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)

RichHTML

10

PDF (PC)

113

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。"

1 中华口腔医学会口腔修复学专业委员会. 牙齿漂白治疗技术指南[J]. 中华口腔医学杂志, 2021, 56(12): 1191-1196.
Prosthetics Professional Committee of Chinese Stomatological Association. Guideline of tooth blea-ching technology[J]. Chin J Stomatol, 2021, 56(12): 1191-1196.
2 Kashima-Tanaka M, Tsujimoto Y, Kawamoto K, et al. Generation of free radicals and/or active oxygen by light or laser irradiation of hydrogen peroxide or sodium hypochlorite[J]. J Endod, 2003, 29(2): 141-143.
3 Kwon SR, Wertz PW. Review of the mechanism of tooth whitening[J]. J Esthet Restor Dent, 2015, 27(5): 240-257.
4 Alkahtani R, Stone S, German M, et al. A review on dental whitening[J]. J Dent, 2020, 100: 103423.
5 Haywood VB. Current status and recommendations for dentist-prescribed, at-home tooth whitening[J]. Contemp Esthet Restorative Pract, 1999, 3: 2-9.
6 Haywood VB. An examination for nightguard vital bleaching[J]. Esthet Dent Update, 1995, 6(2): 51-52.
7 Tay LY, Kose C, Herrera DR, et al. Long-term efficacy of in-office and at-home bleaching: a 2-year double-blind randomized clinical trial[J]. Am J Dent, 2012, 25(4): 199-204.
8 Matis BA, Cochran MA, Wang G, et al. A clinical evaluation of two in-office bleaching regimens with and without tray bleaching[J]. Oper Dent, 2009, 34(2): 142-149.
9 Rodríguez-Martínez J, Valiente M, Sánchez-Martín MJ. Tooth whitening: from the established treatments to novel approaches to prevent side effects[J]. J Esthet Restor Dent, 2019, 31(5): 431-440.
10 Zekonis R, Matis BA, Cochran MA, et al. Clinical evaluation of in-office and at-home bleaching treatments[J]. Oper Dent, 2003, 28(2): 114-121.
11 Matis BA, Cochran MA, Eckert G, et al. The efficacy and safety of a 10% carbamide peroxide blea-ching gel[J]. Quintessence Int, 1998, 29(9): 555-563.
12 Matis BA, Cochran MA, Eckert G. Review of the effectiveness of various tooth whitening systems[J]. Oper Dent, 2009, 34(2): 230-235.
13 de Geus JL, Wambier LM, Boing TF, et al. At-home bleaching with 10% vs more concentrated car-bamide peroxide gels: a systematic review and meta-analysis[J]. Oper Dent, 2018, 43(4): E210-E222.
14 Zhong BJ, Yang S, Hong DW, et al. The efficacy of at-home, in-office, and combined bleaching regimens: a randomized controlled clinical trial[J]. Oper Dent, 2023, 48(3): E71-E80.
15 de Geus JL, Wambier LM, Kossatz S, et al. At-home vs in-office bleaching: a systematic review and meta-analysis[J]. Oper Dent, 2016, 41(4): 341-356.
16 Bowles WH, Ugwuneri Z. Pulp chamber penetration by hydrogen peroxide following vital bleaching procedures[J]. J Endod, 1987, 13(8): 375-377.
17 Carneiro TS, Favoreto MW, Mena-Serrano A, et al. In vitro evaluation of the effect of different blea-ching varnishes: hydrogen peroxide penetration into the pulp chamber and color change[J]. J Esthet Restor Dent, 2024, 36(2): 402-409.
18 Fugaro JO, Nordahl I, Fugaro OJ, et al. Pulp reaction to vital bleaching[J]. Oper Dent, 2004, 29(4): 363-368.
19 薛舒尹, 叶玲. 活髓牙漂白引起牙齿敏感的研究进展[J]. 国际口腔医学杂志, 2017, 44(5): 602-607.
Xue SY, Ye L. Etiology and preventions of blea-ching sensitivity in vital tooth[J]. Int J Stomatol, 2017, 44(5): 602-607.
20 Li Y, Greenwall L. Safety issues of tooth whitening using peroxide-based materials[J]. Br Dent J, 2013, 215(1): 29-34.
21 do Amaral FL, Sasaki RT, da Silva TC, et al. The effects of home-use and in-office bleaching treatments on calcium and phosphorus concentrations in tooth enamel: an in vivo study[J]. J Am Dent Assoc, 2012, 143(6): 580-586.
22 Wang YN, Gao JX, Jiang T, et al. Evaluation of the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment-a systematic review and meta-analysis[J]. J Dent, 2015, 43(8): 913-923.
23 Krishnakumar K, Tandale A, Mehta V, et al. Post-ope-rative sensitivity and color change due to in-office bleaching with the prior use of different desensiti-zing agents: a systematic review[J]. Cureus, 2022, 14(4): e24028.
24 Martini EC, Favoreto MW, Rezende M, et al. Topical application of a desensitizing agent containing potassium nitrate before dental bleaching: a syste-matic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(7): 4311-4327.
25 Markowitz K, Strickland M. The use of anti-inflammatory drugs to prevent bleaching-induced tooth sensitivity is ineffective and unnecessary[J]. Evid Based Dent, 2020, 21(4): 130-131.
26 Paula E, Kossatz S, Fernandes D, et al. The effect of perioperative ibuprofen use on tooth sensitivity caused by in-office bleaching[J]. Oper Dent, 2013, 38(6): 601-608.
27 Al Shethri S, Matis BA, Cochran MA, et al. A clinical evaluation of two in-office bleaching products[J]. Oper Dent, 2003, 28(5): 488-495.
28 Matis BA, Cochran MA, Franco M, et al. Eight in-office tooth whitening systems evaluated in vivo: a pilot study[J]. Oper Dent, 2007, 32(4): 322-327.
29 Moghadam FV, Majidinia S, Chasteen J, et al. The degree of color change, rebound effect and sensitivity of bleached teeth associated with at-home and power bleaching techniques: a randomized clinical trial[J]. Eur J Dent, 2013, 7(4): 405-411.
30 Tay LY, Kose C, Herrera DR, et al. Long-term efficacy of in-office and at-home bleaching: a 2-year double-blind randomized clinical trial[J]. Am J Dent, 2012, 25(4): 199-204.
31 Al-Tarakemah Y, Darvell BW. On the permanence of tooth bleaching[J]. Dent Mater, 2016, 32(10): 1281-1288.
[1] 赵雅丽,王植,高阳,辛鹏飞,张宽收,刘青梅. 磷酸钛氧钾激光在牙齿漂白治疗中的研究进展[J]. 国际口腔医学杂志, 2023, 50(2): 195-202.
[2] 丁景瑜,田子璐,王惠敏,朱轩言,杨宇斌,朱松. 即刻牙本质封闭的研究进展[J]. 国际口腔医学杂志, 2022, 49(1): 121-124.
[3] 张雪雯,李聪,徐小茵,高静,申静. 混合光源系统用于活髓牙漂白的临床研究进展[J]. 国际口腔医学杂志, 2021, 48(6): 683-689.
[4] 薛舒尹, 叶玲. 活髓牙漂白引起牙齿敏感的研究进展[J]. 国际口腔医学杂志, 2017, 44(5): 602-607.
[5] 陆笑, 翁春辉, 王劲茗, 刘少娟, 刘芹, 林珊. luxSem>/AI-2密度感应对缓症链球菌生物膜致病力的影响[J]. 国际口腔医学杂志, 2017, 44(4): 411-420.
[6] 代晓华,姚晖. 光学相干断层成像技术及其在窝沟龋检测中的应用[J]. 国际口腔医学杂志, 2016, 43(3): 352-356.
[7] 余少华1 蒲东全2 刘鲁川1. 铒:钇-铝石榴石激光治疗牙本质敏感症的机制和特点[J]. 国际口腔医学杂志, 2015, 42(6): 673-676.
[8] 孙昌娟，管红雨，韩璐. 含精氨酸和碳酸钙的脱敏抛光膏治疗超声龈下刮治后根面敏感症的疗效观察[J]. 国际口腔医学杂志, 2014, 41(6): 663-666.
[9] 郭晓钰 吴友农. 牙本质敏感的钕:钇-铝石榴石激光治疗[J]. 国际口腔医学杂志, 2014, 41(4): 468-473.
[10] 孙庆忠1 叶宏林2. 68例慢性牙周炎患者龈下菌斑致病菌的分布及耐药性分析[J]. 国际口腔医学杂志, 2013, 40(6): 724-726.
[11] 门乙 李春洁 李龙江 韩波 夏辉 高宁. 超声介导下的细针穿刺活检在腮腺肿瘤中的诊断价值的系统评价和Meta分析[J]. 国际口腔医学杂志, 2013, 40(4): 447-450.
[12] 翁嘉华 麦理想 王大为. 牙齿漂白及其对正畸托槽粘接强度的影[J]. 国际口腔医学杂志, 2013, 40(1): 105-108.
[13] 王海业综述 杜莉 沈颉飞审校. 电压门控离子通道的机械敏感性及其研究进展[J]. 国际口腔医学杂志, 2011, 38(2): 239-241.
[14] 王盼盼，陈新梅. 3种家用脱敏剂阻塞牙本质小管的实验研究[J]. 国际口腔医学杂志, 2010, 37(5): 511-515.
[15] 苗棣1, 张晖2综述 徐屹1审校
. 牙周致病菌对各类抗菌药物敏感性和耐药性的研究进展[J]. 国际口腔医学杂志, 2008, 35(4): 383-383～386.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 王昆润. 在种植体上制作固定义齿以后下颌骨密度的动态变化[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 高卫民,李幸红. 发达国家牙医学院口腔种植学教学现状[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 逄键梁. 两例外胚层发育不良儿童骨内植入种植体后牙槽骨生长情况[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 杨凯. 淋巴化疗的药物运载系统及其应用现状[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 康非吾. 种植义齿下部结构生物力学研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 杨春惠. 耳颞神经在颞颌关节周围的分布[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 蔡霞,李成章. 前列腺素E_2受体EP亚型在牙周炎发病机制中的作用[J]. 国际口腔医学杂志, 2005, 32(06): 461 -462 .
[8] 孟姝,吴亚菲,杨禾. 伴放线放线杆菌产生的细胞致死膨胀毒素及其与牙周病的关系[J]. 国际口腔医学杂志, 2005, 32(06): 458 -460 .
[9] 陈晓 蒋文晖 王文梅. 念珠菌性白斑的研究概况[J]. 国际口腔医学杂志, 2004, 31(02): 138 -140 .
[10] 轩东英,张建波 金岩. 胚胎发育期TGF-β超家族成员与腭裂发生的关系[J]. 国际口腔医学杂志, 2004, 31(02): 132 -134 .