酪蛋白磷酸肽-非结晶型磷酸钙对正畸后釉白斑再矿化的临床评价

Quantification of remineralized effect of casein phosphopeptiode -amorphous calcium phosphate on post orthodontic white spot lesion

目的:量化研究酪蛋白磷酸肽-非结晶型磷酸钙(casein phosphopeptide-amorphous calcium phosphate,CPP-ACP)对正畸治疗所致釉白斑的再矿化作用。方法:选取正畸治疗结束并患有多数釉白斑的患者共10例,平均年龄17.7岁。要求患者每天早晚刷牙后,将含有10%CPP-ACP复合体的糊剂均匀涂抹于牙的唇面,每天2次。治疗前和治疗中均拍摄口内彩色照片。通过肉眼观察和应用Image-Pro Plus图像分析软件,对釉白斑进行测量并计算釉白斑面积比,使用SPSS13.0软件包对治疗前及治疗后1个月、2个月的釉白斑面积比进行配对t检验。量化分析1个月后重新进行图像测量与统计学分析,并使用SPSS13.0软件包计算组内相关系数。结果:使用CPP-ACP1个月后,釉白斑面积平均减少(4.89±2.05)%,2个月平均减少(8.359±3.472)%;与治疗前相比,釉白斑面积均显著减少(P<0.01)。2次测量所得数据的组内相关系数为0.968。结论:CPP-ACP能显著减少正畸所致的釉白斑病损,提高牙的美学效果;利用口内照片量化釉白斑面积具有较好的可靠性与可重复性。

PURPOSE： The aim of this study was to quantify the changes in post-orthodontic demineralized enamel lesion surface areas after using casein phosphopeptide-amorphous calcium phosphate （CPP-ACP）. METHODS： Ten orthodontic patients （mean age, 17.7 years） were involved in this study who had multiple decalcified enamel lesion after fixed orthodontic therapy. Ten percent of CPP-ACP paste（GC Tooth Mousse, Recaldent, Europe）was taught to spread on tooth surface two times per day immediately after tooth brush. Standardized intraoral images were taken before and after using it. Image analysis software Image-Pro Plus was used to quantify the visible areas of the demineralized lesions which were expressed as a percentage of total labial surface areas of each tooth. The measurement data before and after using CPP-ACP for 1 month and 2 months were analyzed by paired t test. The measurement of image was repeated again 1 month later to determine the repeatability of the method by calculating the intraclass correlation coefficient between the two results of analysis with SPSS13.0 software package. RESULTS： CPP-ACP significantly reduced the visible enamel demineralization （P〈0.01, paired t test）. The mean reduction in lesion size after treatment was 4.89%（ SD：2.05%; 95% CI： 1.93%-8.77%） for 1 month, and 2 months was 8.359%（SD： 3.472%; 95%CI： 3.76%-15.01%）. The intraclass correlation coefficient between the two measurements was 0.968. CONCLUSIONS： CPP-ACP can effectively improve the longstanding postorthodontic demineralized enamel white lesion, and the intraoral image analysis is an reliable and repeatable method to measure white spot lesions. Supported by Research Fund from Bureau of Science and Technology of Changchun City （Grant No. 2008108）.