渗透性树脂与氟漆治疗正畸后白垩斑的疗效比较

doi:10.3969/j.issn.2095-4344.2013.29.007

摘要/Abstract

关键词: 生物材料, 组织工程口腔材料, 牙齿正畸, 不良反应, 白垩斑, 渗透性树脂, 氟漆, 疗效, 釉质脱矿, 矫治器

Abstract:

BACKGROUND: White spot lesions caused by enamel demineralization are a common side effect of orthodontic treatment. Resin infiltration treatment for white spot lesions has obtained favorable effects, but there is no report on the difference between resin infiltration and fluoride varnish treatment for post-orthodontic white spot lesions.
OBJECTIVE: To compare the efficiency of resin infiltration and fluride varnish for treatment of post-orthodontic white spot lesions.
METHODS: Twenty-nine patients with post-orthodontic white spot lesions were randomly divided into two groups: one group accepted the resin infiltration treatment and the other group accepted fluoride varnish treatment. Frontal intraoral photos before treatment and 6 months after treatment were collected for study. The difference in efficiency of resin infiltration and fluride varnish for treatment of post-orthodontic white spot lesion was analyzed and evaluated by both dentists and college students who were not engaged in oral medicine.
RESULTS AND CONCLUSION: Except one patient treated with fluride varnish, all the patients completed the referral on schedule. There was significant improvement in the two groups after treatment (P < 0.05). Resin infiltration treatment was better than fluoride varnish treatment in post-orthodontic white spot lesions. Thus, resin infiltration that requires fewer referrals and has better effects is an ideal therapy for post-orthodontic white spot lesions.

中图分类号:

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王璐，简洁，陆慧芳. 渗透性树脂与氟漆治疗正畸后白垩斑的疗效比较[J]. 中国组织工程研究, 2013, 17(29): 5303-5308.

Wang Lu, Jian Jie, Lu Hui-fang. Efficiency of resin infiltration versus fluride varnish for treatment of post-orthodontic white spot lesions[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(29): 5303-5308.

图/表（结果） 4

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引言

材料方法

设计：随机对照临床研究。

时间和地点：于2012年11月在德阳市口腔医院完成。

对象：2012年德阳市口腔医院正畸结束后伴有牙釉质白垩斑患者29例，其中男14例，女15例，年龄12-27岁，平均15岁，共70颗患牙。

纳入标准：正畸治疗结束患者；至少1颗上颌切牙有不透明的白垩色斑改变，探针能勾住或有粗糙的感觉，见图1。

排除标准：不愿意接受随机分组者；治疗后接受过再矿化治疗的患者；白垩斑有明显龋洞形成者。

治疗前告知患者实验情况，患者知情同意。实验中，按患者意愿随机将患者分为两组：渗透性树脂治疗组14例患者，36颗患牙，接受渗透性树脂治疗；氟漆治疗组15例患者，34颗患牙，接受氟漆治疗；而患者本身不知道自己所采用的治疗方法。两组患者均在拆除正畸矫治器并进行牙周洁刮治1周后再接受治疗，以免刚结束时由于牙龈的肿胀掩盖牙面的白垩斑情况。

材料：Icon渗透性树脂为德国DMG公司生产；氟保护漆为瑞士伟瓦登特公司产品，见图2。

实验方法：

渗透性树脂治疗：

(1)治疗前清洁患牙，冲洗干净。放置楔子在邻间隙。使用Icon酸蚀剂涂布在白垩斑区(超出病损区2 mm)，等待30 s，冲洗30 s并吹干。

(2)将Icon干燥剂涂布在白垩斑区，等待30 s，吹干。

(3)将Icon渗透性树脂涂布于已酸蚀的牙面之上，等待3 min，用棉球去除多余材料，光照40 s。

(4)再次涂布Icon渗透性树脂于已酸蚀的牙面之上，等待1 min，光照40 s。

(5)打磨，抛光，嘱患者保持口腔卫生，使用含氟牙膏。

氟保护漆治疗：

(1)治疗前清洁患牙，冲洗干净。隔湿，用棉球擦干牙面。

(2)将0.4 mL体积分数5%的氟保护漆涂布于病损牙面上，氟漆凝固1 min。

(3)嘱患者45 min内不要漱口和进食。

(4)嘱患者保持口腔清洁，使用与第一组同一款含氟牙膏。

(5)患者每月复诊1次，进行如前4步氟漆治疗。

所有组的患者在正畸治疗结束时立即行牙周洁刮治，1周后牙龈炎症消退才进行相应的白垩斑治疗。治疗前由医生拍摄正面的口内照片。在拍摄照片的时候，患者头部略微向上倾斜5°-10°，以避免切牙表面反光，影响后期对牙面白垩斑的评估。多拍摄几张照片，选择最清晰，没有反光的照片。采用Photoshop CS4将每颗患有白垩斑的上切牙裁剪出来，保存为500 dpi的TIFF格式的图片，记录好每张图片的患者姓名，牙位，以及每颗牙所做的治疗方式。由进行治疗操作的医生统一整理，分类。

复诊：患者在治疗完成6个月后复诊。复诊时检查患者口腔卫生情况以及白垩斑改善情况，按照治疗前的方法，拍摄每个患者治疗6个月后的正面口内照片。并将每颗牙齿的图片裁剪，归类，保存。

在收集好所有患者的照片后，治疗医生采用Powerpoint制作幻灯片，将所有患者的每颗牙齿白垩斑治疗前后的照片放在黑色背景的幻灯片上，每颗牙齿白垩斑治疗前后放在同一张幻灯片内。同时通过用Photoshop将原图上的白垩斑区域减少以及白垩斑部分的不透明程度降低制作了评分的校准表，见图3。其中0%是没有任何改善，100%是白垩斑完全消除，而50%是白垩斑病变区域减少一半的效果。

盲法：由两名经过培训的口腔医院护士对评分细则和校准表进行讲解及PPT的播放。为了保证盲法的实施，参与治疗患者与制作幻灯片的研究者不参与后期幻灯片的播放以及评分过程；同时PPT的播放人员不知道每张幻灯片上的牙齿所属的患者资料，以及其所采取的治疗方法。

评分过程：评分者分为两组，专业组由5名口腔医生组成，男2名，女3名，1名口腔外科医生，2名口腔修复医生，1名口腔内科医生以及1名口腔正畸医生；非专业组由没有口腔专业知识以及美学知识的5名大学生组成，男2名，女3名。评分者并不知道患者采取的治疗方法以及实验的设计(盲法评估)。评分前由PPT展示者通过校准表详细讲解评分制度，要求评分者主要从白垩斑面积以及白垩斑颜色的改善程度，以校准表为参考来评分。待评分者完全了解评分细则后，向其展示PPT里面的幻灯片，每一张幻灯片均采用百分比对治疗后的效果进行评分。待评分完成后，每一颗牙在每组中的评分取5个评分者的中间值。比如，专业组的5名评分者对某一牙齿白垩斑的改善程度打分分别为33%，40%，44%，50%，57%，则44%将作为该牙的白垩斑改善程度纳入统计。

重复性检验：在第1次评分完成1周后，从所有照片中随机选取20对白垩斑治疗前后的照片给每一个评分者重新评估。将第2次所得的评分与第一次比较，采用Dahlberg方程检验评价每一位评分者前后的重复性。

主要观察指标：①专业组与非专业组的评分比较：比较口腔医生与非专业组人员的评分是否有差异。②白垩斑治疗前后专业组对每颗患牙的改善程度评分的比较：比较对于专业组评分者，渗透性树脂与氟漆治疗正畸后白垩斑疗效的差别。③白垩斑治疗前后非专业组对每颗患牙的改善程度评分的比较：比较对于非专业组评分者，渗透性树脂与氟漆治疗正畸后白垩斑疗效的差别。

统计学分析：专业组与非专业组分开统计，采用SPSS 17.0软件进行分析，结果用x(_)±s表示，采用t 检验分别比较渗透性树脂与氟漆治疗白垩斑改善程度的差异。P < 0.05为差异有显著性意义。