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光增强漂白对体外牙体表面及牙髓腔内温度升高的影响。

Effect of light-enhanced bleaching on in vitro surface and intrapulpal temperature rise.

作者信息

Baik J W, Rueggeberg F A, Liewehr F R

机构信息

Endodontic Program, Fort Gordon, Georgia, USA.

出版信息

J Esthet Restor Dent. 2001;13(6):370-8. doi: 10.1111/j.1708-8240.2001.tb01022.x.

Abstract

PURPOSE

This study investigated the effect of the presence, absence, and aging of a heat-enhancing compound (colorant) added to bleaching gel on the temperature rise of the gel itself, as well as the temperature rise within the pulp chamber, when a tooth was exposed to a variety of light-curing units in vitro.

MATERIALS AND METHODS

An extracted human upper central incisor was fitted with thermocouples placed in the pulp chamber as well as on the facial tooth surface. A temperature-controlled simulated intrapulpal fluid flow was provided to the tooth, and bleaching agent (Opalesence XTRA, Ultradent) containing heat-enhancing colorant, aged colorant, or no colorant was applied to the facial surface. The tooth and light-curing unit were placed in a thermostatically controlled oven at 37 degrees C, and real-time gel and intrapulpal temperature values were recorded digitally. Light-curing units used were a plasma arc light (PAC) (PowerPac, ADT), a conventional quartz tungsten halogen source (QTH) (Optilux 501, Demetron/Kerr), the QTH light used in high-power (bleaching) mode, and an argon ion laser (AccuCure 3000, LaserMed). An exposure scenario simulating light-enhanced bleaching of 10 upper teeth was developed. Temperature rise over the pre-exposure, baseline value associated with the last light exposure in the bleaching sequence was calculated for each curing and bleaching combination. Five replications for each test condition were made. Temperature rise values were compared using analysis of variance (ANOVA) at a preset alpha of 0.05.

RESULTS

When fresh colorant-containing bleach was used, the PAC light increased bleach temperature 39.3 degrees C above baseline. With no added colorant, temperature rise was 37.1 degrees C. The QTH light in bleach mode resulted in gel temperature 24.8 degrees C above baseline, whereas the temperature increase was only 11.5 degrees C when no colorant was used. Conventional QTH light use increased fresh bleach temperature by 17.7 degrees C, whereas an increase of only 11.1 degrees C was measured without colorant. The argon ion laser produced equivalent temperature rise regardless of the presence or freshness of the colorant, approximately 9.4 degrees C. Intrapulpal temperatures were all significantly lower than those recorded in the bleaching gel and ranged from 5 degrees to 8 degrees C. As a rule, the presence of fresh heat-enhancing colorant in the bleaching gel resulted in a significant intrapulpal temperature increase (approximately 1 degrees C) over that reached using other lights. The PAC and the QTH light used in bleach mode induced greater intrapulpal temperature rise than the laser.

CLINICAL SIGNIFICANCE

Freshness of bleaching agent incorporating light-activated, heat-enhancing colorant influences temperature rise of bleaching gel and also may increase intrapulpal temperature values. Use of intense lights does elevate bleach temperature and also results in increased intrapulpal temperature that may further impact on patient sensitivity and pulpal health resulting from this treatment.

摘要

目的

本研究调查了添加到漂白凝胶中的热增强化合物(着色剂)的存在、缺失和老化对凝胶本身温度升高的影响,以及当牙齿在体外暴露于各种光固化装置时牙髓腔内的温度升高情况。

材料与方法

将一颗拔除的人上颌中切牙安装热电偶,分别置于牙髓腔和牙齿唇面。向牙齿提供温度控制的模拟牙髓内流体流动,并将含有热增强着色剂、老化着色剂或不着色剂的漂白剂(Opalesence XTRA,Ultradent)涂覆在唇面。将牙齿和光固化装置置于37℃的恒温烤箱中,以数字方式记录实时凝胶温度和牙髓内温度值。使用的光固化装置包括等离子弧光(PAC)(PowerPac,ADT)、传统石英钨卤素光源(QTH)(Optilux 501,Demetron/Kerr)、高功率(漂白)模式下使用的QTH光以及氩离子激光(AccuCure 3000,LaserMed)。制定了模拟10颗上牙光增强漂白的暴露方案。计算每次固化和漂白组合在漂白序列中与最后一次光暴露相关的暴露前基线值之上的温度升高。对每个测试条件进行5次重复。使用方差分析(ANOVA)在预设α为0.05的情况下比较温度升高值。

结果

当使用含新鲜着色剂的漂白剂时,PAC光使漂白剂温度比基线升高39.3℃。未添加着色剂时,温度升高为37.1℃。漂白模式下的QTH光使凝胶温度比基线升高24.8℃,而未使用着色剂时温度升高仅为11.5℃。使用传统QTH光使新鲜漂白剂温度升高17.7℃,而未使用着色剂时测量到的升高仅为11.1℃。无论着色剂的存在与否或新鲜程度如何,氩离子激光产生的温度升高大致相同,约为9.4℃。牙髓内温度均显著低于漂白凝胶中记录的温度,范围为5℃至8℃。通常,漂白凝胶中新鲜热增强着色剂的存在导致牙髓内温度比使用其他光时显著升高(约1℃)。PAC和漂白模式下使用的QTH光比激光引起更大的牙髓内温度升高。

临床意义

含有光活化、热增强着色剂的漂白剂的新鲜程度会影响漂白凝胶的温度升高,也可能增加牙髓内温度值。使用强光确实会提高漂白剂温度,也会导致牙髓内温度升高,这可能会进一步影响患者的敏感性和这种治疗对牙髓健康的影响。

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