured by QLF.     

Enamel microhardness after in vitro demineralization and role of different restorative materials

This study aimed to evaluate the extension of enamel demineralization around the margin of restorations after immersion in cariogenic solution, in an attempt to define the role of new restorative materials in preventing secondary caries formation. For this purpose, enamel microhardness was measured. Twelve class V restorations in human extracted third molars were prepared in vitro and immersed in a demineralizing solution (lactic acid, pH 4.5) at 37°C for 3 days to simulate the formation of secondary caries and its effect on the marginal integrity of composite restorations. The restorative systems tested in the study were Scotchbond 1 + Z 250 (group A), ABF + APX (group B), Fuji IX (group C), SE Bond + APX (group D), and Scotchbond 1 + F 2000 (group E). The microhardness was measured close to the margin of restoration (marginal exposed enamel), at 2.0 mm from the margin (exposed enamel), and at approximately 4 mm from the margin in a varnish-covered enamel area (protected enamel). Five measurements were made on each site at 20, 40, 60, 80, and 100 μm depth from the external enamel surface. Exposed enamel and marginal exposed enamel were greatly affected by the cariogenic solution, as confirmed by the high rate of demineralization. The marginal exposed enamel showed a higher rate of demineralization than the exposed enamel, as demonstrated by the lowest microhardness values. The materials that claimed fluoride release did not prevent any type of enamel marginal alteration. This study revealed that enamel close to the margin of restoration may be rapidly affected by secondary caries formation when immersed in a demineralizing-cariogenic solution and that fluoride-releasing materials are unable to reduce the marginal demineralization processes. These demineralization processes may be responsible for marginal secondary caries and for restoration failures.     

自研全光纤光学相干计算机断层摄影术灵敏检测早期牙釉质龋

目的探索新型生物组织高分辨率成像技术——光学相干计算机断层摄影术（OCT）用于龋病早期诊断。方法选用化学酸蚀法在离体人恒牙釉质光滑面制备0、12、24、48、72、96、120h不同时间的早期脱矿人工龋模型,采用自行研发的口腔全光纤OCT（AF-OCT）进行离体人恒牙早期牙釉质人工龋的体外检测．并与同一牙齿样本的显微数码摄影、扫描电子显微镜和偏振光显微镜的检测结果进行比较．检验AF—OCT体外检测早期龋变的效能。结果AF—OCT可早期准确检测到脱矿12h以内的牙釉质表面组织学水平的改变．开窗区釉质表面脱矿深度与脱矿时间成正比。与3种常用体内外检测手段相比．AF—OCT可早于显微数码摄影观察到牙釉质表面的形貌改变．与扫描电子显微镜和偏振光显微镜检测结果高度相关。结论自研AF—OCT可早期、精确、无创地检测出脱矿12h以内的早期牙釉质表面人工龋变,并可实现量化测定和分析．获得的龋变深度量化测量数据与偏振光显微镜下组织学测量结果高度相关。     

The Effect of MIpaste Plus and Reminpro on Incipient Caries Using DIAGNOdent and SEM: An Invitro Study

Background

The remineralization of early caries lesion has an effective role on decreasing caries. For initial remineralization of caries lesion, using Compounds of Casein phosphopeptides (CPP) in different studies has been proposed. REMINPRO including Fluoride, Xylitol and Calcium phosphate has just been offered in the market. This study aims to investigate the efficacy of Reminpro and MI paste plus in terms of remineralization of early enamel lesions.

Enamel microhardness after in vitro demineralization and role of different restorative materials

This study aimed to evaluate the extension of enamel demineralization around the margin of restorations after immersion in cariogenic solution, in an attempt to define the role of new restorative materials in preventing secondary caries formation. For this purpose, enamel microhardness was measured. Twelve class V restorations in human extracted third molars were prepared in vitro and immersed in a demineralizing solution (lactic acid, pH 4.5) at 37 degrees C for 3 days to simulate the formation of secondary caries and its effect on the marginal integrity of composite restorations. The restorative systems tested in the study were Scotchbond 1 + Z 250 (group A), ABF + APX (group B), Fuji IX (group C), SE Bond + APX (group D), and Scotchbond 1 + F 2000 (group E). The microhardness was measured close to the margin of restoration (marginal exposed enamel), at 2.0 mm from the margin (exposed enamel), and at approximately 4 mm from the margin in a varnish-covered enamel area (protected enamel). Five measurements were made on each site at 20, 40, 60, 80, and 100 microm depth from the external enamel surface. Exposed enamel and marginal exposed enamel were greatly affected by the cariogenic solution, as confirmed by the high rate of demineralization. The marginal exposed enamel showed a higher rate of demineralization than the exposed enamel, as demonstrated by the lowest microhardness values. The materials that claimed fluoride release did not prevent any type of enamel marginal alteration. This study revealed that enamel close to the margin of restoration may be rapidly affected by secondary caries formation when immersed in a demineralizing-cariogenic solution and that fluoride-releasing materials are unable to reduce the marginal demineralization processes. These demineralization processes may be responsible for marginal secondary caries and for restoration failures.