Clinical And Experimental Study On Treatment Of Sensitive Wedge-shaped Defect

Objective: Treating the sensitive wedge-shaped defect teeth by three different methods, and observe the pain control of patients in treatment; the improvement of the sensitive after treatment immediately and after three months; and evaluate the effect of these methods in the treatment of sensitive wedge-shaped defect; guiding the dentists to improve the success rate of sensitive wedge-shaped defects, and improve patient satisfaction. Using scanning electron microscope to observe the dentinal tubules and resin tags, and provide experimental basis for clinical treatment.Methods:1 Experiment one: Choosing 95 teeth of 65 patients who with sensitive wedge-shaped defect of second degree and above, and randomly divided into three groups: diode laser group, Gluma group, self-etching adhesive group. Checking the diseased teeth with mechanical and air stimulus and record it down. Diode laser group: set the diode laser treatment instrument, power: 1~1.5 watt, duty cycle: C W, time: 20 seconds, optical fiber: 320 micrometers, mobile phone R21-B. let the diode laser optical fiber aimed at the defect area of the diseased and irradiating, and the distance between the tooth surface and the tooth surface was 5 millimeters to 10 mm, 10 s each time, and repeat 3 to 4 times Smearing 3M ESPE AdperTM Easy One self-etching adhesive on the tooth surface, and resin fill the defect, modified and polishing; Gluma group: Let the brush dipped in the appropriate amount of Gluma desensitizer, smear on the sensitive part, and then whiting for a minute, gently dry teeth surface 5 seconds, Smearing 3M ESPE Adper easy one self-etching adhesive on the tooth surface, and resin fill the defect, modified and polishing; Self-etching adhesive group: Smearing 3M ESPE Adper easy one self-etching adhesive on the tooth surface, and resin fill the defect, modified and polishing. Then ask the patient to complete the questionnaire which include whether there is pain or not in the therapy. Check the sensitivity of diseased teeth record it down after the therapy immediately and after 3 month.2 Experiment two: Making 16 dentine hypersensitivity samples, and randomly divided into 4 groups: blank control group; diode laser treatment group; self-etching adhesive group; diode laser combined with self-etching adhesive treatment group. Observing the surface of each dentine sample by scanning electron microscope. Then, cleave the dentine samples along the dentinal tubules to observe the mixed layer and resin tags. Select the representative parts to take pictures, and then compare every picture.Results:1 The results of pain in response to the treatment in three groups:The incidence rate of pain in three groups: diode laser group was 10%, Gluma group was 38.7%, and self-etching adhesive group was 36.4%. Using Chi-Square test had statistical difference(P<0.05). The effect of diode lasers of pain control was better than the other two groups in treatment; and between the other two groups had no significant difference. The Gluma group had 2 cases of teeth in the treatment which appeared severe pain.2 The improvement of sensitivity among the three groups after treatment immediately:The sensitivity of diseased teeth were all significantly improved in these three groups, diode laser group invalid was 0, effective was 7, markedly effective was 23; Gluma group invalid was 2, effective was 12, markedly effective was 17; self-etching adhesive group invalid was 1, effective was 10, markedly effective was 22. Among the three groups had no statistical difference by Kruskal-Wallis H test(P>0.05). The markedly effective rate: diode laser group(76.7%), self-etching adhesive group(66.7%), Gluma group was 54.8%.3 The situation of diseased teeth among the three groups after 3 months:The sensitivity of diseased teeth were all significantly improved than 3 month ago in these three groups, diode laser group invalid was 0, effective was 4, markedly effective was 26; Gluma group invalid was 2, effective was 9, markedly effective was 20; self-etching adhesive group invalid was 0, effective was 8, markedly effective was 25. Among the three groups had no statistical difference by Kruskal-Wallis H test(P>0.05). Pulp vitality of all the teeth of diode laser group and self-etching adhesive group were normal, Sensitivity of 1 case in Gluma group was increasing after the treatment, and then treated it with root canal therapy. All the fillings of the three groups were not lost.4 Electron microscope observation results:Blank control group: the dentinal tubules were opening, and were smooth and clean in the dentinal tubules.Laser group: dentinal tubules were some or all closed, but there was no blockage in dentinal tubules.Self-etching adhesive group: the dentinal tubules were closed, and the resin tags were found in the dentinal tubules.Combined group: all of the tubules were closed, and the resin tags were found in the dentinal tubules, and the formation of the resin tags had no significantly difference with Self-etching adhesive group.Conclusions:1 Three methods in the treatment of sensitive wedge-shaped defect, can alleviate the sensitive situation of teeth effectively.2 Diode laser in the treatment can significantly reduce the pain of patients during the treatment, the comfort and satisfaction of patients was high, and can be applied to the treatment of severe sensitive wedge-shaped defect.3 Self-etching adhesive has well pain control in treatment, and the operation is simple and convenient. It is a good choice for treatment of mild and moderate sensitive wedge-shaped defect.4 Gluma desensitizer can alleviate the sensitive situation of teeth, but it has a certain stimulating effect on the pulp, so using it in deep sensitive wedge-shaped defect in clinical practice needs a further exploration.