Fagogeni Irini, Metlerska Joanna, Falgowski Tomasz, Górski Maciej, Lipski Mariusz, Nowicka Alicja
Doctoral Studies of the Faculty of Dentistry, Pomeranian Medical University, 70-204 Szczecin, Poland.
Department of Conservative Dentistry and Endodontics, Pomeranian Medical University, 70-204 Szczecin, Poland.
J Clin Med. 2022 Nov 28;11(23):7016. doi: 10.3390/jcm11237016.
Discolouration resulting from regenerative endodontic procedures may have a negative impact on the quality of life of treated patients; therefore, it is recommended to minimize this risk by selecting appropriate scaffolds and barrier materials, and if discolouration occurs, the use of a simple, cost-effective and minimally invasive technique, such as whitening, should be considered. This in vitro study aimed to evaluate tooth discolouration after two- and single-visit regenerative endodontic procedures and the effectiveness of subsequent whitening procedures with carbamide peroxide. Two hundred bovine incisors were included in this study and divided into twenty groups based on the tested material combinations. Two groups were control groups, one with saline and the other group with blood. In the 12 groups, the experiment was designed to be consistent with the two-visit regenerative endodontic procedures. Triple antibiotic paste or calcium hydroxide were placed in the root canal, and then scaffolds (e.g., blood or platelet-rich fibrin) and barrier materials (Biodentine, OrthoMTA or MTA Repair HP) were applied after rinsing the disinfectant pastes. In the six groups that corresponded to the single-visit regenerative endodontic procedure, the use of a disinfectant paste was omitted. Subsequently, the specimens were bleached twice with carbamide peroxide at a 7-day interval. Colour change measurements were performed using a spectrophotometer (VITA Easyshade Compact 5.0, VITA Zahnfabrik, Bad Säckingen, Germany). Statistical analysis was performed with the Kruskal−Wallis H test, the independent t-test and t-test for related samples. Tooth discolouration was noticed after two- and single-visit regenerative endodontic procedures, except for the platelet-rich fibrin+MTA Repair HP group. After the first and second whitening procedures, all of the tested two- and single-visit regenerative endodontic procedures groups showed a change in the colour of the crown, which was noticeable to the naked eye (∆E > 3.3). When analysing the ∆E value between the first and second bleaching procedures, no changes in the colour of teeth were visually noticed in the calcium hydroxide and platelet-rich fibrin +MTA Repair HP groups (∆E < 3.3). Single-visit regenerative endodontic procedures are suggested if possible; however, if two-visit regenerative endodontic procedures are performed, it is recommended to use calcium hydroxide as the disinfectant paste because of the lower staining potential. In the context of discolouration, platelet-rich fibrin is advisable for use as a scaffold. The whitening procedure is worth considering, but does not guarantee a return to the original tooth colour, especially when triple antibiotic paste is used.
再生牙髓治疗引起的牙齿变色可能会对接受治疗患者的生活质量产生负面影响；因此，建议通过选择合适的支架和屏障材料来尽量降低这种风险，如果出现变色情况，应考虑采用简单、经济高效且微创的技术，如牙齿美白。这项体外研究旨在评估两次就诊和单次就诊的再生牙髓治疗后的牙齿变色情况以及随后使用过氧化脲进行牙齿美白治疗的效果。本研究纳入了200颗牛切牙，并根据测试的材料组合将其分为20组。两组为对照组，一组用生理盐水，另一组用血液。在12组中，实验设计与两次就诊的再生牙髓治疗程序一致。将三联抗生素糊剂或氢氧化钙置于根管内，然后在冲洗消毒糊剂后应用支架（如血液或富血小板纤维蛋白）和屏障材料（生物陶瓷、正硅酸四钙或MTA修复HP）。在对应单次就诊再生牙髓治疗程序的六组中，省略了消毒糊剂的使用。随后，每隔7天用过氧化脲对标本进行两次漂白。使用分光光度计（VITA Easyshade Compact 5.0，德国巴德塞京根VITA齿科材料有限公司）进行颜色变化测量。采用Kruskal−Wallis H检验、独立t检验和相关样本t检验进行统计分析。除富血小板纤维蛋白+MTA修复HP组外，两次就诊和单次就诊的再生牙髓治疗程序后均出现牙齿变色。在第一次和第二次牙齿美白治疗后，所有测试的两次就诊和单次就诊的再生牙髓治疗程序组的牙冠颜色均有肉眼可见的变化（∆E>3.3）。在分析第一次和第二次漂白治疗之间的∆E值时，氢氧化钙组和富血小板纤维蛋白+MTA修复HP组的牙齿颜色在视觉上没有变化（∆E<3.3）。如果可能，建议采用单次就诊的再生牙髓治疗程序；然而，如果进行两次就诊的再生牙髓治疗程序，由于染色可能性较低，建议使用氢氧化钙作为消毒糊剂。在牙齿变色的情况下，富血小板纤维蛋白适合用作支架。牙齿美白治疗值得考虑，但不能保证恢复到牙齿原来的颜色，尤其是在使用三联抗生素糊剂的情况下。
