- 學位論文
強力牙齒美白其影響之評估與探討
Evaluation of the Effect of Power Teeth Whitening
摘要
強力牙齒美白是目前最有效率的活性牙齒美白方式。目前市面上有許多不同的藥劑及催化光源搭配可應用於強力牙齒美白。本研究之目的在於評估15%過氧化氫及30%尿素過氧化氫，搭配二極體及電漿光催化光源之臨床美白效果，並以電子顯微鏡及原子力顯微鏡，評估上述強力牙齒美白方式對於牙齒微細結構的影響，同時分析美白藥劑及催化光源光譜的適合性，期望尋找出具效率的搭配。希望實驗結果可成為牙醫師以更經濟、安全的方式，追求牙齒美白治療效率及治療成果時的參考。 臨床實驗共設3個實驗組，每組各15人，共45人。依下列藥劑及光源之搭配進行臨床操作：實驗組A，15% 過氧化氫搭配二極體光源；實驗組B，15%過氧化氫搭配電漿光；實驗組C，30%尿素過氧化氫搭配電漿光。 將拔下之小臼齒依近遠心方向縱切，儲存於室溫下之生理食鹽水備用。電子顯微鏡觀察方面，取15片牙齒樣本，每組各3片，分成以下5組：實驗組A，浸泡生理食鹽水；實驗組B，15% 過氧化氫搭配二極體光源；實驗組C，15%過氧化氫搭配電漿光；實驗組D，30%尿素過氧化氫搭配電漿光；實驗組E，37%磷酸酸蝕劑。原子力顯微鏡觀察及計測方面，取12片牙齒樣本，每組各3片，分成以下4組：實驗組A，15% 過氧化氫搭配二極體光源；實驗組B，15%過氧化氫搭配電漿光；實驗組C，30%尿素過氧化氫搭配電漿光；實驗組D，37%磷酸酸蝕劑。析。 臨床實驗之結果顯示，所有之實驗組均具有美白牙齒之效果。其中以實驗組A，15% 過氧化氫搭配二極體光源的效果最具統計學上之顯著性（p< 0.0001），平均進步5.61±2.93色階。對於輕度深色齒（色階分佈為A或D系列），以實驗組A，15% 過氧化氫搭配二極體光源的效果最具統計學上之顯著性（p< 0.0001）。對於嚴重深色齒（色階分佈為C系列），以實驗組C，30% 尿素過氧化氫搭配電漿光光源的效果最差，與其他各組具有統計學上之顯著差異（p= 0.01< 0.05）。各實驗組對上顎及下顎牙齒之美白效果無統計學上之顯著差異（p= 0.1> 0.05）。上顎及下顎各牙齒部位中，以下顎犬齒的色階有顯著之進步，與其他各牙齒部位具有統計學上之顯著差異（p= 0.0167< 0.05）。 除了浸泡生理食鹽水之牙齒樣本，所有經藥劑處理之牙齒表面均可由掃瞄式電子顯微鏡及原子力顯微鏡，觀察計測出輕度至中等程度不等的牙齒表面變化。尤其以磷酸酸蝕之牙齒表面最為明顯。 15%過氧化氫美白藥劑之吸收光譜，其分布範圍從300nm到800nm，較30%尿素過氧化氫為廣，高峰值約為320nm。30%尿素過氧化氫美白藥劑之吸收光譜，其分布範圍從280nm到600nm，高峰值約為310nm。二極體光源之發射光譜分布範圍從420nm到540nm，高峰值約為470nm。電漿光光源之發射光譜分布範圍較二極體光源為分散，從380nm到540nm，高峰值約為495nm。 根據以上實驗結果，可知本研究所採用之各牙齒美白搭配組合均具有臨床效果，尤其以15% 過氧化氫搭配二極體光源效果最佳。在效果增加的同時，對牙齒表面結構也會造成較顯著之改變。但美白治療對牙齒表面結構所造成的改變，其程度仍遠小於磷酸酸蝕處理所造成的改變。謹慎操作本研究中所採用的各種強力牙齒美白方式，均可安全而有效的美白牙齒。未來強力牙齒美白的研究方向，可尋求藥劑成分及催化光源之特殊搭配，來得到更有效、安全而經濟之強力牙齒美白技術。
並列摘要
Power bleaching is the most effective and efficient way to lighten and whiten tooth color in a short period of time. The purpose of this study is to evaluate the clinical efficiency of two bleaching agents, 15% hydrogen peroxide and 30% carbamide peroxide, combine with two light source, LED and plasma arc. Possible alternations of tooth surface structure were also evaluated in this study. Spectrum distribution of bleaching agents and light sources were also measured. This study might serve as a reference for dentists to choose effective whitening systems with safety. In the clinical study, 45 people were divided into 3 test group, 15 people in each group were bleached with different bleaching agent and light source combinations as follows：Group A, 15% hydrogen peroxide with LED; Group B, 15% hydrogen peroxide with plasma arc; Group C, 30% carbamide peroxide with plasma arc. In vitro tooth surface structure alternations were evaluated with SEM and AFM. In SEM evaluation, 15 tooth segments were divided into 5 groups with 3 segments in each group： Group A, stored in normal saline; Group B, 15% hydrogen peroxide with LED; Group C, 15% hydrogen peroxide with plasma arc; Group D, 30% carbamide peroxide with plasma arc; Group E 37% phosphate acid etching agent. In AFM evaluation, 12 tooth segments were divided into 4 groups with 3 segments in each group： Group A, 15% hydrogen peroxide with LED; Group B, 15% hydrogen peroxide with plasma arc; Group C, 30% carbamide peroxide with plasma arc; Group D, 37% phosphate acid etching agent. In the clinical study, all bleaching group suffer significant clinical tooth whitening effect. The best whitening effect was found in Group A with average 5.61±2.93 color change (p< 0.0001). To mild discoloration teeth (shade A & D group) , the best whitening effect was found in the combination of 15% hydrogen peroxide and LED light source treatment (p<0.0001). To severe discoloration teeth (shade C group), the worst whitening effect was found in the combination of 30% carbamide peroxide and plasma arc light source treatment (p=0.01 < 0.05).There is no static significant difference of color changes between maxilla and mandible (p=0.10). To difference tooth area, the best color changes was found in mandible canines (p=0.0167 < 0.05). With the exception of the normal saline treated group, all groups with minor to moderate enamel surface alternation were founded in SEM and AFM images, especially the 37% phosphate acid agent treated group. In AFM images, all agents treated enamel surfaces became rougher. In micro surface roughness text, 37% phosphate acid agent severely increases the micro surface roughness value than other text groups (p=0.017). 37% phosphate acid etching increased the micro surface roughness value from 33.80 ± 6.06 nm to 267.13 ± 51.12 nm. When compared the micro surface roughness value between different bleaching text groups, there were static significant CHANGE in 15% hydrogen peroxide with LED treated group. (p=0.01< 0.05) The absorption spectrum distribution of 15% hydrogen peroxide is wider than 30% carbamide peroxide, from 300 to 800nm, and the peak value is about 320nm. The spectrum distribution of 30% carbamide peroxide is only from 280 to 600nm, and the peak value is about 310nm. The spectrum distribution of LED is from 420 to 540nm, and the peak value is about 470nm. The spectrum distribution of plasma arc is wider than LED, from 380 to 540nm, and the peak value is about 490nm. These result suggest that all bleaching procedure used in this study could lead to significant whitening effect clinically, especially the combination of 15% hydrogen peroxide with LED. Special combinations of bleaching agents with light source may lead to more efficient clinical result. At the same time, in micro, it seems that better whitening effects also lead to more severe tooth structure alternation. But surface changes were mild in all bleaching groups when compared with conventional acid etching technique group. So, all bleaching combinations in this study can be safely used in clinic tooth bleaching treatment with cautions. To find effective bleaching agents combine with suitable light source may be the next step to develop more efficient, safer, and economic power tooth bleaching technique.