国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (3): 249-255.doi: 10.7518/gjkq.2024045

• 专家笔谈 •    下一篇

牙齿漂白技术的临床应用策略

张敏(),李继遥()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院牙体牙髓病科 成都 610041
  • 收稿日期:2023-11-30 修回日期:2024-01-23 出版日期:2024-05-01 发布日期:2024-05-06
  • 通讯作者: 李继遥
  • 作者简介:张敏，副主任医师，博士，Email：<email>zhangmin0812@163.com</email>|<named-content content-type="corresp-name">张敏</named-content>，四川大学华西口腔医院牙体牙髓病科副主任医师，2015年毕业于四川大学华西口腔医学院，获口腔医学博士学位，先后赴荷兰阿姆斯特丹牙科学术中心及美国罗切斯特大学研修。任中华口腔医学会口腔美学专业委员会委员、四川省口腔美学专业委员会常务委员兼秘书。临床主攻微创牙体美学修复及微创治疗，临床病例多次在各级病例展评中获得一等奖。主持国家级、省部级科研项目3项，获得数字化牙体修复技术相关国家发明专利授权3项，参编《牙体牙髓科诊疗与操作常规》《口腔内科学实验教程》等教材及临床专著5部。|<named-content content-type="corresp-name">李继遥</named-content>，四川大学华西口腔医学院教授，博士生导师。中华口腔医学会牙体牙髓病学专业委员会副主任委员、四川省口腔医学会口腔美学专业委员会主任委员、牙体牙髓病学专业委员会副主任委员、国际牙医师学院（International College of Dentists，ICD）院士，国家执业医师资格考试命审题专家委员会（口腔类）委员。四川省“卫生健康英才计划”首席专家、四川省卫生健康领军人才。获国家科技进步二等奖1项、部省级科技进步一等奖5项。擅长牙体牙髓病的现代治疗，尤其在牙体微创美学修复方面具有特色。
  • 基金资助:
    四川大学研究生教育教学改革研究项目(GSSCU2023116)

Clinical strategies for dental bleaching

Min Zhang(),Jiyao Li()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2023-11-30 Revised:2024-01-23 Online:2024-05-01 Published:2024-05-06
  • Contact: Jiyao Li
  • Supported by:
    Project on Teaching Reform of Graduate Education at Sichuan University(GSSCU2023116)

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摘要：

牙齿漂白技术是微创治疗牙齿着色的有效方法之一。漂白技术实施简单，但是临床应用中颇具挑战性。术前进行充分的医患沟通和评估，根据病因和难度制定个性化方案，对于治疗中可能出现的问题进行有计划地防控，是治疗取得成功的关键。本文结合文献回顾和笔者的临床体会，对活髓牙漂白技术的临床策略进行探讨，以期为着色牙的漂白治疗提供参考。

关键词: 牙齿漂白, 着色牙, 漂白方案, 敏感, 颜色回弹

Abstract:

Vital tooth bleaching is one of the effective methods for the minimally invasive treatment of discolored tooth. Tooth bleaching techniques is simpler than other dental treatments, but challenges are still encountered in clinical practice. For a successful treatment, some key issues must be addressed through doctor-patient communication before treatment, and personalized treatment plans based on the etiology and difficulty of cases and the planned prevention and management of potential clinical complications during treatment must be considered. This article combines literature review and the author’s clinical experience to discuss clinical strategies for tooth-whitening treatment, aiming to provide a reference for dental bleaching treatment in clinical settings.

Key words: dental bleaching, discolored tooth, bleaching planning, sensitivity, colour regression

中图分类号: 

  • R781.2

图 1

1例牙体矿化程度高的着色牙的诊室漂白A：术前比色A2，釉质半透性高；B：一次诊室漂白（38% HP，15 min，2次）无明显效果，术后即刻比色A2。"

图 2

1例氟斑牙的家庭漂白A：漂白术前，存在牙齿深着色、牙体缺损和前牙间隙等问题；B：家庭漂白（10% CP）2个月后棕色斑块改善，但未能完全解决前牙美观问题。"

图 3

将Vita Classical比色板按明度排列（左侧为漂白色）"

表 1

Vita Classical比色板色阶等级排列与对应分值"

分值色阶
1B1
2A1
3B2
4D2
5A2
6C1
7C2
8D3
9A3
10D4
11B3
12A3.5
13B4
14C3
15A4
16C4

图 4

在1例诊室漂白病例中观察到的颜色回弹A：术前比色A2；B：一次诊室漂白（38% HP），术后即刻颜色提升，比色较A1浅；C：术后1周颜色回弹，比色A1，但较术前有改善。"

图 5

1例釉质矿化不全着色牙的联合漂白A：术前比色A3；B：一次诊室漂白（38% HP），术后即刻比色为A2，着色斑块无法去除；C：家庭漂白（10% CP）1月后，牙色显著改善，着色斑块颜色变淡。"

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