牙齿漂白剂对牙釉质的影响及预防的实验研究
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摘要
临床工作中,有些患者因牙齿着色而希望获得较正常的牙齿颜色,但又不愿接受对牙体组织有破坏的瓷贴面或是烤瓷全冠修复。牙齿漂白技术虽不能达到美学修复的效果,但是仍可在一定程度上改善牙齿的美观,因其无创伤、无痛苦的特点,而易于被接受。对于牙齿漂白是否会引起釉质理化性能的改变,是否需要积极采取防护措施是临床和实验室研究关注的热点。
本研究首先在实验一中采用离体牙制备釉质漂白模型,通过显微硬度仪、扫描电镜、激光扫描共聚焦显微镜、能谱分析仪等技术对釉质硬度、粗糙度、矿物质含量进行定量检测,并定性观察釉质表面形态和三维结构变化,结果表明漂白治疗能造成牙釉质表面粗糙,局部无机物崩解而发生脱矿,并造成表面钙、磷元素的含量下降,牙釉质表面的显微硬度降低。含氟漂白剂虽然在一定程度上有稳定釉质结构的作用,但是延长漂白剂的作用时间,仍会加重釉质理化性能的改变。
已有研究证实氟化物对漂白后釉质脱矿的再矿化有促进作用,但关于CPP-ACP在漂白后的应用,却未见相关的研究报道。因此,本研究的实验二在釉质漂白模型中应用护牙素(CPP-ACP)和再矿化液分别处理漂白后釉质面,评估护牙素(CPP-ACP)在体外再矿化作用,以及与氟制剂之间的作用效果进行了比较。结果显示在CPP-ACP的作用下,延长再矿化时间,脱矿釉质的表面硬度、钙磷含量均呈增加趋势;与再矿化液处理相比较增加更为稳定,图像分析结果证实CPP-ACP可以显著减小釉质缺损的面积,经过较长时间的使用,可以逐步减轻釉质表面的破坏程度。
本实验研究还进一步探讨了CPP-ACP再矿化效果与再矿化液的作用效果的差异,结果表明CPP-ACP的再矿化效果能够达到含氟再矿化液的效果。将CPP-ACP应用于临床白斑的治疗,可以提高漂白的最终美学效果。
Objective: Aesthetic dentistry is an important direction for the development of dental treatment, teeth white as a healthy and beautiful standard, gradually formed a consensus. Teeth bleaching technology mainly make teeth whitening by peroxide,the mechanism of peroxide caused pigmentation degraded by oxidation degradation on the enamel,specially diffused in dentine. 10% carbamide peroxide is considered "standard" of the bleaching agent. In the context of dental aesthetics, bleaching treatment is the foundation of treatment,with the aesthetic repair, they were promote and complementary each other. But in the bleaching process, the deeply research of bleaching agent influenced on enamel surface morphology, ingredient, property has not been report. This research take the exsomatize teeth as research object, used blanching technology in vitro, by scanning electronic microscope, energy spectrum analysis, microhardness determination, laser passing confocal microscopy, observed enamel surface morphologic changed, quantitative detection of mineral enamel surface contented, analyzed enamel surface physical property and the degree of coarseness, the research of blanching treatment on enamel surface morphologic, ingredient, hardness influence, which could provide the experiment result for clinical practice. The use of mineralized solution on enamel demineralization is an effective method,however, the research of Casein phosphopeptide’s function confirmed : CPPs could promote the remineralization of enamel demineralization, in recent years .Therefore,this experiment focuses on the research of effect of inhibiting demineralization about CPP-ACP and the common remineralization solution.
Methods: 1: Experiment l, deionized water as the blank,artificial demineralization solution for the positive control grou,sub-commercial tooth membrane,3% hydrogen peroxide,16% carbamide peroxide,16% fluorine peroxide 4 bleach treatment group, the number of 48 enamel exemplars were randomly divided into 6 groups,each group has 6 granulationes. After 7 days treatment and 14 days after treatment using the following method to detect indicators: hardness tester hardness of enamel surface changes; sectroscoy analysis detected calcium in the enamel surface; scanning electron microscoy of enamel surface morhology before and after treatment; laser scanning confocal microscopy analysis of enamel surface roughness changes. Exeriment 2: In the bleaching treatment eriod, resectively, CPP-ACP and remineralization remineralization of liquid handling,within 7 days and 14 days observation and exeriment a similar indicator. Exeriment 1 and exeriment 2 the data were statistically analyzed using SPSS software,using the same grou were aired t test between the two grous into a set of data by T test.
Results: Experiment 1, 1.SEM observed morphological changes of enamel on the surface,the enamel surface roughness local area,as the depression of honeycomb,the performance of irregular demineralization,the enamel rods enamel rods around the center are visible or demineralization solution. Control group enamel surface is smooth,with normal enamel surface morphology. 2. Enamel surface energy sectrum analysis,by each grou before and after bleaching of calcium and hoshorus content in significantly different(P<0.05); 3. Enamel surface hardness and rough salvation of each grou before and after treatment by the bleached enamel surface hardness and coarse There were significant differences salvation(P<0.05).
Experiment 2,1. SEM observation, after treatment by the remineralization of enamel surface became smooth depression, You have a quality surface mineral deposits; by the dental care factors (major components of CPP-ACP) demineralization of enamel after treatment with uniformly The highlight of material deposited there; by fluoride over-10ppm saturated solution of calcium and phosphorus remineralization of demineralized enamel surface treated with granular deposition of mineralized nodules, showing bright spherical protuberance. by CLEM color three-dimensional imaging Analysis shows that the surface structure of enamel color uniform, the same color plane without the low-level color appears. Carbamide peroxide and in fluoride remineralization treatment group, showing central depression formed visible remineralization processes.2. After EDS calcium content, the factor by dental care (major components of CPP-ACP) for 7 days and 14 days, 7 days and 14 days of enamel calcium statistically significant difference, P<0.05. 7 days in each group differences exist between the overall (P<0.05); 14 days in each group was not significant (P>0.05). The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel calcium A group, B group, C group were no statistically significant difference (P>0.05), D groupP<0.05. 3. After Dental care factors (major components of CPP-ACP) treatment, 7 days and 14 days of enamel surface hardness values than A group (P = 0.02), the no significant difference, P>0.05. The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel surface roughness values were not statistically no difference between salvation, P>0.05.4. The Dental care factors (major components of CPP-ACP) treatment, 7 days and 14 days of enamel surface hardness values than A group (P = 0.02), the no significant difference, P>0.05. The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel surface roughness values were not statistically no difference between salvation, P>0.05.
Conclusion: 1. The bleach treatment can cause the enamel surface roughness, reduce the surface hardness of enamel, enamel surface showed mild demineralization performance like the honeycomb; extended the time would increase the local demineralization phenomenon. 2. After bleaching treatment , the mineral matter of surface enamel showed downward trend, and analyzed by statistics had significant difference; The treatment time was been lengthened , the levels of calcium was down with statistical significance. 3.CPP-ACP could promoted calcium and phosphorus deposited on the teeth enamel surface obviously, the teeth enamel mineralized again. The result of mineralization, CPP-ACP was batter than the common mineral solution.
本研究首先在实验一中采用离体牙制备釉质漂白模型,通过显微硬度仪、扫描电镜、激光扫描共聚焦显微镜、能谱分析仪等技术对釉质硬度、粗糙度、矿物质含量进行定量检测,并定性观察釉质表面形态和三维结构变化,结果表明漂白治疗能造成牙釉质表面粗糙,局部无机物崩解而发生脱矿,并造成表面钙、磷元素的含量下降,牙釉质表面的显微硬度降低。含氟漂白剂虽然在一定程度上有稳定釉质结构的作用,但是延长漂白剂的作用时间,仍会加重釉质理化性能的改变。
已有研究证实氟化物对漂白后釉质脱矿的再矿化有促进作用,但关于CPP-ACP在漂白后的应用,却未见相关的研究报道。因此,本研究的实验二在釉质漂白模型中应用护牙素(CPP-ACP)和再矿化液分别处理漂白后釉质面,评估护牙素(CPP-ACP)在体外再矿化作用,以及与氟制剂之间的作用效果进行了比较。结果显示在CPP-ACP的作用下,延长再矿化时间,脱矿釉质的表面硬度、钙磷含量均呈增加趋势;与再矿化液处理相比较增加更为稳定,图像分析结果证实CPP-ACP可以显著减小釉质缺损的面积,经过较长时间的使用,可以逐步减轻釉质表面的破坏程度。
本实验研究还进一步探讨了CPP-ACP再矿化效果与再矿化液的作用效果的差异,结果表明CPP-ACP的再矿化效果能够达到含氟再矿化液的效果。将CPP-ACP应用于临床白斑的治疗,可以提高漂白的最终美学效果。
Objective: Aesthetic dentistry is an important direction for the development of dental treatment, teeth white as a healthy and beautiful standard, gradually formed a consensus. Teeth bleaching technology mainly make teeth whitening by peroxide,the mechanism of peroxide caused pigmentation degraded by oxidation degradation on the enamel,specially diffused in dentine. 10% carbamide peroxide is considered "standard" of the bleaching agent. In the context of dental aesthetics, bleaching treatment is the foundation of treatment,with the aesthetic repair, they were promote and complementary each other. But in the bleaching process, the deeply research of bleaching agent influenced on enamel surface morphology, ingredient, property has not been report. This research take the exsomatize teeth as research object, used blanching technology in vitro, by scanning electronic microscope, energy spectrum analysis, microhardness determination, laser passing confocal microscopy, observed enamel surface morphologic changed, quantitative detection of mineral enamel surface contented, analyzed enamel surface physical property and the degree of coarseness, the research of blanching treatment on enamel surface morphologic, ingredient, hardness influence, which could provide the experiment result for clinical practice. The use of mineralized solution on enamel demineralization is an effective method,however, the research of Casein phosphopeptide’s function confirmed : CPPs could promote the remineralization of enamel demineralization, in recent years .Therefore,this experiment focuses on the research of effect of inhibiting demineralization about CPP-ACP and the common remineralization solution.
Methods: 1: Experiment l, deionized water as the blank,artificial demineralization solution for the positive control grou,sub-commercial tooth membrane,3% hydrogen peroxide,16% carbamide peroxide,16% fluorine peroxide 4 bleach treatment group, the number of 48 enamel exemplars were randomly divided into 6 groups,each group has 6 granulationes. After 7 days treatment and 14 days after treatment using the following method to detect indicators: hardness tester hardness of enamel surface changes; sectroscoy analysis detected calcium in the enamel surface; scanning electron microscoy of enamel surface morhology before and after treatment; laser scanning confocal microscopy analysis of enamel surface roughness changes. Exeriment 2: In the bleaching treatment eriod, resectively, CPP-ACP and remineralization remineralization of liquid handling,within 7 days and 14 days observation and exeriment a similar indicator. Exeriment 1 and exeriment 2 the data were statistically analyzed using SPSS software,using the same grou were aired t test between the two grous into a set of data by T test.
Results: Experiment 1, 1.SEM observed morphological changes of enamel on the surface,the enamel surface roughness local area,as the depression of honeycomb,the performance of irregular demineralization,the enamel rods enamel rods around the center are visible or demineralization solution. Control group enamel surface is smooth,with normal enamel surface morphology. 2. Enamel surface energy sectrum analysis,by each grou before and after bleaching of calcium and hoshorus content in significantly different(P<0.05); 3. Enamel surface hardness and rough salvation of each grou before and after treatment by the bleached enamel surface hardness and coarse There were significant differences salvation(P<0.05).
Experiment 2,1. SEM observation, after treatment by the remineralization of enamel surface became smooth depression, You have a quality surface mineral deposits; by the dental care factors (major components of CPP-ACP) demineralization of enamel after treatment with uniformly The highlight of material deposited there; by fluoride over-10ppm saturated solution of calcium and phosphorus remineralization of demineralized enamel surface treated with granular deposition of mineralized nodules, showing bright spherical protuberance. by CLEM color three-dimensional imaging Analysis shows that the surface structure of enamel color uniform, the same color plane without the low-level color appears. Carbamide peroxide and in fluoride remineralization treatment group, showing central depression formed visible remineralization processes.2. After EDS calcium content, the factor by dental care (major components of CPP-ACP) for 7 days and 14 days, 7 days and 14 days of enamel calcium statistically significant difference, P<0.05. 7 days in each group differences exist between the overall (P<0.05); 14 days in each group was not significant (P>0.05). The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel calcium A group, B group, C group were no statistically significant difference (P>0.05), D groupP<0.05. 3. After Dental care factors (major components of CPP-ACP) treatment, 7 days and 14 days of enamel surface hardness values than A group (P = 0.02), the no significant difference, P>0.05. The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel surface roughness values were not statistically no difference between salvation, P>0.05.4. The Dental care factors (major components of CPP-ACP) treatment, 7 days and 14 days of enamel surface hardness values than A group (P = 0.02), the no significant difference, P>0.05. The over-saturated with calcium and phosphorus 10ppm fluoride remineralization solution treatment, 7 days and 14 days of enamel surface roughness values were not statistically no difference between salvation, P>0.05.
Conclusion: 1. The bleach treatment can cause the enamel surface roughness, reduce the surface hardness of enamel, enamel surface showed mild demineralization performance like the honeycomb; extended the time would increase the local demineralization phenomenon. 2. After bleaching treatment , the mineral matter of surface enamel showed downward trend, and analyzed by statistics had significant difference; The treatment time was been lengthened , the levels of calcium was down with statistical significance. 3.CPP-ACP could promoted calcium and phosphorus deposited on the teeth enamel surface obviously, the teeth enamel mineralized again. The result of mineralization, CPP-ACP was batter than the common mineral solution.
引文
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