口腔酸碱环境下渗透树脂联合再矿化对釉质白斑治疗稳定性影响的实验研究

doi:10.13701/j.cnki.kqyxyj.2023.09.011

摘要/Abstract

摘要： 目的: 在口腔酸碱循环环境下观察比较渗透树脂联合不同再矿化治疗釉质白斑后釉质粗糙度、硬度以及Ca/P比的变化情况。方法: 72颗完整离体前磨牙在牙冠颊面正中切取4 mm×4 mm×2 mm釉质块。在其表面(除颊侧面外)涂布抗酸指甲油后,置于脱矿液中3 d,建立釉质白斑体外脱矿模型。经渗透树脂处理后,用抗酸指甲油覆盖一半釉质面作为自身对照侧,另一半作为实验侧。将样本随机分为3组(n=24),RI组不做再矿化处理,RI/B组行生物活性玻璃处理(2次/日),RI/C组行含氟酪蛋白磷酸肽/无定形磷酸钙(CPP-ACPF)处理(2次/日),共计7 d。除再矿化治疗外,所有样本均置于酸碱循环溶液中。去除对照侧覆盖的指甲油记为酸碱循环前(T₀时刻),实验侧为酸碱循环后(T₁时刻)。观察并测量各组样本酸碱循环前后粗糙度、显微硬度及Ca/P比并行统计学分析。结果: 再矿化和酸碱循环均可显著影响渗透树脂处理后釉质表面粗糙度和Ca/P比(P<0.05)。经酸碱循环后,3组样本的粗糙度值均有增加,但RI/B组增加值(T₁-T₀)最少,RI/C组次之,RI组增加最多(P<0.05);3组显微硬度值均略有降低但无统计学差异(P>0.05);3组Ca/P比均显著性降低(P<0.05),但RI组降低最多,RI/B组降低最少。结论: 釉质白斑树脂渗透治疗后,在酸碱循环环境下出现粗糙度增加、硬度及Ca/P比降低;联合生物活性玻璃或CPP-ACPF再矿化治疗,可以有效改善釉质抗脱矿能力,提高渗透树脂治疗稳定性。

关键词: 釉质白斑, 树脂渗透, 含氟酪蛋白磷酸肽/无定形磷酸钙, 生物活性玻璃, 酸碱循环

Abstract: Objective: To observe and compare the changes of enamel roughness, hardness, and Ca/P ratio after resin infiltration combined with different remineralization treatment in oral acid-base circulation environment (pH cycle). Methods: A 4 mm×4 mm×2 mm enamel block was cut from 72 intact premolars in the center of the buccal surface of the crown. After acid-resistant nail polish was coated on its surface (except buccal side), it was placed in demineralization solution for 3 days to establish an in vitro demineralization model of enamel white spots. After resin infiltration treatment, half of the enamel surface was covered with acid-resistant nail polish as its own control side, and the other half was used as the experimental side. The samples were randomly divided into three groups (n=24). RI group was not treated with remineralization, RI/B group was treated with bioactive glass (twice a day), and RI/C group was treated with phosphopeptide containing fluorine casein/amorphous calcium phosphate (CPP-ACPF) (twice a day) for 7 days. Except for remineralization treatment, all samples were placed in pH cycle solution. The nail polish removed from the control side was recorded as before the pH cycle (time T₀) and after the pH cycle (time T₁) on the experimental side. The roughness, microhardness, and Ca/P ratio of each group of samples before and after pH cycle were observed and measured. Results: Both remineralization and pH cycle can significantly affect the enamel surface roughness and Ca/P ratio (P<0.05). After pH cycling, the roughness values of three groups of samples all increased, but the added value of RI/B group (T₁-T₀) was the least, followed by RI/C group and RI group increased the most (P<0.05). The microhardness of three groups decreased slightly without statistical difference (P>0.05). The Ca/P ratio of three groups decreased significantly (P<0.05), but the decrease in RI group was the most, and that in RI/B group was the least. Conclusion: After resin infiltration treatment of enamel white spot lesions, the roughness was increased, and the hardness and Ca/P ratio were decreased in pH cycle environment. Combined with bioactive glass or CPP-ACPF remineralization treatment, it can effectively improve the demineralization resistance of enamel and improve the stability of resin infiltration treatment

Key words: white spot lesions of enamel, resin infiltration, fluorinated casein phosphopeptide/amorphous calcium phosphate, bioactive glass, acid-base cycle

王琰, 倪恪, 贺晶宇, 李迎梅, 孟庆飞. 口腔酸碱环境下渗透树脂联合再矿化对釉质白斑治疗稳定性影响的实验研究[J]. 口腔医学研究, 2023, 39(9): 821-826.

WANG Yan, NI Ke, HE Jingyu, LI Yingmei, MENG Qingfei. Effect of Resin Infiltration Combined with Remineralization on Stability of Enamel White Spot Lesions in Oral Acid-base Environment[J]. Journal of Oral Science Research, 2023, 39(9): 821-826.

参考文献

[1] 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.
[2] Yagci A, Korkmaz YN, Buyuk SK, et al. White spot lesion formation after treatment with full-coverage rapid maxillary expanders [J]. Am J Orthod Dentofacial Orthop, 2016, 149(3):331-338.
[3] Gu X, Yang L, Yang D, et al. Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized clinical trial [J]. Angle Orthod, 2019, 89(3):372-377.
[4] Youssef A, Farid M, Zayed M, et al. Improving oral health: a short-term split-mouth randomized clinical trial revealing the superiority of resin infiltration over remineralization of white spot lesions [J]. Quintessence Int, 2020, 51(9):696-709.
[5] Zakizade M, Davoudi A, Akhavan A, et al. Effect of resin infiltration technique on improving surface hardness of enamel lesions: A systematic review and meta-analysis [J]. J Evid Based Dent Pract, 2020, 20(2):101405.
[6] Piątek-Jakubek K, Nowak J, Bołtacz-Rzepkowska E. Influence of infiltration technique and selected demineralization methods on the roughness of demineralized enamel: An in vitro study [J]. Adv Clin Exp Med, 2017, 26(8):1179-1188.
[7] Liu G, Yang L, Gao L, et al. Durability of infiltrated resin application on white spot lesions after different challenges: An ex vivo study [J]. J Prosthet Dent, 2022:S0022-3913(22)00086-5.
[8] Ritwik P, Jones CM, Fan Y, et al. Hydrolytic and color stability of resin infiltration: A preliminary in vitro trial [J]. J Contemp Dent Pract, 2016, 17(5):377-381.
[9] Zhao X, Pan J, Zhang S, et al. Effectiveness of resin-based materials against erosive and abrasive enamel wear [J]. Clin Oral Investig, 2017, 21(1):463-468.
[10] Paris S, Hopfenmuller W, Meyer-Lueckel H. Resin infiltration of caries lesions: an efficacy randomized trial [J]. J Dent Res, 2010, 89(8):823-826.
[11] Akin M, Basciftci FA. Can white spot lesions be treated effectively? [J]. Angle Orthod, 2012, 82(5):770-775.
[12] Mendes AC, Restrepo M, Bussaneli D, et al. Use of casein amorphous calcium phosphate (CPP-ACP) on white-spot lesions: Randomised clinical trial [J]. Oral Health Prev Dent, 2018, 16(1):27-31.
[13] Sinfiteli PP, Coutinho TCL, Oliveira PRA, et al. Effect of fluoride dentifrice and casein phosphopeptide-amorphous calcium phosphate cream with and without fluoride in preventing enamel demineralization in a pH cyclic study [J]. J Appl Oral Sci, 2017, 25(6):604-611.
[14] Milly H, Festy F, Watson TF, et al. Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders [J]. J Dent, 2014, 42(2):158-166.
[15] Taha AA, Patel MP, Hill RG, et al. The effect of bioactive glasses on enamel remineralization: A systematic review [J]. J Dent, 2017, 67:9-17.
[16] 程亚楠,吴毓聪,毛秋华,等.渗透树脂联合生物活性玻璃修复脱矿牙釉质的效果及稳定性[J].中国组织工程研究,2021,25(22):3522-3526.
[17] 李慧,王丹,高鹏,等.生物活性玻璃对渗透树脂治疗早期釉质龋抗脱矿能力的影响[J].临床口腔医学杂志,2019,35(4):209-212.
[18] Bhavsar B, Vijo M, Sharma P, et al. Comparative assessment of enamel remineralisation on the surface microhardness of demineralized enamel - an in vitro study [J]. PeerJ, 2022, 10:e14098.
[19] 邢心坦.渗透树脂与氟保护剂对牙釉质再脱矿预防作用的比较研究[D].天津医科大学,2021.
[20] 方谦.生物活性玻璃促进早期釉质龋再矿化作用的体外研究[D].华北理工大学,2017.
[21] Catelan A, Briso AL, Sundfeld RH, et al. Effect of artificial aging on the roughness and microhardness of sealed composites [J]. J Esthet Restor Dent, 2010, 22(5):324-330.
[22] Soveral M, Machado V, Botelho J, et al. Effect of resin infiltration on enamel: A systematic review and meta-analysis [J]. J Funct Biomater, 2021, 12(3):48.
[23] Aswani R, Chandrappa V, Uloopi KS, et al. Resin infiltration of artificial enamel lesions: Evaluation of penetration depth, surface roughness and color stability [J]. Int J Clin Pediatr Dent, 2019, 12(6):520-523.
[24] Neres ÉY, Moda MD, Chiba EK, et al. Microhardness and roughness of infiltrated white spot lesions submitted to different challenges [J].Oper Dent, 2017, 42(4):428-435.
[25] Yazkan B, Ermis RB. Effect of resin infiltration and microabrasion on the microhardness, surface roughness and morphology of incipient carious lesions [J]. Acta Odontol Scand, 2018, 76(7):473-481.
[26] Paris S, Meyer-Lueckel H, Cölfen H, et al. Resin infiltration of artificial enamel caries lesions with experimental light curing resins [J]. Dent Mater J, 2007, 26(4):582-588.
[27] Taher NM. Atomic force microscopy and tridimensional topography analysis of human enamel after resinous infiltration and storage in water [J]. Saudi Med J, 2015, 36(7):885.
[28] Dai Z, Xie X, Zhang N, et al. Novel nanostructured resin infiltrant containing calcium phosphate nanoparticles to prevent enamel white spot lesions [J]. J Mech Behav Biomed Mater, 2022, 126:104990.
[29] Gelani R, Zandona AF, Lippert F, et al. In vitro progression of artificial white spot lesions sealed with an infiltrant resin [J]. Oper Dent, 2014, 39(5):481-488.
[30] Turska-Szybka A, Gozdowski D, Mierzwiska-Nastalska E, et al. Randomised clinical trial on resin infiltration and fluoride varnish vs fluoride varnish treatment only of smooth-surface early caries lesions in deciduous teeth [J]. Oral Health Prev Dent, 2016, 14(6):485-491.
[31] Jayarajan J, Janardhanam P, Jayakumar P, et al. Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization-an in vitro study using scanning electron microscope and DIAGNOdent [J]. Indian J Dent Res, 2011, 22(1):77-82.
[32] Ramadoss R, Padmanaban R, Subramanian B. Role of bioglass in enamel remineralization: Existing strategies and future prospects-A narrative review [J]. J Biomed Mater Res B Appl Biomater, 2022, 110(1):45-66.
[33] Hench LL, Jones JR. Bioactive glasses: Frontiers and challenges [J]. Front Bioeng Biotechnol, 2015, 3:194.
[34] Poggio C, Lombardini M, Dagna A, et al. Protective effect on enamel demineralization of a CPP-ACP paste: an AFM in vitro study [J]. J Dent, 2009, 37(12):949-954.
[35] Somasundaram P, Vimala N, Mandke LG. Protective potential of casein phosphopeptide amorphous calcium phosphate containing paste on enamel surfaces [J]. J Conserv Dent, 2013, 16(2):152-156.
[36] Zhang YY, Wong HM, McGrath CPJ, et al. In vitro and in vivo evaluation of electrophoresis-aided casein phosphopeptide-amorphous calcium phosphate remineralisation system on pH-cycling and acid-etching demineralised enamel [J]. Sci Rep, 2018, 8(1):8904.
[37] Narayana SS, Deepa VK, Ahamed S, et al. Remineralization efficiency of bioactive glass on artificially induced carious lesion an in-vitro study [J]. J Indian Soc Pedod Prev Dent, 2014, 32(1):19-25.