本文關鍵詞： 美白反色效應 激光美白 冷光美白 樹脂表面保護劑　出處：《大連醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：背景:牙齒漂白技術為臨床口腔醫(yī)學常見的改變齒色有效手段。比較瓷牙或樹脂貼片乃至全瓷牙冠,牙齒美白因其不須去除齒質,治療上較為保守費時較短,因此不論是家庭漂白或診室漂白皆廣為臨床口腔醫(yī)師采用。牙齒表面的顏色由牙齒最外層的牙釉質和次一層牙本質的比例,牙釉質為透明白色,牙本質則呈現(xiàn)黃色,由于牙釉質具通透性,故會透出里層牙本質的黃色。如果牙釉質較薄或牙本質較厚,牙齒就顯得較黃,反之如果牙釉質較厚,齒黃的程度較淺。美白完成后,齒色呈現(xiàn)不穩(wěn)定狀態(tài),尤其于美白初期階段,齒色快速變棕色或褐色,有牙齒反色現(xiàn)象(initial color relapse)的產(chǎn)生。一般反色現(xiàn)象出現(xiàn)于漂白后2-6個星期之間。且不論采用何種美白法,在美白完成初期,皆容易產(chǎn)生反色現(xiàn)象,降低美白的成效。此現(xiàn)象雖然早被觀察到,但反色發(fā)生的原因與機制仍舊不明確。目前多研究指出牙齒美白后造成的牙釉質表面粗糙,容易造成染色層的沾粘,成此現(xiàn)象。當牙齒漂白后,牙齒表面會有理化性的改變,常見牙釉質表面鈣磷比值下降,造成牙釉質表面變化而導致牙釉質滲透性增加,牙齒表面粗糙度增加等等。這些改變使得牙釉質有一個色層再著色的有利條件,容易為外來色素等物質附著而變色,造成了牙齒美白后顏色再度改變的的初期反色效應。牙科研究中,有利用樹酯表面保護劑的,嘗試制造光華牙表面,以期降低來自于外源性染色沾黏的現(xiàn)象。目的:本研究具體目標為研究光固化樹脂表面處理劑應用于不同牙齒美白方法后的反色效應觀察。采用診室漂白方法,使用的較高濃度的漂白藥劑,包含35%過氧化氫,并配合雷射與電漿光光照來加速化學反應。實驗采用新式光固化樹脂表面保護劑adpersinglebond2adhesive,希望利用其特性,包括不容于水并可在潮濕環(huán)境黏著丶能有效提高齒色填補物的相對耐磨度丶增加齒色牙科填補材之機械性質丶染色因子著色不明顯等,以進行牙齒漂白后的反色觀察。實驗中取adpersinglebond2adhesive材料特性,涂于牙齒表面作為美白后牙齒的表面保護劑,期待減緩牙釉質滲透性與牙齒表面粗糙度,破壞牙釉質色層再著色的表面條件。實驗將樣本分為二小組分別浸泡蒸餾水或茶水溶液,進行老化(aging)測試。透過測色儀測色與掃描電子顯微鏡scanningelectronmicroscope(sem)觀察美白后涂抹保護劑的牙齒表面,以探討牙齒反色現(xiàn)象的改變。材料和方法:本研究主要采用的光照美白方式為激光與冷光漂白。牙齒的激光美白方法,是在牙齒表面涂上固定濃度與適當層次的過氧化氫,并在牙齒進行熱處理,讓過氧氫釋放純氧經(jīng)由牙釉管滲入牙齒深層象牙層,打斷深色素的碳環(huán)結構,快速消除由喝茶丶咖啡丶抽菸等所產(chǎn)生的齒垢,可以改善2至4個色階的美白效果,發(fā)熱的光來自科技半導體激光(波長810±10nm),催化藥物產(chǎn)生純氧。冷光美白用冷光(波長400～500nm)實施漂白,照射在涂有特殊美白劑(過氧化氫)的牙齒表面上產(chǎn)生催化還原作用,改變色素的碳環(huán)結構,清除在牙齒表面沉積已久的垢斑,使牙齒顏色由灰黃轉潔白,達到美白牙齒的效果。本研究采用樹脂表面涂劑adpersinglebond2adhesive作為牙齒美白后的表面保護,期望能藉由此保護層達到減緩初期牙齒漂白后反色效應,維持美白效果。透過文獻考察與實驗,進一步探討比較經(jīng)樹脂表面保護劑作為美白防護后與未經(jīng)樹脂表面保護劑處理的牙齒顏色反色效應,與其機制上的推論與研究。在實驗過程中美白后第1丶3丶5丶7丶14丶21丶28丶35丶42天接用分光比色儀測顏色cie(l*,a*,b*)并紀錄色差變化。本研究以測色儀測色結果(Δe)進行evidence-based判定。以齒色數(shù)據(jù)統(tǒng)計比較組別差異性,并以sem觀察表面微結構改變。結果:涂抹表面保護劑前后色差改變分別為;激光美白后Δe8.46(3.7),涂表面保護劑adpersinglebond2adhesive后Δe8.32(3.97),以激光美白組其一小時后色差Δe為7.82(2.74),以冷光美白組其一小時后色差Δe為9.17(4.71)二者以mann-whitneyutest分析無統(tǒng)計上之差異(p0.05)。冷光美白后Δe9.19(4.93),涂上adpersinglebond2adhesive后Δe8.02(5.50)wilcoxonsignedrankstest分析二者間沒有統(tǒng)計上之意(p0.05)。在浸泡蒸餾水之4組,涂上adpersinglebond2adhesive與沒涂上二組以mann-whitneyutest就分析顯示,沒有統(tǒng)計上有意義差異(p0.05)。色差變化在美白后3-5天Δe值仍繼續(xù)上升,顯示美白效果在美白后3-5天內仍持續(xù)加強。在浸泡茶水水的4組(l+b+t丶l+t丶p+b+t丶p+t),以kruskal-wallish分析其各組間呈現(xiàn)統(tǒng)計上之有意義差異(p0.05)(表九),以涂抹adpersinglebond2adhesive與否,比較其色差之變化,分析結果顯示,測試結果皆呈現(xiàn)統(tǒng)計上明顯之差異(p0.05),Δe色差隨aging時間增加而增加,且不涂adpersinglebond2adhesive組增加之幅度明顯大于涂抹組。將浸泡茶水組的Δe與Δl比較,顯示Δl隨老化時間增加而減少,其結果造成Δe的增加,Δe與Δl二者之間相關系數(shù)高達-0.968。結論:涂上adpersinglebond2adhesive后,因其產(chǎn)生較為平滑的表面,使色層沾附能力降低,也顯示光固化樹脂保護劑對美白后牙齒色層的沾黏有保護丶減緩的作用。研究結果顯示以激光與冷光美白后的牙齒,涂上光固化樹脂adpersinglebond2adhesive,其齒色較接近美白初期外,牙齒具平滑表面,應能有效減緩牙釉質滲透性與牙齒表面粗糙度,降低牙釉質色層再著色。故評估光固化樹脂adpersinglebond2adhesive可作為美白后減緩牙齒反色效應的表面處理的材料。本研究為離體牙實驗,也是初期實驗利用光固化樹脂保護劑針對減緩美白后初期反色提出改善的方法,未來進一步體內臨床實驗應是必需要的,以利提供更多抑制反色效應的機制探討。
[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.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R783

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