Marcondes Maurem, Paranhos Maria Paula Gandolfi, Spohr Ana Maria, Mota Eduardo Gonçalves, da Silva Isaac Newton Lima, Souto André Arigony, Burnett Luiz Henrique
Department of Restorative Dentistry, School of Dentistry, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
J Biomed Mater Res B Appl Biomater. 2009 Jul;90(1):388-95. doi: 10.1002/jbm.b.31297.
The Nd:YAG laser can be used in Dentistry to remove soft tissue, disinfect canals in endodontic procedures and prevent caries. However, there is no protocol for Nd:YAG laser application in dental bleaching. The aims of this in vitro study were: (a) to observe the tooth shade alteration when hydrogen peroxide whitening procedures are associated with dyes with different wavelengths and irradiated with Nd:YAG laser or halogen light; (b) to measure the Vickers (VHN) enamel microhardness before and after the whitening procedure; (c) to evaluate the tensile bond strength of two types of adhesive systems applied on bleached enamel; (d) to observe the failure pattern after bond strength testing; (e) to evaluate the pulpal temperature during the bleaching procedures with halogen light or laser; (f) to measure the kinetic reaction of hydrogen peroxide.
Extracted sound human molar crowns were sectioned in the mesiodistal direction to obtain 150 fragments that were divided into five groups for each adhesive system: WL (H(2)O(2) + thickener and Nd:YAG), WH (H(2)O(2) + thickener and halogen light), QL (H(2)O(2) + carbopol + Q-switch and Nd:YAG), QH (H(2)O(2) + carbopol + Q-switch and halogen light), and C (Control, without whitening agent). Shade assessment was made with a shade guide and the microhardness tests were performed before and after the bleaching procedures. Immediately afterwards, the groups were restored with the adhesive systems Adper Single Bond 2 or Solobond M plus composite resin, and the tensile bond strength test was performed. The temperature was measured by thermocouples placed on the enamel surface and intrapulpal chamber. The kinetics of hydrogen peroxide was observed by ultraviolet analysis.
The shade changed seven levels for Nd:YAG laser groups and eight levels for halogen light. According to the student's t-test, there was no statistical difference between the VHN before and after the whitening protocols (p > 0.05). The tensile bond strength showed no statistical significance between the test groups and the controls, considering both adhesive systems tested by ANOVA and Tukey tests (p > 0.05). The predominant failure pattern after bond strength testing was mixed. The temperature was safe for laser and halogen light. The kinetic reaction showed that after 5 min all the hydrogen peroxide had been consumed.
Nd:YAG laser associated with hydrogen peroxide bleached the enamel, the shade being similar to that obtained with the traditional method performed with halogen light. Moreover, the Vickers' microhardness and bond strength values were not altered in comparison with those for nonbleached enamel.
钕钇铝石榴石(Nd:YAG)激光可用于牙科,以去除软组织、在牙髓治疗中对根管进行消毒以及预防龋齿。然而,目前尚无关于Nd:YAG激光在牙齿漂白中应用的方案。本体外研究的目的是:(a)观察过氧化氢美白程序与不同波长染料联合使用并经Nd:YAG激光或卤素灯照射时牙齿颜色的变化;(b)测量美白程序前后的维氏(VHN)釉质显微硬度;(c)评估两种粘结系统在漂白釉质上的拉伸粘结强度;(d)观察粘结强度测试后的失效模式;(e)评估用卤素灯或激光进行漂白程序时的牙髓温度;(f)测量过氧化氢的动力学反应。
将拔除的健康人磨牙牙冠沿近远中方向切片,获得150个碎片,针对每种粘结系统分为五组:WL(过氧化氢+增稠剂和Nd:YAG)、WH(过氧化氢+增稠剂和卤素灯)、QL(过氧化氢+卡波姆+Q开关和Nd:YAG)、QH(过氧化氢+卡波姆+Q开关和卤素灯)以及C组(对照组,不使用美白剂)。使用比色板进行颜色评估,并在漂白程序前后进行显微硬度测试。之后,立即用Adper Single Bond 2或Solobond M粘结系统加复合树脂对各组进行修复,并进行拉伸粘结强度测试。通过放置在釉质表面和牙髓腔内的热电偶测量温度。通过紫外线分析观察过氧化氢的动力学反应。
Nd:YAG激光组牙齿颜色改变了7个色阶,卤素灯组改变了8个色阶。根据学生t检验,美白方案前后的VHN无统计学差异(p>0.05)。考虑到通过方差分析(ANOVA)和Tukey检验测试的两种粘结系统,测试组与对照组之间的拉伸粘结强度无统计学意义(p>0.05)。粘结强度测试后的主要失效模式为混合性。激光和卤素灯照射时温度安全。动力学反应表明,5分钟后所有过氧化氢均已消耗。
Nd:YAG激光与过氧化氢联合使用可漂白釉质,其颜色变化与传统卤素灯方法相似。此外,与未漂白釉质相比,维氏显微硬度和粘结强度值未发生改变。