光固化树脂表面处理剂应用于不同牙齿美白方法后反色效应之研究

发布时间：2018-01-22 13:39

本文关键词： 美白反色效应激光美白冷光美白树脂表面保护剂　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:牙齿漂白技术为临床口腔医学常见的改变齿色有效手段。比较瓷牙或树脂贴片乃至全瓷牙冠,牙齿美白因其不须去除齿质,治疗上较为保守费时较短,因此不论是家庭漂白或诊室漂白皆广为临床口腔医师采用。牙齿表面的颜色由牙齿最外层的牙釉质和次一层牙本质的比例,牙釉质为透明白色,牙本质则呈现黄色,由于牙釉质具通透性,故会透出里层牙本质的黄色。如果牙釉质较薄或牙本质较厚,牙齿就显得较黄,反之如果牙釉质较厚,齿黄的程度较浅。美白完成后,齿色呈现不稳定状态,尤其于美白初期阶段,齿色快速变棕色或褐色,有牙齿反色现象(initial color relapse)的产生。一般反色现象出现于漂白后2-6个星期之间。且不论采用何种美白法,在美白完成初期,皆容易产生反色现象,降低美白的成效。此现象虽然早被观察到,但反色发生的原因与机制仍旧不明确。目前多研究指出牙齿美白后造成的牙釉质表面粗糙,容易造成染色层的沾粘,成此现象。当牙齿漂白后,牙齿表面会有理化性的改变,常见牙釉质表面钙磷比值下降,造成牙釉质表面变化而导致牙釉质渗透性增加,牙齿表面粗糙度增加等等。这些改变使得牙釉质有一个色层再着色的有利条件,容易为外来色素等物质附着而变色,造成了牙齿美白后颜色再度改变的的初期反色效应。牙科研究中,有利用树酯表面保护剂的,尝试制造光华牙表面,以期降低来自于外源性染色沾黏的现象。目的:本研究具体目标为研究光固化树脂表面处理剂应用于不同牙齿美白方法后的反色效应观察。采用诊室漂白方法,使用的较高浓度的漂白药剂,包含35%过氧化氢,并配合雷射与电浆光光照来加速化学反应。实验采用新式光固化树脂表面保护剂adpersinglebond2adhesive,希望利用其特性,包括不容于水并可在潮湿环境黏着丶能有效提高齿色填补物的相对耐磨度丶增加齿色牙科填补材之机械性质丶染色因子着色不明显等,以进行牙齿漂白后的反色观察。实验中取adpersinglebond2adhesive材料特性,涂于牙齿表面作为美白后牙齿的表面保护剂,期待减缓牙釉质渗透性与牙齿表面粗糙度,破坏牙釉质色层再着色的表面条件。实验将样本分为二小组分别浸泡蒸馏水或茶水溶液,进行老化(aging)测试。透过测色仪测色与扫描电子显微镜scanningelectronmicroscope(sem)观察美白后涂抹保护剂的牙齿表面,以探讨牙齿反色现象的改变。材料和方法:本研究主要采用的光照美白方式为激光与冷光漂白。牙齿的激光美白方法,是在牙齿表面涂上固定浓度与适当层次的过氧化氢,并在牙齿进行热处理,让过氧氢释放纯氧经由牙釉管渗入牙齿深层象牙层,打断深色素的碳环结构,快速消除由喝茶丶咖啡丶抽菸等所产生的齿垢,可以改善2至4个色阶的美白效果,发热的光来自科技半导体激光(波长810±10nm),催化药物产生纯氧。冷光美白用冷光(波长400～500nm)实施漂白,照射在涂有特殊美白剂(过氧化氢)的牙齿表面上产生催化还原作用,改变色素的碳环结构,清除在牙齿表面沉积已久的垢斑,使牙齿颜色由灰黄转洁白,达到美白牙齿的效果。本研究采用树脂表面涂剂adpersinglebond2adhesive作为牙齿美白后的表面保护,期望能藉由此保护层达到减缓初期牙齿漂白后反色效应,维持美白效果。透过文献考察与实验,进一步探讨比较经树脂表面保护剂作为美白防护后与未经树脂表面保护剂处理的牙齿颜色反色效应,与其机制上的推论与研究。在实验过程中美白后第1丶3丶5丶7丶14丶21丶28丶35丶42天接用分光比色仪测颜色cie(l*,a*,b*)并纪录色差变化。本研究以测色仪测色结果(Δe)进行evidence-based判定。以齿色数据统计比较组别差异性,并以sem观察表面微结构改变。结果:涂抹表面保护剂前后色差改变分别为;激光美白后Δe8.46(3.7),涂表面保护剂adpersinglebond2adhesive后Δe8.32(3.97),以激光美白组其一小时后色差Δe为7.82(2.74),以冷光美白组其一小时后色差Δe为9.17(4.71)二者以mann-whitneyutest分析无统计上之差异(p0.05)。冷光美白后Δe9.19(4.93),涂上adpersinglebond2adhesive后Δe8.02(5.50)wilcoxonsignedrankstest分析二者间没有统计上之意(p0.05)。在浸泡蒸馏水之4组,涂上adpersinglebond2adhesive与没涂上二组以mann-whitneyutest就分析显示,没有统计上有意义差异(p0.05)。色差变化在美白后3-5天Δe值仍继续上升,显示美白效果在美白后3-5天内仍持续加强。在浸泡茶水水的4组(l+b+t丶l+t丶p+b+t丶p+t),以kruskal-wallish分析其各组间呈现统计上之有意义差异(p0.05)(表九),以涂抹adpersinglebond2adhesive与否,比较其色差之变化,分析结果显示,测试结果皆呈现统计上明显之差异(p0.05),Δe色差随aging时间增加而增加,且不涂adpersinglebond2adhesive组增加之幅度明显大于涂抹组。将浸泡茶水组的Δe与Δl比较,显示Δl随老化时间增加而减少,其结果造成Δe的增加,Δe与Δl二者之间相关系数高达-0.968。结论:涂上adpersinglebond2adhesive后,因其产生较为平滑的表面,使色层沾附能力降低,也显示光固化树脂保护剂对美白后牙齿色层的沾黏有保护丶减缓的作用。研究结果显示以激光与冷光美白后的牙齿,涂上光固化树脂adpersinglebond2adhesive,其齿色较接近美白初期外,牙齿具平滑表面,应能有效减缓牙釉质渗透性与牙齿表面粗糙度,降低牙釉质色层再着色。故评估光固化树脂adpersinglebond2adhesive可作为美白后减缓牙齿反色效应的表面处理的材料。本研究为离体牙实验,也是初期实验利用光固化树脂保护剂针对减缓美白后初期反色提出改善的方法,未来进一步体内临床实验应是必需要的,以利提供更多抑制反色效应的机制探讨。
[Abstract]:Background: tooth bleaching technology for color change gear common effective means of Clinical Stomatology. Comparison of porcelain teeth or resin and patch all ceramic crowns, teeth whitening because it is not necessary to remove the tooth, conservative treatment is time-consuming short, so whether it is household bleach or bleach consulting room are widely used. The enamel and dentists a layer of dentin surface ratio of tooth color from the outer tooth enamel, transparent white, dentin is yellow, because with enamel permeability, so the layer of dentin with yellow. If the enamel thinner or thicker dentin, teeth is more yellow, if the relatively thick enamel yellow teeth, shallow degree. After the completion of the tooth whitening, color is unstable, especially in the early stages of tooth whitening, fast color brown or brown, with teeth color phenomenon (initial color relapse) the general anti. The color phenomenon appeared in 2-6 weeks after bleaching and whitening. Regardless of the law, in the early finish are prone to whitening, anti color phenomenon, reduce whitening effect. Although this phenomenon was observed, but the reason and mechanism of the color still not clear. The study pointed out that the enamel surface caused by tooth whitening rough, easy to cause the sticky dip dye layer, this phenomenon. When the teeth after bleaching, the tooth surface will rationalize the change of common enamel surface of calcium and phosphorus ratio decreased, resulting in changes in the enamel surface and cause enamel permeability increase, the tooth surface roughness increases and so on. These changes make the advantages of a layer of enamel re coloring, easy for foreign substances such as pigments attached and color, resulting in color change again after the tooth whitening effect. The early anti dental research, use of resin surface Protective agent, attempt to reduce the brilliance of tooth surface, from the extrinsic stain sticking phenomenon. Objective: This study is a study of light cured resin surface treatment agent should be used for different color teeth whitening method after the observation of effect of specific goals. The consulting room bleaching method, make use of the high concentration of bleaching chemicals, including 35% hydrogen peroxide, and with the laser plasma light to accelerate the chemical reaction. The use of new light curing resin surface protective agent adpersinglebond2adhesive, hoping to use its characteristics, including not in water and can effectively improve the tooth color filling in adhesion, moist environment, increase the relative wear resistance and mechanical properties of dental tooth color fill material the factor is not obvious, dyeing and coloring, observation for tooth bleaching after color. Adpersinglebond2adhesive material properties experiment, coating on the tooth surface as whitening after The surface protection agent of the teeth, look forward to slow down the enamel permeability and tooth surface roughness, surface condition damage coloring. The enamel layer samples were divided into two group were soaked in distilled water or tea solution, aging (aging) test. Through the color measurement instrument of color measurement and scanning electron microscopy (SEM) observation of white scanningelectronmicroscope after smearing protective agent of tooth surface, in order to explore the change of teeth color phenomenon. Materials and methods: This study used light whitening for laser and whitening teeth whitening method. The laser is coated on the surface of the teeth, in the fixed concentration and appropriate levels of hydrogen peroxide, and heat treatment in the teeth, let peroxide the release of hydrogen oxygen through the enamel tube into the deep layer of ivory teeth, carbon ring structure interrupted dark pigment, tea, coffee, the rapid elimination of smoke produced by Tartar, can 2 to 4 levels to improve the whitening effect, heating light from the technology of semiconductor laser (wavelength 810 + 10nm), catalytic drugs. Pure whitening with cold light (wavelength 400 500nm) implementation of bleaching, irradiation has special whitening agent in the coating on the surface of the teeth (hydrogen peroxide) to produce catalytic reduction, carbon ring the structure change of pigment, remove long deposition on the tooth surface stained teeth, the gray color yellow to white, achieve the effect of teeth whitening. This research adopts adpersinglebond2adhesive as the surface of the resin coating surface of teeth whitening after protection, can expect through this protective layer to reduce negative effect in early tooth bleaching, whitening maintenance results. Through literature review and comparative experiments, further study by resin surface protective agent as whitening protection without teeth color color and effect of resin surface treatment and its mechanism The inference and whitening research. During the experiment after first, 3, 5, 7, 14, 21, 28, 35, 42 days after using the colorimetric measurement of color CIE (l*, a*, b*) and color changes. Based on the records of the color measurement instrument of color measurement results (e judge evidence-based.) to the data of tooth color statistical comparison group difference was observed by SEM surface micro structure change. Results: paint the surface protective agent before and after color change respectively; laser whitening after e8.46 (3.7), surface protective agent adpersinglebond2adhesive e8.32 (3.97), with a group of laser whitening 7.82 hours after the color difference delta e (2.74), with whitening group after one hour difference delta e is two to 9.17 (4.71) mann-whitneyutest analysis of no statistical difference (P0.05). After whitening e9.19 (4.93), e8.02 adpersinglebond2adhesive (5.50) after applying wilcoxonsignedrankstest analysis between the two no statistically Italy (P0.05). In the 4 group were soaked in distilled water, coated with adpersinglebond2adhesive and not with two group by mann-whitneyutest analysis showed no statistically significant difference (P0.05). The color change is still continue to rise in the white 3-5 days after e values show, whitening effect continued to strengthen in 3-5 days after in 4 groups of water soaked tea (l+b+t, l+t, p+t, p+b+t, and kruskal-wallish) by statistical analysis of significant difference between groups (P0.05) and the present (table nine), to apply adpersinglebond2adhesive or not, the color changes, analysis results show that the test results showed significant difference of Statistics (P0.05), a e color difference increases with the increase of aging amplitude and time increased, not coated with adpersinglebond2adhesive group increased significantly larger than smear group. Soak Tea Group E and delta L, delta l showed increased and decreased with aging time, which resulted in a e The increase of the correlation coefficient between delta E and delta l two up to -0.968. conclusion: with adpersinglebond2adhesive, the surface is smooth, the color adhesion ability is reduced, also shows the light cured resin protective agent for whitening teeth layer is stuck with protection, slowing effect. The results show that after laser and whitening teeth, coloured light cured resin adpersinglebond2adhesive, the tooth color is close to early whitening, teeth with smooth surface, should be able to effectively reduce the enamel permeability and surface roughness of teeth, enamel layer and then colored. The lower evaluation of light cured resin adpersinglebond2adhesive can be used as a whitening teeth color effect slows down after surface treatment the material for this study. In vitro experiment, but also the early experiments using light cured resin protective agent for whitening slow after the initial color improvement measures, Further in vivo clinical trials should be required to provide more inhibitory mechanism, color effects.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783

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