脉冲Er:YAG激光去龋、制洞的临床和扫描电镜观察

目的:临床观察脉冲Er:YAG激光去除龋损组织和术中患者的疼痛反应。扫描电镜脉冲Er:YAG激光去龋后洞壁表面的结构特征。方法:使用脉冲Er:YAG激光去除龋损组织、制洞,扫描电镜观察。结果:脉冲Er:YAG激光能够完全去除龋损组织,制洞,术中患者基本无疼痛反应。脉冲Er:YAG激光制洞后的牙体组织表面无玷污层、无微裂,牙本质小管口呈开放状态,洞壁表面粗糙。结论:脉冲Er:YAG激光可以去除龋损组织、制洞,洞壁结构利于黏接,患者术中无疼痛反应或轻度的酸痛感,无需局部注射麻醉。     

脉冲Er:YAG激光去龋、备洞临床技术要点

脉冲Er:YAG激光是一种应用于口腔硬组织的新型激光,在国外临床上已广泛使用,有关这方面的研究也较多,国内临床使用还不多见,脉冲Er:YAG激光的特点在于治疗过程中无痛、不刺激牙髓组织、不改变牙体组织结构特征等.DEKA Smart 2940D型Er:YAG激光机操作简单,能够去龋、制备各类窝洞,本文就脉冲Er:YAG激光在临床应用的技术特点作一总结.     

Er:YAG激光治疗牙体牙髓病的研究进展

Er:YAG激光是一种新型牙体硬组织激光,可以高效地切割牙体并且不会对牙髓造成热损伤。临床上Er:YAG激光可用于去龋备洞及粘结修复前的牙面蚀刻。另外,Er:YAG激光在根管预备以及盖髓术、牙髓切断术中也有着良好的应用前景。     

Er:YAG激光应用于牙齿漂白的研究进展

Er:YAG激光漂白作为一种新型牙齿漂白方法,与传统漂白技术相比,Er:YAG激光显著提高了漂白效率,具有安全性高、治疗时间短及漂白效果优异等优点,被广泛应用于临床操作。本文就Er:YAG激光漂白技术的作用原理、漂白特点及对牙体组织结构的影响作一综述。现有文献表明,Er:YAG激光对水和羟基磷灰石的高吸收特性使其可以作用于含水组织及牙体组织,当其被牙面上的漂白剂吸收后,能够加速催化氧化还原反应,选择性作用于沉着于牙齿上的色素颗粒,进而起到牙齿漂白的效果。Er:YAG激光漂白可适用于大多数变色牙,漂白过程快速且效果明显,在漂白过程中,对于牙髓组织而言,髓腔升温均低于5.6℃的临界值,对牙髓组织无病理损伤;对于牙体硬组织而言,激光照射会造成钙磷元素等化学成分的改变,牙釉质呈现出独特的熔岩状形态,漂白后牙体粘接强度有所增加。与其他激光相比,Er:YAG激光波长与水的峰值接近,且无需在漂白剂中添加其他成分,能量几乎全部用于漂白剂,对周围组织几乎无损伤。     

不同参数激光处理根管对纤维桩粘结强度影响的实验研究

目的:研究不同参数Er:YAG激光处理根管壁牙本质对纤维桩粘结强度的影响,为激光临床应用提供参考。方法:收集60颗人类上颌中切牙,根据不同处理方法随机分为5组;空白对照组;3 W-50 μs Er:YAG激光组;3 W-100 μs Er:YAG 激光组;4.5 W-50 μs Er:YAG激光组;4.5 W-100 μs Er:YAG激光组,每组12颗。离体牙根管预备,充填,桩道预备后,Bisco树脂加强型纤维桩通过RelyX^TM Unicem粘结树脂水门汀粘固于根管内。流水状态下慢速锯将纤维桩外周平行片切,再垂直粘结面片于试件1 mm、4 mm、7 mm处切成三段1.0 mm×1.0 mm的长方形柱状试件,进行微拉伸强度测试。不同根管处理方法与牙根不同区域微拉伸强度均数采用两因素方差分析(α=0.05)。电镜下进行断裂类型分析,组件不同类型断裂率采用χ²检验(α=0.05)。 结果:3 W10-100 μs Er:YAG组拉伸强度值最高(5.55±0.97) MPa,与对照组(4.06±1.22) MPa相比较差异有显著性(P＜0.05) 。根管上部和中部粘结强度高于根管下部,差异有显著性(P＜0.05)。结论:Er:YAG激光处理牙本质表面对其与纤维桩粘结强度的影响与激光功率大小和脉冲持续时间有关,3 W-100 μs Er:YAG激光处理表面可以显著增强纤维桩与根管牙本质的粘结强度。     

柠檬酸和戊二醛表面预处理对Er:YAG激光照射后牙本质粘接性能的影响

有文献报道Er:YAG激光照射会降低牙本质与树脂的粘接强度,其原因有二:Er:YAG激光改变了牙本质的机械性能;激光产生的热效应引起牙本质蛋白变性。而戊二醛可使热变性牙本质蛋白复性。本研究采用戊二醛处理 Er:YAG激光照射的牛牙本质,探讨对粘接性能的影响。     

Er:YAG激光备洞对牙髓P物质表达的影响

目的探讨Er:YAG激光备洞对牙髓的生物学效应。方法雄性SD大鼠66只随机分为实验组与对照组,实验组大鼠左上第一磨牙用高速牙钻备洞,右上第一磨牙用Er:YAG激光备洞,对照组大鼠磨牙不作任何处理。于不同时段分批处死大鼠,取标本做HE染色进行牙髓组织病理学观察,免疫组化法观察P物质(substance P,SP)的表达情况。结果 Er:YAG激光备洞后牙髓组织病理学改变及P物质的表达改变恢复正常要快于高速牙钻备洞。结论 Er:YAG激光备洞对牙髓的刺激小。     

Er：YAG激光治疗牙体牙髓病的研究进展

Er：YAG激光是一种新型牙体硬组织激光，可以高效地切割牙体并且不会对牙髓造成热损伤，临床上Er：YAG激光可用于去龋备洞及粘结修复前的牙面蚀刻．另外，Er：YAG激光在根管预备以及盖髓术、牙髓切断术中也有着良好的应用前景．     

Er:YAG激光备洞对牙髓降钙素基因相关肽表达的影响

目的探讨Er:YAG激光备洞对牙髓的生物学效应。方法雄性SD大鼠66只随机分为实验组与对照组,实验组大鼠左上第一磨牙用高速牙钻备洞,右上第一磨牙用Er:YAG激光备洞,对照组大鼠磨牙不作任何处理。于不同时段分批处死大鼠,取标本做HE染色进行牙髓组织病理学观察,免疫组化染色法观察牙髓内降钙素基因相关肽(calcitonin cene-related peptide,CGRP)的表达。结果 Er:YAG激光备洞后牙髓组织病理学改变及降钙素基因相关肽的表达改变恢复正常要快于高速牙钻备洞。结论 Er:YAG激光备洞对牙髓的刺激小。     

Er∶YAG激光对牙本质与瓷块间粘接强度影响研究

目的 评价Er∶YAG激光照射对牙本质与瓷块间粘接强度的影响.方法 选取2010年9月至2011年9月山西医科大学口腔医院颌面外科因正畸拔除的完整无龋坏、无隐裂的前磨牙30颗,分别制备3 mm ×3 mm的牙本质面,随机分为以下3组:Er∶YAG激光组、酸蚀组、酸蚀+Er∶YAG激光组,每组10个样本.通过扫描电镜观察各组样本的表面形态,并检测牙本质与瓷块间的粘接强度.结果 酸蚀+Er∶YAG激光组粘接强度值最高,与酸蚀组和Er∶YAG激光组相比较,差异有统计学意义(P＜0.01),而酸蚀组与Er∶YAG激光组间差异无统计学意义(P＞0.05).结论 酸蚀联合Er∶YAG激光照射能够增强牙本质与瓷块间的粘接强度,是牙体组织粘接前有效的表面处理方式.     

Potential applications of Erbium:YAG laser in periodontics

OBJECTIVES: Since lasers were introduced for the treatment of oral diseases, there has been considerable advancement in technology. As a result, numerous laser systems are currently available for oral use. Neodymium:Yttrium-Aluminum:Garnet (Nd:YAG), carbon dioxide (CO(2)) laser and the semiconductor Diode lasers have already been approved by the US Food and Drug Administration for soft tissue treatment in oral cavity. The Erbium:YAG (Er:YAG) laser was approved in 1997 for hard tissue treatment in dentistry and recent studies have reported positive results. This suggests that the Er:YAG laser system is a promising apparatus, which will be able to revolutionize and improve dental practice, in particular periodontal treatment. In this mini-review, we would like to describe the positive characteristics of the Er:YAG laser which indicate its potential as a new treatment modality in periodontics. MATERIALS AND METHODS: Recent findings are summarized briefly to evaluate the potential of the Er:YAG laser for clinical application in periodontics. RESULTS: The Er:YAG laser possesses suitable characteristics for oral soft and hard tissue ablation. Recently, it has been applied for effective elimination of granulation tissue, gingival melanin pigmentation and gingival discoloration. Contouring and cutting of bone with minimal damage and even or faster healing can also be performed with this laser. In addition, irradiation with the Er:YAG laser has a bactericidal effect with reduction of lipopolysaccharide, high ability of plaque and calculus removal, with the effect limited to a very thin layer of the surface and is effective for implant maintenance. CONCLUSION: The Er:YAG laser seems to be an effective tool for periodontal therapy, however, further clinical and basic investigations are required to confirm its clinical application.     

铒∶钇铝石榴石激光照射后牙本质分析方法研究进展

目前,铒∶钇铝石榴石（erbium∶yttrium-aluminum-garnet,Er∶YAG）激光可用于临床治疗牙体硬组织疾病,包括防龋、去腐备洞、根管预备及消毒、根尖手术等。体外实验已证实,Er∶YAG激光可促进牙本质形貌及有机物和无机物的成分改变。为进一步研究Er∶YAG激光在口腔科的适用性,一些学者利用现代生物材料分析方法对Er∶YAG激光照射前后牙本质进行分析,从牙本质的形貌、结构及成分变化,探讨Er∶YAG激光照射对牙本质的作用。文章对既往研究中涉及的研究方法及结果做一阐述,以期为后续研究设计及临床实践提供参考。     

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??Nowadays??erbium??yttrium-aluminum-garnet??Er??YAG??laser has been used widely in dental hard tissue treatment??including caries prevention??caries removal??canal preparation and decontamination??periapical surgery and so on. In vitro studies have shown that Er??YAG laser irradiation can cause chemical and morphological changes in dentin. In order to identify the adaptability of Er??YAG laser to dental hard tissue??some researchers have utilized analysis methods of modern biological material investigations. They analyzed the dentin before and after Er??YAG laser irradiation??contrasted the change of dentin morphology??structure and chemical composition. The aim of this paper is to review the previous research methods and results, in order to provide reference for the future study design and clinical practice.     

Er∶YAG激光在儿童口腔临床中研究与应用

Er∶YAG激光波长2940 nm,可被水和羟基磷灰石充分吸收,可有效切割硬组织,不对牙髓产生损伤,具有杀菌作用,治疗时微创、无痛、舒适。应用Er∶YAG激光进行乳牙备洞后扫描电镜观察牙本质表面无玷污层,起伏不平,牙本质小管清晰。Er∶YAG激光备洞后配合使用自酸蚀粘接系统可获得更高粘接力和减少微渗漏。儿童患者应用Er∶YAG激光去腐备洞与传统方法相比,多数患儿认为激光治疗舒适、无痛或轻微疼痛。目前,Er∶YAG激光在儿童口腔科可进行乳恒牙龋齿备洞治疗、间接牙髓治疗、激光辅助窝沟封闭、预防性树脂充填、牙髓切断术以及软组织小手术（如系带成形术、牙齿助萌术）等。     

Er：YAG激光与传统机械去腐制备洞形的体外可行性比较

目的　为Er：YAG激光去除龋损和粘接修复的可行性提供更多的证据。方法　选取南京医科大学附属口腔医院口腔颌面外科门诊拔除的36颗龋坏深及牙本质的磨牙。每个离体牙的龋损都被切成大小相等的两份,分别纳入对照组(机械预备组)和实验组(Er：YAG激光组)。通过测量微拉伸粘接强度(mTBS)、微渗漏深度、观察组织学形貌、微观形态和测量操作时间比较了Er：YAG激光与传统机械法在这些方面的特性。结果　实验组的微拉伸粘接强度高于对照组(n=13,P<0.05),而平均微渗漏深度低于对照组,但差异无统计学意义(n=13,P>0.05)。实验组残留感染牙本质小管少于对照组(n=6,P<0.01)。扫描电镜观察显示,实验组牙本质小管开放、清晰、裸露,而经机械预备的牙本质表面有玷污层(n=4)。实验组的去龋时间明显长于对照组(n=36,P<0.05)。结论　虽然去龋时间较长,但Er：YAG激光用于窝洞预备较传统机械法有更高的微拉伸粘接强度和更少的感染牙本质小管残留。因此,Er：YAG激光是一种合适的临床去龋方法。     

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??Er??YAG??2940 nm??laser is in the near-infrared region of the electromagnetic spectrum where it is readily absorbed by water within and between the hydroxyapatite crystals in the tooth. With its many advantages such as painlessness??minimal invasiveness and comfort??Er??YAG laser has been widely used in dental practice since its introduction and is approved by the FDA in 1997 for dental hard tissues. It can effectively cut enamel and dentin without damaging the pulp and reduce the bacteria stayed in the dentin to prevent secondary caries. The surface morphology of cavities has been evaluated by SEM after laser preparation in the primary teeth??and the laser has been shown to be able to remove smear layer. The surfaces were scale-like and uneven with open dentinal tubules without plugging of the tubules. Self-etching system was recommended to be used after irradiation by Er??YAG laser on primary teeth to obtain superior bonding strength and less marginal micro-leakage. When used in caries therapy in children??most children considered Er??YAG laser was more comfortable and painlessness compared with drill treatment. At present??Er??YAG laser can undertake??cavity preparation in permanent or primary teeth??indirect pulp treatment??laser assisted pit and fissure sealants??preventive resin restoration??pulp amputation. Besides that Er??YAG laser can be used on soft tissue such as operculectomy??frenectomy??etc. Finally??laser has proven to offer new treatment opportunities that were not available in the dental field in the past.     

激光在口腔种植中的应用

激光是继种植后的口腔医学新技术,正在逐渐受到重视、推广和发展。学者和临床医生也对激光在口腔种植中的应用进行了广泛探索,前景美好。由于激光具有软组织切割疼痛轻、出血少、术后反应小等特点,较早即应用于二期手术暴露埋入式种植体、种植体周围软组织修整与塑形及切开翻瓣手术等方面,效果满意。应用Er∶YAG/Er,Cr∶YSGG硬组织激光还可以进行骨修整、种植窝洞预备、块状骨移植的取骨术、上颌窦底提升术的骨窗预备、牙槽嵴骨劈开术等。目前应用广泛并具有独特优势的是治疗种植体周围炎,包括多种波长激光和光动力疗法。此外,激光还被认为有促进骨结合的作用,弱激光对促进组织愈合以及减轻术后反应的作用也使激光可以参与种植修复的整个治疗过程。但需要重视的是,我们应该了解不同波长激光的特性及操作规范,以减少对种植体表面和种植体周围组织的影响,充分利用激光的优势以获得更好的临床效果。     

Lasers in dentistry 4. Removal of carious tissue using lasers

Many lasers are available today for clinical application in dentistry. For the removal of caries in enamel or dentin only few lasers can be used. Er:YAG lasers have a wavelength that coincides with the absorption maximum of water. Because of this characteristic the ablative effect in enamel and dentin is high and these lasers can be used beneficially for caries removal and small preparations. The possible side effects of Er:YAG lasers with water-cooling are minor compared to those of rotary instruments. A pulpal reaction will occur only if there is a very thin dentin layer over the pulp or direct application of the laser beam to the pulp. There is no increased heating with the Er:YAG laser so with vital teeth there is a positive reaction by the formation of reparative dentin. To the existing indications for lasers like caries removal and preparation of small cavities, in the future new techniques can be added like the use of dyes for enhancement of absorption of the laser radiation, and minimal invasive techniques using feedback from a system for caries detection.     

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激光是继种植后的口腔医学新技术,正在逐渐受到重视、推广和发展。学者和临床医生也对激光在口腔种植中的应用进行了广泛探索。由于激光具有软组织切割疼痛轻、出血少、术后反应小等特点,较早即应用于二期手术暴露埋入式种植体、种植体周围软组织修整与塑形及切开翻瓣手术等方面,效果满意。应用Er∶YAG或Er,Cr∶YSGG激光还可以进行骨修整、种植窝洞预备、块状骨移植的取骨术、上颌窦底提升术的骨窗预备、牙槽嵴骨劈开术等。目前应用广泛并具有独特优势的是治疗种植体周围炎,包括多种波长激光和光动力疗法。此外,激光还被认为有促进骨结合的作用,弱激光对促进组织愈合以及减轻术后反应的作用也使激光可以参与种植修复的整个治疗过程。但需要重视的是,我们应该了解不同波长激光的特性及操作规范,以减少对种植体表面和种植体周围组织的影响,充分利用激光的优势以获得更好的临床效果。     

Er：YAG 激光龋齿去腐对低龄儿童牙科焦虑症影响的初步观察

临床选取3岁±3月、乳磨牙(牙合)面Ⅱ度龋的患儿20例,随机分成试验组（激光组）和对照组（车针组,n ＝10）,在不使用开口器、束缚带的情况下分别用 Er：YAG 激光和车针去腐。观察患儿初诊、复诊时治疗成功率及畏惧程度。结果显示激光组治疗成功率高于车针组（P ＜0．05）,畏惧程度低于车针组（P ＜0．05）。激光治疗可缓解儿童牙科焦虑,有利于提高临床治疗成功率。