光学相干成像无创检测不同漂白方法对釉质白斑治疗效果的实验研究

doi:10.13591/j.cnki.kqyx.2023.03.005

摘要/Abstract

摘要：

目的探讨采用光学相干成像技术(OCT)检测不同漂白方法对釉质白斑的治疗效果,评价其用于釉质白斑治疗效果监测的可行性。方法选取因正畸拔除的完整离体前磨牙48颗,在牙冠颊面正中切取4 mm×4 mm×2 mm釉质块。在其表面(除颊侧面外)涂布抗酸指甲油后,置于脱矿溶液中浸泡18 d,建立釉质白斑体外脱矿模型。将样本随机分为4组(n=12),A组为对照组仅脱矿处理;B组为40%过氧化氢漂白处理;C组为Icon渗透树脂处理;D组为40%过氧化氢漂白联合Icon渗透树脂处理。每组随机抽取8个样本,应用OCT扫描釉质块颊侧面,观察各组釉质表层成像变化并测量表层光强改变;将釉质块用环氧树脂包埋固定(仅暴露颊侧面),显微硬度仪测量并记录各组硬度值变化。各组剩余4个样本纵向切开,扫描电镜观察各组样本超微结构变化。结果 OCT显示,各组釉质表层光散射特性均发生改变,可见高亮层形成,但C、D组的高亮层厚度显著低于A、B组(P<0.05)。各组样本显微硬度值分别是(214.99±31.70)、(250.66±33.64)、(312.42±18.01)、(286.53±26.65)kg/mm²。C、D组样本的釉质表面显微硬度显著高于A、B组(P<0.05),且SEM显示C、D组的釉质表面更为致密平整。结论渗透树脂或40%过氧化氢联合渗透树脂治疗可有效改善釉质白斑,OCT无创扫描可作为釉质白斑诊断与治疗的较好评价方法。

关键词: 釉质白斑, 渗透树脂, 诊室漂白, 显微硬度, 光学相干成像技术

Abstract:

Objective To investigate the efficacy of different bleaching methods on white-spot lesions of the enamel using optical coherence tomography and to evaluate its feasibility for monitoring the therapeutic effects on white-spot lesions. Methods Forty-eight sound premolars extracted for orthodontic reasons were selected and cut for 4 mm×4 mm×2 mm enamel blocks in buccal surfaces of the crowns. The samples were covered with acid-resistant varnish (except for the buccal surfaces) and immersed in demineralization solution for 18 days to establish the white-spot lesion models of the enamels. Samples were randomly divided into four groups (n=12). Group A was given demineralization only. Specimens in Group B, C and D were treated with 40% hydrogen peroxide, resin infiltration and 40% hydrogen peroxide combined with resin infiltration, respectively. Eight samples in each group were randomly selected. OCT was applied to observe the optical changes of the enamel surface and according to the OCT scanning results, the demineralization depth of enamel samples in each group was calculated. Then, the enamel blocks were embedded in epoxy resins, except the buccal surfaces, and measured for the microhardness values of the enamel surface by a microindentation hardness tester. Four samples in each group were cut longitudinally, and the ultrastructural changes of enamel samples in each group were observed by scanning electron microscope. Results OCT showed that the light scattering characteristics of enamel surface changed in all groups, and the bright layer was formed, but the thickness of bright layer in Group C and D was significantly lower than that in Group A and B (P<0.05). The microhardness values (kg/mm²) of the samples in Group A-D were (214.99±31.70), (250.66±33.64), (312.42±18.01) and(286.53±26.65), respectively. The microhardness of enamel surfaces in Group C and D was significantly higher than that in Group A and B (P<0.05), and the ultrastructure of enamel surfaces in Group C and D were more flat and dense in SEM observation (P<0.05). Conclusion The methods of resin infiltration therapy or 40% hydrogen peroxide combined with resin infiltration could effectively improve white-spot lesions of the enamel and the non-invasive OCT can be used as a better evaluation method for the diagnosis and treatment of white-spot lesions of the enamel.

Key words: white-spot lesion, resin infiltration, in-office bleaching, microhardness, optical coherence tomography

中图分类号:

R783.2

李迎梅, 寇鹏, 陈雨昕, 王情情, 倪恪, 王琰, 孟庆飞. 光学相干成像无创检测不同漂白方法对釉质白斑治疗效果的实验研究[J]. 口腔医学, 2023, 43(3): 217-221.

LI Yingmei, KOU Peng, CHEN Yuxin, WANG Qingqing, NI Ke, WANG Yan, MENG Qingfei. Experimental study on the therapeutic effect of different bleaching methods on white-spot lesions of the enamel using optical coherence tomography[J]. Stomatology, 2023, 43(3): 217-221.

图/表 3

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组别	高亮层厚度/μm	显微硬度/(kg/mm²)
A组(脱矿釉质组)	110.78±5.98^a	214.99±31.70^a
B组(漂白组)	86.71±4.23^b	250.66±33.64^b
C组(渗透树脂组)	62.79±4.23^c	312.42±18.01^c
D组(漂白渗透组)	71.76±8.46^c	286.53±26.65^c