脉冲Nd:YAG激光应用于牙体硬组织粘结的初探

目的探讨脉冲Nd:YAG激光照射后牙体硬组织表面形态的变化和对其粘结性能的影响.方法选择40个离体人前磨牙,完全随机分成4组,组A:35%磷酸酸蚀牙釉质30 s;组B:脉冲Nd:YAG激光处理牙釉质;组C:37%磷酸酸蚀牙本质15 s;组D:脉冲Nd:YAG激光处理牙本质.测试抗张粘结强度.另选择12个牙齿样本完全随机分成6组,牙釉质和牙本质各增加一个不处理组,其余4组的表面处理同上,观察表面形态.结果组A的抗张粘结强度显著高于其它3组(P＜0.01),组D显著高于组C(P＜0.05),其余两组间无显著性差异(P＞0.05).电镜显示,磷酸酸蚀和激光照射,均可去除牙釉质和牙本质表面的玷污层.牙釉质表面均形成粗糙的蜂窝状结构,激光组不规则.牙本质经磷酸酸蚀后,几乎所有的牙本质小管口都呈开放状态;而激光照射后,大部分牙本质小管口处于封闭或半封闭状态.结论脉冲Nd:YAG激光不能替代磷酸作为牙釉质表面处理方法,但能提高牙本质的粘结强度,并能封闭部分牙本质小管口.

A primary study of pulse Nd:YAG laser on morphology and bonding of enamel and dentin

Objective To investigate the morphology and bonding of enamel and dentin conditioned by 35% phosphoric acid and pulse Nd:YAG laser.Methods A total of 52 human premolars were selected,40 of which were divided into four groups randomly: group A [enamel treated with 35% phosphoric acid(Scotchbond,3M) for 30 s];group B [enamel treated with pulse Nd:YAG laser(Evlaser Friendly A4 Italy) for 20 s];group C(dentin treated with 35% phosphoric acid for 15 s);group D(enamel treated with pulse Nd:YAG laser for 15 s).The tensile bond strength(TBS) were determined.Except 4 out of 12 human premolars without any treatment,8 were divided into 4 groups and were treated with the method mentioned above.The surfaces of 12 human premolars were observed under SEM.Results The highest TBS was obtained in group A in comparison with the other 3 groups(P<0.01).The TBS of group D was higher than group C(P<0.05).There was no significant deference between the other groups(P>0.05).The smear layer on enamel and dentin could be removed after conditioned by both phosphoric acid and pulse Nd:YAG laser.The honeycomb structures were observed on all enamel but less regularly in lased group.Almost all the orifices of dentinal tubules were open in the acid group and sealed or half-sealed in lased group.Conclusion The pulse Nd:YAG laser did not contribute to bonding of enamel,but could improve the bonding of dentin and seal most of the orifices of dentinal tubules,which reduced the harmful stimulation to the dental pulp.