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Journal of Korean Academy of Oral Health 2016 March 40(1):31-37 http://dx.doi.org/10.11149/jkaoh.2016.40.1.31 Original Article Primer 를함께사용하는자가미백부착대의임상적효과 신해은 1, 임상욱 1, 김은경 2, 김종훈 3, 안재현 3, 최연희 1, 송근배 1 1 경북대학교치의학전문대학원예방치과학교실, 2 경북대학교과학기술대학치위생학과, 3 LG 생활건강기술연구원 Effects of a whitening strip combined with a desensitizing primer on tooth color Hae-Eun Shin 1, Sang-Uk Im 1, Eun-Kyung Kim 2, Jong-Hun Kim 3, Jae-Hyun Ahn 3, Youn-Hee Choi 1, Keun-Bae Song 1 1 Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, 2 Department of Dental Hygiene, College of Science & Technology, Kyungpook National University, Sangju, 3 LG Household & Health Care LTD, Research Park, Daejeon, Korea Received: January 8, 2016 Revised: February 12, 2016 Accepted: February 18, 2016 Corresponding Author: Keun-Bae Song Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, 2177, Dalgubeol-daero, Junggu, Daegu 41940, Korea Tel: +82-53-660-6870 Fax: +82-53-423-2947 E-mail: kbsong@knu.ac.kr *This research was supported by LG Household & Health Care Research Park, 2013. Objectives: The purpose of this study was to evaluate the efficacy of a 2.9% hydrogen peroxide (HP) whitening strip with a desensitizing agent as a primer. Methods: This study was approved by the Institutional Review Board of Kyungpook National University Hospital. A total of 144 subjects (mean age: 21.7 years) were recruited after they provided informed consent for participation in the study. All participants used the whitening strip and primer for 1.5 h a day for 14 days. ShadeEye-NCC and Vita classical shade guide were used to determine the color changes, with respect to baseline, after 1, 3, 5, 7, and 14 days. A self-administered questionnaire was used to collect data on satisfaction after bleaching and irritating symptoms during the 14 days. All collected data were analyzed with repeated measures ANOVA and one-way ANOVA using SPSS 20.0 for windows. Results: Brightness (ΔL*) was significantly higher in groups 2 and 3 than in the control group after 3 days of the experiment. Chroma (Δb*) started to decrease in groups 2 and 3, compared to control, after 1 day. Perceived symptoms of irritation were significantly lower in groups using the strip combined with the desensitizing primer than in the control group. Satisfaction after bleaching was higher in the experimental groups than in control. Conclusions: The HP whitening strip with a desensitizing agent as a primer is clinically effective in bleaching human enamel after 3 days of use. It also reduces the prevalence of gingival irritation. Key Words: Desensitizing agent, Primer, Whitening strip 서론 아름다움의기준은문화나시대에따라다르겠지만예로부터동양에서는미인을일컬어 단순호치 ( 丹脣皓齒 ) 또는 명모호치 ( 明眸皓齒 ) 라표현할만큼하얀치아를아름다움의조건으로꼽았다 1). 치아는일상생활에서마주보며대화를하거나웃을때, 눈에많이띄게되는부분으로인상을좌우하는주요한요인이며, 아름 다운미소를위한필수적요소이다 2). Vallittu 등 3) 에따르면연구대상자가치과치료중가장받기를원하는치료는심미치료였으며, 그중치아미백을원하는대상자가가장많다고하였다. 국내의경우도 20세기후반부터경제적인여유와기술의발전, 대중매체의발달로심미치료에대한요구와관심도가날로증가하고있는추세이며, 치과를찾는환자중치아의저작기능과발음기능의회복뿐아니라심미적개선을위한미용의목적으로내원하는경우도 Copyright 2016 by Journal of Korean Academy of Oral Health This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. JKAOH is available at http://www.jkaoh.org pissn 1225-388X / eissn 2093-7784

32 J Korean Acad Oral Health 2016;40:31-37 많아지고있다 4-6). 치아미백이란과산화수소 (hydrogen peroxide, HP) 나, 과산화요소 (carbamide peroxide, CP) 등의 peroxide 제제를이용하여치질내의착색부분인유기질을산화시켜치아의색조를밝게하는술식이다. 7) 치아미백의종류에는치과에서시행하는전문가치아미백술 (in-office bleaching) 과치과의사의지도하에환자의구강에맞게제작된미백장치를이용해미백제를적용하는자가미백술 (home bleaching), 전문가의도움이나처방없이시행하는의약외품미백술 (over the count bleaching, OTC 미백술 ) 로구분할수있다 8). OTC 미백술은미리 peroxide의농도를측정하여제작된부착대를이용하는방법으로전문가미백술이나자가미백술보다낮은농도의 peroxide를사용하므로보다유리한효과를낼수없지만, 별도의 tray를사용하지않아도되기때문에입안이물감이적고 tray의제작이나조절이필요하지않아직접적용이가능하므로간편하고경제적이라는장점을가지고있다 9,10). 미백치료는화학제를사용하므로치료중일시적인치은자극과지각과민증이나타날수있다. 이러한부작용은환자에게불편감을야기하나가역적이며처치를중단할정도의상태에는이르지않는다고보고되었으며 11,12), 전문가치아미백술보다는부작용의위험이낮으나 OTC 미백술에서도일시적인치은자극이나지각과민증의부작용이보고되고있다 13). 미백의부작용을줄이기위한방안으로진통제복용 14), 미백화학제의농도감소, 지각완화제를사용하는방법 15,16) 등이있는데그중가장많이선호되는방안이지각완화제를사용하는방법이다. 지각완화제로인산칼슘 (calcium phosphate), 불소 (fluoride), 질산칼륨 (potassium nitrate) 등의성분을이용한선행연구에의하면지각완화제는미백효과에는영향을미치지않고구강경조직과연조직에민감성이나구강자극을줄여주는효과를보인다고하였다 17). Costa 등 17) 에의하면지각완화제는치아에계면활성제의역할을하여치면과부착대의부착성을높이고, 치아의얼룩을제거하는데도움을주어치아를더욱하얗게한다고하였으며, 법랑질의탈회를막고재광화에도움을준다고하였다. 여러선행연구들에의해 HP를이용한자가미백부착대의안전성과효능이인정받고있다 8,13,18). 하지만국가간자가미백부착 Table 1. Inclusion and exclusion criteria Inclusion criteria Exclusion criteria - Be in good general and oral health - Have all natural anterior teeth of which shade are between D3-A2 shade guide - Willing to return for post whitening evaluation - Agree to sign a consent form - Have anterior teeth with orthodontic braces or restoration - Have critical pathological lesion in oral tissue - Have gingival inflammation or multiple dental caries - Have more than two teeth need to be treated immediately - Have ever been involved in other study in 6 months - Have experience of high sensitivity during dental bleaching - Have ever used of whitening agent in 6 months 대의 HP 농도함량에대한법적인기준이서로달라국외선행연구들과는차이가있을수있으며, 국내의자가미백부착대의부작용을줄이기위한지각완화제에대한연구는미비한실정이다. 본연구는지각완화도포제가적용된 primer와 2.9% HP 자가미백부착대를함께사용하였을때색조변화를알아보고자가미백의효과에미치는영향을알아보았다. 또한지각완화제를사용했을때의자각증상을알아보기위하여도포제의재료를달리할경우자각증상의차이를알아보고, 자가미백시행후만족도를조사하였다. 연구대상및방법 1. 연구대상본연구는경북대학교병원임상시험심사위원회 (Institutional Review Board) 의승인을받았다 (KNUH-2013-07-024). 대구지역 3개의대학에서지원자를모집하였으며, 자가미백을원하는 149명중치과의사의구강검진을통하여포함기준을충족하는대상자를선별하였으며 (Table 1), 미백의부작용을충분히설명한후, 이에동의한 99명을최종대상자로선정하였다. 대상자들의연령분포는 20세에서 30세로평균 21.7세였으며여성 90명, 남성 9 명이었다. 2. 연구재료도포제 (Primer) 와부착대 (Patch) 포함성분에따라 3개의군으로나누고 (Table 2), 대상자를각군에무작위배정하였으며, 이중맹검법 (double blind test) 을실시하였다. 제 1군은대조군으로자극완화제가포함된도포제와 HP를함유하지않은부착대군이며, 제 2군은자극완화제가포함된도포제와 2.9% HP를함유한부착대군, 제 3군은 2.8% 의 HP가포함된도포제와 2.9% HP를함유한부착대군이다. 2.8% 도포제는 LG 생활건강에서출시한펜형태의미백젤을사용하였으며 (Effect Pen, LG 생활건강, Korea) 2.9% HP 부착대와자극완화제는 LG생활건강에서출시할예정인제품이며, 자극완화제에는타우린 (taurine), 인산칼륨 (calcium phosphate), 염화철 (iron chloride) 성분등이포함되었다. 3. 연구설계대상자는개인에게할당된도포제와부착대를하루에 1시간 30분씩 2주간사용하도록하였다. 도포제는펜타입으로, 부착되어있는실리콘팁을이용하여일정량을치아에엷게바른후부착대를붙이도록하였다. 취침전사용하도록권장하여미백처치후 Table 2. Study group and characteristic of treatment materials Group Patch Primer Group 1 Not contained HP Contained desensitizing agents Group 2 Contained 2.9% HP Contained desensitizing agents Group 3 Contained 2.9% HP Contained 2.8% HP HP: hydrogen peroxide.

33 신해은외 Primer를함께사용하는자가미백부착대의임상적효과 부터측정까지개인간시간차이가적도록하였다. 또한미백처치기간동안동일한칫솔질방법을사용할수있도록교육하였으며, 같은재질과성분의칫솔과치약을지급하여사용하도록하였다. 실험기간동안흡연과커피, 카레등과같은착색을일으킬수있는식품을금하도록하였다 19,20). 4. 연구방법 4.1. 색조색차계 (Shade eye-ncc) 를이용한측정실험대상자의상악 6전치의색조를측정하고그평균값을구하였다. 색조색차계 (Shade eye-ncc, SHOFU Co., Japan) 는분석모드로측정하였고, 자가미백부착대사용전 baseline, 사용 1일후, 3일후, 5일후, 7일후, 14일후의치아색조를각각측정했다. 측정된값은 CIE ( 국제조명의원회 ) 의 lab system에의거하여 L*, a*, b* 값으로산출하였으며, 미백전색조값과각측정일의색조값을이용하여미백전 후 L*, a*, b* 의색조변화량을알아보고각색조변화량을이용하여전체의변화량인 E* 를구하였다. E* 를구하는방법 21) 은아래와같다. 4.2. 비색법 (Shade guide) 을이용한측정 16단계의 Vita classical shade guide (Vita Zahnfabrik, H. Rauter GmbH & Co, KG, Bad Sackingen, Germany) 를이용한치아색조측정은측정자가육안으로만해당치아와가장흡사한색상탭을선택하는비색법이다. 16단계중가장밝은 B1을 1점으로부여하고각단계별로 1점씩더하여가장어두운 C4를 16점으로하였다 (B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4, C3, A4, C4) 22). 매측정시동일한한명의측정자가상악전치부의각치아에점수를부여하고평균값을산출하였다. 즉, 평균값이낮아질수록비색법으로본치아의색조가밝아짐을의미한다. 4.3. 주관적측정 (1) 자각증상조사 : 자각증상은미백제사용 1일후, 3일후, 5 일후, 7일후, 14일후의색조측정시에설문지를통해자기기입식으로작성되었다. (2) 만족도조사 : 미백에대한기대도나만족도의문항은자기기입식의설문지작성을이용하여조사하였다. Likert 5점척도로측정하였으며, 각문항점수의합을이용하여분석하였다. Table 3 은만족도에사용된설문조사지로요인분석과신뢰도분석을시행하여타당성와신뢰성을검토하였고, 신뢰성검정은 Cronbach s alpha를사용하였다. 5. 통계분석이연구의수집된자료는 IBM SPSS (IBM SPSS 20.0 for windows, SPSS Inc, USA) 프로그램을이용하여분석하였다. 연구대상자의일반적특성과자가증상을알아보기위해빈도분석과기술통계분석을실시하였다. 미백후시점별색조변화중비색법을이용한측정에는반복측정분산분석법 (repeated measures ANOVA) 을시행하였으며, 색조색차계를이용한군별색조변화량과만족도의군간차이는일원배치분산분석법 (one-way ANOVA) 을시행한후, 통계적으로유의한차이를보이는경우 Tukey 방법으로사후검정을실시하였다. 통계적유의성을판단하기위한유의수준은모두 5% 로설정하였다. 연구성적 1. 색조색차계 (Shade eye-ncc) 를이용한변화량미백전 baseline과각측정시명도값 (L*) 의변화량은 Table 4와같다. 미백 1일후에는세군모두유의한차이가없었다 (P=0.076). 미백 3일이후부터 2군과 3군의 L* 값이증가하여대조군과유의한차이를보였고 (P<0.001), 실험군인 2군과 3군간에는유의한차이가없었다 (P>0.05). Table 5는적색채도인 a* 의변화량이다. 미백후 3일후부터 Table 3. Factor analysis for tooth bleaching satisfaction and reliability of each decisive factor Factors Items Factor loading I II III Cronbach's Satisfaction My teeth became more white after bleaching. 0.88 0.10 0.16 0.93 Self-confidence of personal relations was increased after bleaching. 0.80 0.05 0.09 My teeth became more bright after bleaching. 0.90 0.17 0.15 My teeth became more clear after bleaching. 0.88 0.10 0.01 Self-confidence during smile was increased after bleaching. 0.84 0.04 0.06 I really satisfied with tooth bleaching. 0.84 0.08 0.06 Side effects I felt cold sensitivity during bleaching. 0.14 0.11 0.75 0.61 My teeth became more rough after bleaching. 0.12 0.04 0.66 My teeth was impaired after bleaching. 0.00 0.04 0.82 Social life I agree that tooth bleaching can affect my future life. 0.07 0.77 0.01 0.75 White teeth have an effect on social life. 0.13 0.82 0.07 White teeth is a basal condition of the beauty. 0.05 0.84 0.04

34 J Korean Acad Oral Health 2016;40:31-37 Table 4. Color changes L* of total tooth among the group at each time Baseline 71.03±1.81 70.62±1.42 70.10±1.44 0.511 After 1 day 0.04±0.76 0.27±0.89 0.49±0.71 0.076 After 3 days 0.00±0.92 a 0.77±1.06 b 1.07±0.82 b <0.001 After 5 days 0.29±1.19 a 0.81±1.43 b 1.32±1.21 b <0.001 After 7 days 0.09±1.30 a 1.38±1.64 b 1.64±1.24 b <0.001 After 14 days 0.05±1.52 a 2.26±1.80 b 2.25±1.45 b <0.001 Table 5. Color changes a* of total tooth among the group at each time Group1 Group2 Group3 P-value Baseline 0.59±0.72 0.53±0.63 0.35±0.60 0.325 After 1 day 0.06±0.48 0.05±0.34 0.08±0.47 0.382 After 3 days 0.05±0.43 a 0.39±0.43 b 0.56±0.46 b <0.001 After 5 days 0.16±0.52 a 0.46±0.54 b 0.53±0.47 b <0.001 After 7 days 0.22±0.59 a 0.66±0.53 b 0.48±0.52 b <0.001 After 14 days 0.15±0.59 a 0.89±0.64 b 0.92±0.70 b <0.001 Table 6. Color changes b* of total tooth among the group at each time Baseline 14.61±2.32 14.84±2.52 14.60±2.04 0.325 After 1 day 0.27±0.89 a 0.79±0.74 b 1.26±0.96 c <0.001 After 3 days 0.48±1.14 a 2.20±0.93 b 2.90±1.34 c <0.001 After 5 days 0.41±1.01 a 2.80±1.21 b 2.89±2.79 b <0.001 After 7 days 0.51±0.94 a 3.49±1.19 b 4.42±1.45 c <0.001 After 14 days 0.17±0.97 a 4.51±1.68 b 5.70±1.49 c <0.001 Table 7. Color changes E* of total tooth among the group ΔE 1.71±0.78 a 5.38±1.91 b 6.34±1.72 c <0.001 대조군인 1군에비해 2군과 3군이유의하게감소하는것을확인할수있다. 2군과 3군의차이는유의하지않았다. Table 6은황색채도인 b* 의변화량을나타낸것이다. 미백후 1일부터 2군과 3군에서 b* 값이감소하는것을보였으며 1군과 2군, 1군과 3군, 2군과 3군에서모두유의한차이를보였다 (P<0.001). b* 의차이는 3군이가장많았다. 2군과 3군에서 L* 값이유의하게증가하고, a* 와 b* 값이유의하게감소하여치아의색조가밝아지는것을알수있었다. L*, a*, b* 의색조변화량을이용한전체변화량 E* 는 Table 7 과같다. 2. 비색법 (Shade guide) 를이용한측정값 Vita shade guide를이용하여색조의차이를측정한값의변화는 Table 8과같다. 미백전 baseline은유의한차이를보이지않았으며, 미백 3일후부터 1군과 3군에서유의한차이가나타났고 (P<0.001), 미백 7일후에는 1군과 2, 3군에서유의한차이를보였으며 (P<0.001), 2군과 3군에는유의한차이가나타나지않았다 (P>0.05). 3. 자극및만족도조사 Table 9 는미백에따른치은자극여부를주관적증상으로설

35 신해은외 Primer를함께사용하는자가미백부착대의임상적효과 Table 8. Vita classical shade guide Baseline 6.20±2.07 6.64±2.06 7.14±1.61 0.145 After 1 day 5.86±1.53 6.29±2.10 6.37±1.44 0.448 After 3 days 5.84±1.61 a 5.05±1.98 ab 4.53±1.93 b 0.018 After 5 days 5.51±1.65 a 4.54±1.81 ab 3.89±1.60 b 0.001 After 7 days 5.21±1.37 a 3.47±1.50 b 3.29±1.42 b <0.001 After 14 days 5.56±1.58 a 2.90±1.63 b 2.18±1.07 b <0.001 P-value** 0.021 <0.001 <0.001 **P-value was determined by repeated measures ANOVA. Table 9. Gingiva irritation of each group (Unit: N (%)) After 1 day After 3 days After 5 days After 7 days After 14 days Group 1 0 (0.0) 0 (0.0) 0 (0.0) 2 (15.4) 0 (0.0) Group 2 0 (0.0) 1 (11.1) 1 (7.7) 1 (7.7) 2 (6.1) Group 3 0 (0.0) 8 (88.9) 12 (92.3) 10 (76.9) 8 (80.0) P-value* 0.001 <0.001 0.002 0.003 Chi-square test. Table 10. Satisfaction score of each group (Unit: Mean±SD) Satisfaction score 13.82±3.74 a 20.42±3.50 b 20.69±3.63 b <0.001 문한결과이다. 미백 1일후에는모든군에서치은자극을느끼는사람이없었지만미백 3일후부터 3군에서미백에의한치은자극을느끼는대상자가 8명이었으며, 5일후에는 12명, 7일후에는 10명, 14일후에는 8명으로 1, 2 군에비해많은대상자가치은자극을경험한것으로조사되었다. 지각완화제를사용한 2군에서는치은자극을느끼는대상자가 3군에비해적었으며, 그값이통계적으로유의하였다 (P<0.05). 미백후만족도를조사한결과 (Table 10), 1군은 13.82, 2군은 20.42, 3군은 20.69로나타났으며 1군과 2, 3 군에서유의한차이가나타났다 (P<0.001). 2군과 3군은유의한차이를보이지않아미백후만족도는 2군과 3군에서차이가없었다 (P>0.05). 고안 과학이발전하고경제사회가성장하며인공적미백치료에대한관심이높아지고있다 4-6). 고농도의전문가치아미백은빠른효과를기대할수있으나고가의비용과부작용으로인한문제점이보고되었고 9), 2000년에들어비교적낮은농도를이용한의약외품자가미백부착대가개발되어효과가입증되었다 18). 그러나일부환자에게서의약외품자가미백부착대로인한부작용이보고되 었다 13), 본실험에서는실험대상자를 3개의군으로나누어 2.9% 의 HP 자가미백부착대가치면에더욱잘부착될수있도록하고또한지각완화효과도유도할수있도록하기위하여도포제를함유시켜미백효과를비교하였다. 또한미백후의만족도와자각증상에대해알아보았다. Park 등 23) 이연구한 2.9% HP가함유된부착대를이용한연구에서 3.30의색조변화량을보였다. 본연구에서명도와채도의값을이용한색조변화량 ( E*) 은지각완화도포제를사용한군에서는 5.34, 2.8% HP 도포제를사용한군에서 6.34의변화량을보여이전연구에비해더많은색조변화량을보이지만단순히변화값으로비교를하기엔어려움이따른다. 또한 2.6% 의 HP가함유된자가미백부착대를이용한 Jung 24) 등의연구에서는 shade guide를이용한비색법을사용하였는데세단계정도의색조변화가나타났다. 이것은 shade guide의변화량을수치로표현한이번실험과유사한정도의변화량이다. 지각완화제에대한선행연구중 Elize 등 25) 의연구에서는전문가미백전지각완화도포제를사용한치아미백시자극강도가낮아지기는하였으나, 대조군과비교하였을때그차이가유의하지않았다고하였으며, Kose 등 26) 의연구에서도지각완화도포제를사용하였을때미백의효과에영향을주지않았으나지각완화효과에서대조군과유의한차이가나지않

36 J Korean Acad Oral Health 2016;40:31-37 는다고하였다. Costa 등 17) 은지각완화도포제를사용한군과사용하지않은군에서미백의효과에는유의한차이가없는반면, 지각완화도포제를사용한군에서연조직에대한자극증상이더적은것으로보고하였다. 본연구에서지각완화도포제를사용한 2군과 2.8% HP 도포제를사용한 3군을비교하였을때명도값에서는유의한차이를보이지않았으며, 치은자극이더낮은것으로나타나 Costa 등 17) 의보고와유사한결과를보였다. 임상시험중 HP가포함되지않은도포제와부착대를사용한 1군에서도지각과민증상을보였는데. 이러한결과는맹검법사용에따른참가대상자들개별적인주관적판단에따른현상으로해석할수있으며, 자가미백부착대의안전성을평가하기위해 6% 의 HP와 HP를포함하지않은부착대를사용한 Farrell 등 27) 의연구에서 HP를포함하지않은대상군의실험자가구강내자극을호소하여실험을그만두게되었던것과비슷한경우라비교할수있다. 이논문의제한점으로먼저본연구는치아의표면변화와내부적변화의관찰이아닌단순한색조변화와대상자의주관적판단에따른자가증상에따른결과를관찰한것이므로미백의효과를일반화하기에는무리가따른다. 이는추후연구설계에반영하여보완하여야할것이다. 두번째, 조사대상자가편의표본추출법에의해선정되었으므로전체를대표하는표본이라고할수없다. 또한참여대상자들의거의대부분이 20대의젊은여성들이었기때문에결과를전체인구집단으로일반화시키기에도조금무리가있을것이라사료된다. 그러나실제생활가운데에서치아미백을위한심미적인욕구나성향이가장강한젊은여성들이주대상이되는것은인구집단선정에가장적합한요소로볼수있으며, 이연구는자가미백제의경우 3% 농도미만의 HP를사용하도록권장하고있는국내기준을고려하려자가미백부착대에지각완화제를함유시켰을때의임상적효과를알아보았다는것에의의를둘수있겠다. 따라서본연구결과는향후진행될치아미백의지각완화제에대한연구에도움을줄수있는자료로활용될수있기를기대한다. 또한사후만족도조사를통해의약외품자가미백사용에대해효과적인피드백의요소로사용될수있을것이라사료된다. 결론 1. HP를사용하지않은대조군에비해 2.9% HP 부착대를사용한 2군과 3군에서 L* 값이유의하게증가하였으며, 지각완화도포제를사용한 2군과 2.8% HP 도포제를사용한 3군간 L* 값의차이는유의하지않았다. 2. 2.8% HP 도포제를사용한 3군에비해지각완화도포제를사용한 2군에서자각증상이적게나타났다. 3. 미백시행후 HP를사용하지않은대조군에비해 2.9% HP 부착대를사용한실험군에서만족도가높았으며, 지각완화도포제사용한군과 2.8% HP 도포제사용한군의만족도차이는유의하지않았다. 지각완화도포제를사용한 2.9% HP 자가미백부착대의사 용은임상적으로인지가능한수준의치아미백효과가나타났고, 2.8% HP 도포제를사용한자가미백부착대사용군에비해치은자극이감소된것으로나타났다. References 1. Xiao J, Zhou XD, Zhu WC, Zhang B, Li JY, Xu X. The prevalence of tooth discolouration and the self-satisfaction with tooth colour in a Chinese urban population. J Oral Rehabil 2007;34:351-360. 2. Hong JH. Good teeth care is sufficient enough to change one s impression. Seoul:Pampas; 2007;210-211. 3. Vallittu PK, Vallittu AS, Lassila VP. Dental aesthetics: A survey of attitudes in different groups of patients. J Dent 1996;24:335-338. 4. Lee HJ, Jeon ES. A research on the questionnaires about Busan citizens understanding of the tooth whitening. J Korean Soc Dent Hyg 2006;6(1):79-91. 5. Gu HJ, Lee YE, Baek HJ, Kim JS, Song KB. Effect of fluoride application after tooth bleaching using the diode laser. J Korean Acad Dent Health 2008;32(2):160-169. 6. Jung SH, Bae KH, Lee WJ, Moon HS, Paik DI, Kim JB. Clinical study on the effect of therapeutic toothpaste, vitamin E, and hydrogen peroxide on the tooth whitening. J Korean Acad Dent Health 2001; 25(2):221-226. 7. Haywood VB, Heymann HO. Nightguard vital bleaching. Quintessence Int 1989;20(3):173-176. 8. Heymann H. Tooth whitening: Facts and fallacies. Br Dent J 2005; 198(8):514. 9. Gerlach RW, Gibb RD, Sagel PA. A randomized clinical trial comparing a novel 5.3% hydrogen peroxide whitening strip to 10%, 15%, and 20 carbamide peroxide tray based bleaching systems. Compend Contin Educ Dent 2000;29 Suppl :S22-28. 10. Gerlach RW. Whitening paradigms 1 year later: Introduction of a novel professional tooth-bleaching system. Compend Contin Educ Dent 2002;23(1):4-8. 11. Cibirka RM, Myers M, Downey MC. Clinical study of tooth shade lightening from dentist-supervised patient-applied treatment with two 10% carbamide peroxide gels. J Esthet Dent 1999;11:325-331. 12. Hasson H, Ismail AI, Neiva G. Home-based chemically induced whitening of teeth in adults. The Cochrane library 2006;4:1-59. 13. Auschill TM, Hellwig E, Schmidale S, Sculean A, Arweiler NB. Efficacy, side-effects and patients acceptance of different bleaching techniques (OTC, in-office, at-home). Oper Dent 2005;30(2):156-163. 14. Charakorn P, Cabanilla LL, Wagner WC, Foong WC, Shaheen J, Pregitzer R et al. The effect of preoperative ibuprofen on tooth sensitivity caused by in-office bleaching. Oper Dent 2009;34:131-135. 15. Kossatz S, Dalanhol AP, Cunha T, Loguercio A, Reis A. Effect of light activation on tooth sensitivity after in-office bleaching. Oper Dent 2001;36:251-257. 16. Reis A, Dalanhol AP, Cunha TS, Kossatz S, Loguercio AD. Assessment of tooth sensitivity using a desensitizer before light activated bleaching. Oper Dent 2011;36:12-17. 17. Costa J, Lubisich E, Ferracane J, Hilton T. Comparison of efficacy of an in office whitening system used with and without a whitening priming agent. J Esthet Restor Dent 2011;23(2):97-104. 18. Gustavo M, Patricia A, Greice B, Edward J, Swift Jr. Svetlana F, et al. Safety and efficacy of a high-adhesion whitening strip under extended wear regimen. J Dent 2013;41 Suppl 3:S46-52. 19. Meireles SS, Heckmann SS, Santos IS, Della Bona A, Demarco FF. A double blind randomized clinical trial of at home tooth bleaching using two carbamide peroxide concentration: 6 month follow up. J

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