硝酸钾凝胶预防活髓牙夜间脱色治疗中牙过敏症的临床观察

Clinical survey of potassium nitrate gel to prevent nightguard vital bleaching sensitivity

目的:评价硝酸钾凝胶在活髓牙夜间脱色(Nightguard Vital Bleaching,NGVB)中预防牙过敏症的效果。方法:经过筛选的60位变色牙患者被随机均分为两组接受16%过氧化脲NGVB治疗。治疗组在每次NGVB前后均使用硝酸钾凝胶预防牙齿过敏。对照组则仅接受常规的NGVB漂白治疗。用VITALESCENCE美学修复比色板比较牙齿漂白前后的色阶变化,评价漂白临床效果。通过两组患者填写牙齿敏感程度表,根据牙齿敏感程度自我评估打分来进行牙齿敏感程度评估。采用Loe-Silness牙龈指数及牙龈退缩评估来评价不同的治疗对两组患者牙周的影响。结果:对照组的轻,中,重度牙齿敏感的发生率均明显高于治疗组,治疗组和对照组分别有36.6%及66.6%的患者发生过牙齿敏感,两组间存在显著差异(P<0.01)。治疗组和对照组对活髓变色牙的治疗均有较好的疗效,两组间无明显差异(P>0.05)。但对色阶的提高,治疗组优于对照组,两组之间有显著差异(P<0.05),此外两组均显示,牙敏感程度越高,色阶提高越少。治疗组和对照组的牙齿敏感自我评分的平均值分别为1.36,2.24,两组间有显著性差异(P<0.01)。两组中有唇面釉质裂纹及牙龈退缩的患者发生牙齿敏感的百分比均明显高于无唇面釉质裂纹及牙龈退缩的患者(P<0.01)。两组的Loe-Silness牙龈指数及牙龈退缩评估均显示出令人满意的牙周安全性。结论:在过氧化脲NGVB中应用硝酸钾凝胶不会影响美白效果及牙周健康,可以有效地预防牙齿敏感症的发生,大大减少及减轻牙齿敏感,提高患者的舒适感及美白效果,值得在NGVB治疗中推广。

Objective To evaluate the clinical efficacy of potassium nitrate gel to prevent nightguard vital bleaching sensitivity. Method 60 pre-selected patients with discolored teeth were randomly and evenly divided into 2 groups. The treatment group used potassium nitrate gel before and after each NGVB, while the control group was treated with NGVB only. Vitalescence Esthetic Restorative Masters Shade Guide was used to record the change of color and help evaluate the lightening efficacy. Results The control group has a higher incidence of light, medium and heavy sensitivity. 66.6% of patients from the control group and 36.6% from the treatment group reported bleaching sensitivity, and there is a remarkable difference between the two groups （P〈0.01）. Both groups have satisfied lightening efficacy for discolored teeth, and there is no significant difference between them （P〉0.05）. However, the treatment group has a better grade improvement than the control group （P〈0.05）. Both groups show that a higher degree of tooth sensitivity means a lower degree of shade enhancement. The treatment group＇s average grade（1.36） of sensitivity self evaluation is much lower than that （2.24） of the control group, and there is a significant difference between the two groups （P〈0.01）. Patients of both groups with facial enamel fissures and gingival recession have a much higher incidence of sensitivity than those without （P〈0.01）. Both groups＇ Loe-Silness gingival index and gingival recession assessment all showed satisfying periodontal safety. Conclusion Potassium nitrate gel will not affect NGVB＇S bleaching efficacy, could effectively prevent the incidence of bleaching sensitivity, alleviate sensitivity discomfort, improve patient＇s feeling of comfort, help achieve a better lightening effect,and is highly recommended to be used along with NGVB.