牙齿漂白技术规范操作的研究进展

牙齿漂白技术作为牙科美容医学中的一项重要内容越来越多地受到了学者的关注,但如何规范操作,台合理掌握适应证,对提高漂美效果、发展牙齿漂美技术有着重要的作用。该文将对牙齿漂美技术的规范操作做一综述。     

牙齿增白涂膜的临床效果观察

目的：研制一种价廉且使用方便的牙齿增白剂。方法将国际公认的牙齿漂白药过氧化脲加入无毒高分子成膜剂配成胶状液,涂于干牙面１－２分钟形成附着于牙面的薄膜,可维持１小时以上,在临床上观察用此法漂白牙面面烟茶染色及治疗中、轻度氟斑牙、四环素牙的效果,结果漂白牙面烟茶染色的治愈率为９９．４５％,有效率为０．５５％,没有无效者,平均只需涂５．４次,中、轻度氟斑牙、牙面烟茶染色的治愈率为９９．４５％,有效率为０．５５％,没有无效者,平均只需涂５．４次。中、轻度氟斑牙、四环素牙治愈率分别为８４．０９％和７７．７８％,平均需涂膜次数分别为２０．３次和３６．５次。结论牙齿增白涂膜是一种简便有效的漂白牙齿方法,但用于治疗氟斑牙、四环素牙尚需进一步改进。     

ELETE SMILE超冷光牙齿美白临床效果观察

目的观察ELETE SMILE超冷光牙齿美白技术的漂白效果及不良反应。方法采用ELETE SMILE超冷光牙齿美白技术对23例患者进行漂白治疗。比较治疗前后牙色的改变,记录术中及术后出现牙髓酸痛的发生率及严重程度。结果除1例中度四环素变色牙外,其余病例均取得了令患者和医生满意的疗效。增龄性着色牙的漂白效果优于轻度四环素牙和氟斑牙;切牙的漂白效果优于尖牙及第一前磨牙。仅有2例患者治疗期间出现轻度牙髓酸痛症状,发生率为8.6%。结论增龄性着色牙、轻度四环素及氟斑牙应用ELETE SMILE超冷光牙齿美白技术均可获得满意的美白效果,且治疗过程安全可靠。     

冷光美白技术对人牙釉质硬度的影响

目的研究冷光美白技术对人牙釉质硬度的影响。方法选择正畸拔出的双尖牙15颗,颊面近中部分进行美白,远中部分作为空白对照,显微硬度计测量近中和远中牙釉质表面硬度。结果美白后牙釉质硬度(Hv0.5)为361.0±8.9,空白对照组釉质硬度是365.7±5.8,两组釉质硬度差异无统计意义(P>0.05)。结论冷光美白不降低牙釉质表面硬度。     

3种过氧化脲漂白剂对釉质表面作用的SEM观察

目的：了解3种过氧化脲漂白剂在体情况下对釉质表面的影响。方法：选用临床正畸患者即将拔除的健康前磨牙，分为4组，每天分别给予3种过氧化脲漂白剂(300、160g／L CP—Rembrandt，150g／L CP—瑞康)漂白处理，空白对照组不作处理。2周后，拔除受试牙，即刻用扫描电镜对釉质表面进行观察。结果：300g／L过氧化脲漂白组釉质表面局部有轻度溶解、脱矿现象；160、150g／L组漂白后釉质表面较光滑，无明显脱矿。结论：临床情况下，以上受试产品中，300g／L过氧化脲对釉质局部表面有轻微脱矿作用，160、150g／L过氧化脲对釉质表面无明显脱矿作用。上述脱矿现象与釉质本身表面结构有关。     

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。     

一种实用的牙齿漂白技术

将国际公认的牙齿漂白药物过氧化脲加入无毒高分子成膜剂配成胶状液 ,涂于干燥牙面1— 2分钟形成附着于牙面的薄膜 ,可维持 1小时以上。此期间过氧化脲分解释放新生氧而将牙齿漂白。临床研究表明 :牙齿增白涂膜是一种安全、有效、实用的漂白牙齿方法。本产品已获中国专利 (专利号 :96 1186 0 5.4 ,PCT/ CN97/ 0 0 0 0 4 )     

牙齿漂白和釉质微打磨对釉质表面形态的影响

目的：探讨牙齿漂白和质微打磨方法对釉质表面形态的影响。方法：将16颗健康离体牙随机使用蒸馏水作为对照组、夜间活髓牙漂白、Croll釉质微打磨和Longhurst釉质微打磨，通过扫描电镜观察釉质表面形态的变化。结果：夜间活髓牙漂白后釉质表面孔隙增多，Croll釉质微打磨能形成致密的釉质表面矿化结构，Longhurst釉质微打磨则形成无釉柱结构表层，有细小划痕。结论：夜间活髓牙漂白能造成釉质的脱矿。Croll釉质微打磨能形成致密的矿化表层，对釉质形态有利。Longhurst釉质微打磨是釉质表面的机械磨除，但未造成釉质的明显粗糙。     

用色度学方法研究牙齿漂白剂增白牙齿的效果

目的:研究牙齿漂白剂增白牙齿的效果,建立用色度学分析手段研究牙齿漂白剂增白牙齿效果的方法。方法:将166名受试者随机分配到三个实验组,经过两周的临床实验,分别用Vita比色板法和数码照像计算机色度分析系统,分析并比较实验前后牙面Vita色度和色差△Eab的变化。结果:118名受试者完成实验,三个实验组间受试者在性别、年龄、吸烟量等基本情况方面分布均衡;两种漂白剂使用两周后,牙面Vita色度与实验前比较相差非常显著(P<0.01),而空白对照组与实验前比较相差不显著(P>0.05);与空白对照组比较,两漂白剂组△Eab值相差非常显著(P<0.01),两漂白剂组之间△Eab值相差不显著(P>0.05)。结论:建立了用色度学分析手段研究牙齿漂白剂增白牙齿效果的方法,用该方法研究表明,两种漂白剂都具有增白牙齿的效果,并且它们增白牙齿的效果之间没有差别。     

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目的评价家庭夜间美白法与冷光美白技术用于着色牙漂白的临床效果。方法收集广州市东升医院口腔科2007--2010年的96例着色牙病例,分别用家庭夜间美白法（50例）与冷光美白技术（46例）进行牙齿漂白,以VITA比色板分析脱色效果,用数字化疼痛评判法（VAS）记录受试者术中牙齿敏感程度。术后及2年后复查评价疗效。结果术后家庭夜间美白组总有效率为98．0％,冷光美白组为100．0％,两组总有效率差异无统计学意义（P〉0．05）。四环素牙治疗显效率、总有效率方面：家庭夜间美白组为72．2％、94．4％,冷光美白纽为90．0％、100．0％,差异均有统计学意义（均P〈0．05）。术中VAS评判：家庭夜间美白组敏感率为84．0％,冷光美白组为80．4％,两组敏感率差异无统计学意义（P〉0．05）。所有敏感者停止用药后6～24h均能缓解。2年后复查：两组牙齿颜色均出现反色。家庭夜间美白组总有效率为32．0％,冷光美白组为28-3％,两组差异无统计学意义（P〉0．05）;与治疗结束时的总有效率差异有统计学意义（P〈0．05）。2年后检查两组牙髓活力均正常。结论家庭夜间美白法与冷光美白技术治疗着色牙效果显著,在四环素牙上冷光美白技术优于家庭夜间美白法。2年后两组牙颜色均出现反色。两种漂白方法均具有临床安全性。     

In vitro evaluation of variances between real and declared concentration of hydrogen peroxide in various tooth-whitening products

Abstract

Objectives. The aim of this in vitro study was to analyze the real hydrogen peroxide (HP) concentration in various commercially available tooth-whitening products containing HP and/or carbamide peroxide (CP). Materials and methods. Sixteen commercially available tooth-whitening products containing various concentrations of CP or HP were investigated. The products were divided into four groups: dentist-supervised home bleaching products (Group 1, n = 5), in-office bleaching products (Group 2, n = 4), over-the-counter bleaching products (Group 3, n = 3) and whitening toothpastes and rinses (Group 4, n = 4). The peroxide concentration was determined using the oxy-reduction titration method. All the reagents used in the study were of analytic grade and freshly prepared before the experiment. Results. The HP concentration in various dentist-supervised home bleaching products and in-office bleaching products ranged from 3.02–37.08% (expected range = 3–38%). The HP concentration of over-the-counter whitening products ranged from 1.24–5.57% (expected range cannot be estimated as no concentration of active ingredient was provided). Among whitening toothpastes and rinses, Colgate Plax whitening rinse showed more than 1% HP concentration, whereas it was lower than 0.05% in other whitening toothpastes and oral rinses (expected range cannot be estimated as no active ingredient was mentioned). Conclusions. HP concentration of most of the professional tooth-whitening products was different from the expected concentrations, although the deviations were small and most of the products were close to the expected concentration. No concentration of active ingredient was provided for over-the-counter whitening products and no active ingredient was mentioned for whitening toothpastes and rinses.     

活髓牙漂白引起牙齿敏感的研究进展

漂白引起的牙齿敏感(BS)是活髓牙漂白最常见的不良反应,影响了患者接受漂白治疗的舒适度和满意度,也增加了临床对活髓漂白治疗安全性的担忧.本文旨在从BS的临床特点、病因学理论、可能的影响因素和防治措施作一综述.     

非侵入性牙齿美白技术的研究进展

牙齿美白技术是口腔医学美学的代表技术之一,被广泛应用于临床.随着人们对口腔美学需求的增加,研究者对牙齿美白技术及其相关问题的认识越来越清晰,也越来越广泛和深入.本文针对非侵入性牙齿美白技术的相关研究做一个阶段性的回顾,包括牙齿美白技术的发展、种类、效果评价、安全性、延伸应用及药物的联合应用等.     

Effect of bleaching agents and whitening dentifrices on the surface roughness of human teeth enamel

Abstract

Objective. The aim of this in vitro study was to evaluate the surface roughness of human enamel bleached with 10% carbamide peroxide or 10% hydrogen peroxide bleaching agents at different times and also subjected to different superficial cleaning treatments. Materials and methods. One hundred and forty flat enamel samples were divided into 14 groups, Group 1–Group 14 (G1–G14). G1–G7 were treated with 10% carbamide peroxide and different dentifrices, G8–G14 were treated with 10% hydrogen peroxide and different dentifrices (G1 and G8: not brushed as control groups; G2 and G9: brushed with Ipana® toothpaste; G3 and G10: brushed with Clinomyn® toothpaste; G4 and G11: brushed with Moos Dent® toothpaste; G5 and G12: brushed with Signal® toothpaste; G6 and G13: brushed with Colgate® toothpaste; G7 and G14: brushed without dentifrice). A profilometer was used to measure average roughness values of the initial surface roughness and at each 7-day-interval. The bleaching was performed for 6 h a day and the surface cleaning treatment was performed 3-times a day, 2 min each time, for 4 weeks. The samples were stored in distilled water during the test period. Results. Statistical analysis revealed significant differences in surface roughness values over time for all groups except G1 and G8 (not brushed). The results of the surface roughness of all groups were nearly the same. Conclusions. The bleaching with 10% hydrogen peroxide and 10% carbamide peroxide did not alter the enamel surface roughness, but when the bleaching treatment was performed combined with abrasive dentifrices, a significant increase in roughness values was observed.     

10%过氧化脲漂白内源性着色活髓牙的疗效分析

目的观察10%过氧化脲漂白对不同原因内源性着色活髓牙的漂白效果。方法对36例患者568颗内源性着色活髓牙进行药物漂白治疗,其中增龄性变色牙72颗,四环素牙287颗,氟斑牙209颗。对照Vita比色板,观察记录其治疗前、后的色阶变化并评价其临床疗效。结果经不同时间的漂白治疗后,各组着色牙的色阶值显著降低(P<0.05)。不同原因着色牙的治疗效果不同,但其总体有效率差异无显著性(P>0.05)。结论10%过氧化脲漂白对不同原因导致的内源性着色活髓牙均有较好的漂白作用。     

Multiple external cervical root resorptions after home whitening treatment: a case report

Invasive multiple cervical root resorptions after vital tooth bleaching is a rare condition. The aim of this article is to present a case of multiple external cervical root resorptions (ECRR) after a misguided home whitening treatment. A 34 year old male patient presented with slight sensitivity and mobility in several teeth. Despite the manufacturer's recommendations, the patient used a 22% carbamide peroxide‐based tooth bleaching gel at home for 4 days consecutively, at night, on the upper and lower arches. Clinical examination revealed gingival swelling, probing depths ranging 5–7 mm on the buccal and proximal surfaces, and grade 2 mobility of the teeth affected by ECRR. Radiographs revealed presence of ECRR in several teeth during initial examination, and development of multiple new lesions 6 months later. The teeth were subsequently extracted. Histological analysis showed multiple dentine lacunae and areas of dentine reparation. The careful use of these products can prevent sequelae such as those reported in this clinical case. As the vital bleaching has a variable success rate, patients should be informed through a consent form of the benefits and risks of tooth bleaching treatment.