釉质白垩斑治疗方法的研究进展

doi:10.7518/gjkq.2022101

摘要/Abstract

摘要：

白垩斑是口腔正畸治疗中常见的并发症，因牙齿釉质脱矿使得牙齿表面失去光泽呈现出白垩色而得名。白垩斑通常可在牙齿表面出现单独分散的白点，也可有多个白色斑块并连成片。白垩斑严重影响牙齿的美观，给患者造成心理压力，同时降低了患者进行正畸的满意度，也增加了患龋的风险，危害牙齿健康。及时对白垩斑进行干预治疗具有重要的临床意义。白垩斑的治疗有多种方法，包括口腔卫生指导，氟化物、酪蛋白磷酸肽钙磷复合体等再矿化方法的应用，以及树脂渗透技术、釉质微研磨技术、有创牙体修复技术等美学修复治疗方法。本文对白垩斑的各种治疗方法进行综述，为其进一步研究提供参考。

关键词: 白垩斑, 正畸治疗, 再矿化, 渗透树脂, 微研磨

Abstract:

White spot lesions are a common complication of orthodontic treatment. They are named for the enamel demineralization that causes the tooth surface to lose luster and exhibit a chalky color. Usually, separate white spots or multiple white plaques merged into one lesion may be present on the tooth surface. These lesions seriously affect the appearance of teeth, exert psychological pressure on patients, reduce the satisfaction of patients with orthodontics, increase the risk of dental caries, and endanger dental health. The timely treatment of white spot lesions has important clinical significance. The treatment methods for white spot lesions include oral hygiene guidance;remineralization methods, such as the fluoride and casein phosphopeptide-amorphic calcium phosphate method; and aesthetic restoration treatment methods, such as infiltration resin, microabrasion, and invasive dental restoration technologies. This article reviews these treatment methods to provide a reference for the research and development of treatment methods for white spot lesions in the future.

Key words: white spot lesions, orthodontic treatment, remineralization, resin infiltration, microabrasion

中图分类号:

R 781.1

王启秋,支清惠. 釉质白垩斑治疗方法的研究进展[J]. 国际口腔医学杂志, 2022, 49(6): 717-723.

Wang Qiqiu,Zhi Qinghui.. Research progress on treatments of enamel white spot lesions[J]. Int J Stomatol, 2022, 49(6): 717-723.

图/表 1

图1

参考文献 56

1	Fernández-Ferrer L, Vicente-Ruíz M, García-Sanz V, et al. Enamel remineralization therapies for treating postorthodontic white-spot lesions: a systematic review[J]. J Am Dent Assoc, 2018, 149(9): 778-786.e2.
2	Lucchese A, Bondemark L, Marcolina M, et al. Ch-anges in oral microbiota due to orthodontic appliances: a systematic review[J]. J Oral Microbiol, 2018, 10(1): 1476645.
3	Sardana D, Zhang JY, Ekambaram M, et al. Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis[J]. J Dent, 2019, 82: 1-10.
4	Cosma LL, Şuhani RD, Mesaroş A, et al. Current treatment modalities of orthodontically induced white spot lesions and their outcome-a literature review[J]. Med Pharm Rep, 2019, 92(1): 25-30.
5	Pathak S, Roopa K, Poornima P, et al. White spot lesions: a literature review[J]. J Pediatr Dent, 2015, 3(1): 1-7.
6	Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding[J]. Am J Orthod, 1982, 81(2): 93-98.
7	Austin D, JayaKumar HL, Chandra KM, et al. Cross-sectional study on white spot lesions and its association with dental caries experience among school children[J]. Int J Clin Pediatr Dent, 2020, 13(2): 107-112.
8	Paula AB, Fernandes AR, Coelho AS, et al. Therapies for white spot lesions-a systematic review[J]. J Evid Based Dent Pract, 2017, 17(1): 23-38.
9	Horst JA, Tanzer JM, Milgrom PM. Fluorides and other preventive strategies for tooth decay[J]. Dent Clin North Am, 2018, 62(2): 207-234.
10	Almohefer SA, Levon JA, Gregory RL, et al. Caries lesion remineralization with fluoride toothpastes and chlorhexidine-effects of application timing and toothpaste surfactant[J]. J Appl Oral Sci, 2018, 26: e20170499.
11	Hajiahmadi M, Faghri J, Salehi Z, et al. Comparative evaluation of antibacterial effect of propolis and aloe vera, xylitol, and cpp-acp gels on Streptococcus mutans and Lactobacillus in vitro [J]. Int J Dent, 2021, 2021: 5842600.
12	Ribeiro AA, Azcarate-Peril MA, Cadenas MB, et al. The oral bacterial microbiome of occlusal surfaces in children and its association with diet and caries[J]. PLoS One, 2017, 12(7): e0180621.
13	Hamba H, Nakamura K, Nikaido T, et al. Remineralization of enamel subsurface lesions using toothpaste containing tricalcium phosphate and fluoride: an in vitro µCT analysis[J]. BMC Oral Health, 2020, 20(1): 292.
14	Shan D, He YW, Gao MY, et al. A comparison of resin infiltration and microabrasion for postorth-odontic white spot lesion[J]. Am J Orthod Dentofacial Orthop, 2021, 160(4): 516-522.
15	Zingler S, Pritsch M, Wrede DJ, et al. A randomized clinical trial comparing the impact of different oral hygiene protocols and sealant applications on plaque, gingival, and caries index scores[J]. Eur J Orthod, 2014, 36(2): 150-163.
16	Xiao J, Alkhers N, Kopycka-Kedzierawski DT, et al. Prenatal oral health care and early childhood caries prevention: a systematic review and meta-analysis[J]. Caries Res, 2019, 53(4): 411-421.
17	Schlueter N, Klimek J, Saleschke G, et al. Adoption of a toothbrushing technique: a controlled, randomised clinical trial[J]. Clin Oral Investig, 2010, 14(1): 99-106.
18	Marinho VC, Chong LY, Worthington HV, et al. Fluoride mouthrinses for preventing dental caries in children and adolescents[J]. Cochrane Database Syst Rev, 2016, 7: CD002284.
19	Alamri A, Salloot Z, Alshaia A, et al. The effect of bioactive glass-enhanced orthodontic bonding resins on prevention of demineralization: a systematic review[J]. Molecules, 2020, 25(11): E2495.
20	Sardana D, Manchanda S, Ekambaram M, et al. Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review[J]. Eur J Orthod, 2019, 41(6): 661-668.
21	Mahesh J, Veeresh DJ, Akhil P, et al. Comparative evaluation of root caries remineralization effect of plain milk, 5 ppm of fluoridated milk, and 5 ppm of sodium fluoride in deionized water using surface microhardness test: an in vitro study[J]. J Pharm Bioallied Sci, 2020, 12(): S182-S189.
22	Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries[J]. Cochrane Database Syst Rev, 2019, 3: CD007868.
23	Benson PE, Parkin N, Dyer F, et al. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment[J]. Cochrane Database Syst Rev, 2019, 2019(11): CD003809.
24	Kamber R, Meyer-Lueckel H, Kloukos D, et al. Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis[J]. Sci Rep, 2021, 11(1): 16556.
25	Nam HJ, Kim YM, Kwon YH, et al. Fluorinated bioactive glass nanoparticles: enamel demineralization prevention and antibacterial effect of orthodontic bonding resin[J]. Materials (Basel), 2019, 12(11): E1813.
26	Meshki R, Basir L, Rahbar N, et al. Comparison of the effect of fluoride gel and two toothpastes with different materials on remineralization of initial carious lesions in primary teeth[J]. J Family Med Prim Care, 2021, 10(9): 3309-3313.
27	Twetman S, Keller MK. Fluoride rinses, gels and foams: an update of controlled clinical trials[J]. Caries Res, 2016, 50(): 38-44.
28	Radha S, Kayalvizhi G, Adimoulame S, et al. Comparative evaluation of the remineralizing efficacy of fluoride varnish and its combination varnishes on white spot lesions in children with ECC: a rando-mized clinical trial[J]. Int J Clin Pediatr Dent, 2020, 13(4): 311-317.
29	Ijaz S, Marinho VC, Croucher R, et al. Professionally applied fluoride paint-on solutions for the control of dental caries in children and adolescents[J]. Cochrane Database Syst Rev, 2018: CD008364.
30	Helfenstein U, Steiner M. Fluoride varnishes (duraphat): a meta-analysis[J]. Community Dent Oral Epidemiol, 1994, 22(1): 1-5.
31	Sonesson M, Bergstrand F, Gizani S, et al. Management of post-orthodontic white spot lesions: an updated systematic review[J]. Eur J Orthod, 2017, 39(2): 116-121.
32	Hu HM, Feng C, Jiang ZW, et al. Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis[J]. Clin Oral Investig, 2020, 24(12): 4153-4167.
33	Splieth CH, Treuner A, Gedrange T, et al. Caries-preventive and remineralizing effect of fluoride gel in orthodontic patients after 2 years[J]. Clin Oral Investig, 2012, 16(5): 1395-1399.
34	Bock NC, Seibold L, Heumann C, et al. Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part Ⅰ: photographic data evaluation[J]. Eur J Orthod, 2017, 39(2): 134-143.
35	Akin M, Basciftci FA. Can white spot lesions be treated effectively[J]. Angle Orthod, 2012, 82(5): 770-775.
36	Wang JX, Yan Y, Wang XJ. Clinical evaluation of remineralization potential of casein phosphopeptide amorphous calcium phosphate nanocomplexes for enamel decalcification in orthodontics[J]. Chin Med J (Engl), 2012, 125(22): 4018-4021.
37	Shen PY, Fernando JR, Walker GD, et al. Addition of CPP-ACP to yogurt inhibits enamel subsurface demineralization[J]. J Dent, 2020, 103: 103506.
38	Dashper SG, Shen P, Sim CPC, et al. CPP-ACP promotes SnF₂ efficacy in a polymicrobial caries model[J]. J Dent Res, 2019, 98(2): 218-224.
39	Fernando JR, Shen PY, Sim CPC, et al. Self-assembly of dental surface nanofilaments and remineralisation by SnF₂ and CPP-ACP nanocomplexes[J]. Sci Rep, 2019, 9(1): 1285.
40	Bakry AS, Abbassy MA. Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions[J]. J Dent, 2018, 76: 52-57.
41	Wang YX, Hua F, Jiang H. CPP-ACP May be effective, but not significantly greater than using fluorides alone, in preventing and treating white spot lesions around orthodontic brackets[J]. J Evid Based Dent Pract, 2020, 20(1): 101416.
42	Borges AB, Caneppele TM, Masterson D, et al. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? a systematic review[J]. J Dent, 2017, 56: 11-18.
43	Bourouni S, Dritsas K, Kloukos D, et al. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis-a systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(8): 4711-4719.
44	Attal JP, Atlan A, Denis M, et al. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2)[J]. Int Orthod, 2014, 12(1): 1-31.
45	Abdullah Z, John J. Minimally invasive treatment of white spot lesions: a systematic review[J]. Oral Health Prev Dent, 2016, 14(3): 197-205.
46	Nogueira VKC, Mendes Soares IP, Fragelli CMB, et al. Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: an 18-Month randomized clinical trial[J]. J Dent, 2021, 105: 103570.
47	Kim S, Kim EY, Jeong TS, et al. The evaluation of resin infiltration for masking labial enamel white spot lesions[J]. Int J Paediatr Dent, 2011, 21(4): 241-248.
48	Tong LS, Pang MK, Mok NY, et al. The effects of etching, micro-abrasion, and bleaching on surface enamel[J]. J Dent Res, 1993, 72(1): 67-71.
49	Sundfeld RH, Franco LM, Machado LS, et al. Treatment of enamel surfaces after bracket debonding: case reports and long-term follow-ups[J]. Oper Dent, 2016, 41(1): 8-14.
50	Romero MF, Babb CS, Delash J, et al. Minimally invasive esthetic improvement in a patient with dental fluorosis by using microabrasion and bleaching: a clinical report[J]. J Prosthet Dent, 2018, 120(3): 323-326.
51	Sundfeld D, Pavani CC, Schott TC, et al. Dental bleaching on teeth submitted to enamel microabrasion 30 years ago-a case report of patients’ compliance during bleaching treatment[J]. Clin Oral Investig, 2019, 23(1): 321-326.
52	Costa JLSG, Nogueira BR, de Oliveira Junior OB, et al. Association of microabrasion and tooth whitening with LED/laser system in the treatment of incisor hypomineralization: 3-year follow-up[J]. Photodiagnosis Photodyn Ther, 2021, 33: 102197.
53	Chen H, Gu LS, Liao BY, et al. Advances of anti-caries nanomaterials[J]. Molecules, 2020, 25(21): 5047.
54	Gresnigt MMM, Sugii MM, Johanns KBFW, et al. Comparison of conventional ceramic laminate veneers, partial laminate veneers and direct composite resin restorations in fracture strength after aging[J]. J Mech Behav Biomed Mater, 2021, 114: 104172.
55	Sampson V, Sampson A. Diagnosis and treatment options for anterior white spot lesions[J]. Br Dent J, 2020, 229(6): 348-352.
56	Cury JA, Tenuta LMA. Enamel remineralization: controlling the caries disease or treating early caries lesions[J]. Braz Oral Res, 2009, 23(): 23-30.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	王钢,陈卓. 邻面去釉后釉质表面患龋风险控制的描述性综述[J]. 国际口腔医学杂志, 2023, 50(4): 395-400.
[2]	周梦琪,陈学鹏,傅柏平. 正畸治疗中牙槽骨骨开窗骨开裂的预防和应对策略[J]. 国际口腔医学杂志, 2021, 48(5): 600-608.
[3]	刘玲,龚仁国,董秀华,刘入梦. 正畸联合双颌手术治疗前牙区严重骨性开长期稳定性的Meta分析[J]. 国际口腔医学杂志, 2021, 48(2): 173-179.
[4]	赵玉洁,管晓燕,李小兰,陈琦君,王倩,刘建国. 巨噬细胞极化参与正畸牙移动的研究进展[J]. 国际口腔医学杂志, 2020, 47(4): 478-483.
[5]	陈艺尹,刘俊圻,李承浩. 牙槽突裂的裂隙特点及正畸治疗对唇腭裂患者牙槽突植骨术的影响[J]. 国际口腔医学杂志, 2020, 47(3): 345-350.
[6]	陈玉,姜欢,刘楠,陆晨萌,唐中元,韩茹钰,胡敏. 正畸治疗对骨性Ⅱ类错畸形患者上气道及周围结构变化的影响[J]. 国际口腔医学杂志, 2019, 46(5): 578-584.
[7]	高洁,马锐,葛振林. 热激活镍钛弓丝矫治效率的系统评价[J]. 国际口腔医学杂志, 2019, 46(4): 393-399.
[8]	何育薇,张智君,谢雨朗,梁英豪. 青少年正畸患者的心理状况研究[J]. 国际口腔医学杂志, 2019, 46(4): 413-419.
[9]	陶思颖,梁坤能,李继遥. 仿生多肽促进牙体硬组织再矿化的研究进展[J]. 国际口腔医学杂志, 2019, 46(1): 37-42.
[10]	罗惟丹, 李明云, 周学东, 程磊. 纳米羟磷灰石在牙体修复和牙髓治疗领域的应用[J]. 国际口腔医学杂志, 2018, 45(2): 192-198.
[11]	李锦锦, 潘剑. 自体牙移植及其结合正畸治疗的研究进展[J]. 国际口腔医学杂志, 2018, 45(1): 91-96.
[12]	徐晶, 张晓蓉. 正畸治疗对上气道形态影响的研究进展[J]. 国际口腔医学杂志, 2017, 44(5): 544-449.
[13]	潘颖丹, 刘艺琴, 肖立伟. 替牙期唇腭裂患者的正畸治疗[J]. 国际口腔医学杂志, 2017, 44(4): 380-384.
[14]	王压冲, 胡德渝, 董滢, 涂蕊, 李雪, 孔恒. 成都农村儿童患龋状况调查报告[J]. 国际口腔医学杂志, 2017, 44(1): 28-31.
[15]	姚霜, 刘晓君, 周治, 杨鸘, 季娟娟, 周新, 沈勇. 咬合调整对牙周炎正畸治疗患者牙周状况的影响[J]. 国际口腔医学杂志, 2017, 44(1): 50-54.