半导体激光在种植体周围病中的应用及研究进展

激光治疗已成为治疗种植体周围病的重要手段,半导体激光因其优良的生物调节作用、灭菌效果和生物安全性在种植体周围病辅助治疗中展现出独特优势。该文就半导体激光的原理、作用特点、安全性、生物学效应及临床研究进行综述,为其临床应用于种植体周围病治疗提供参考。     

激光在种植体周围炎治疗中的应用及研究进展

种植体周围炎是导致种植失败的主要原因之一,但现有的治疗方法均存在一定的局限性,导致针对这一疾病尚缺乏明确的、标准化的治疗方案。激光因具有许多传统清洁方法所不具备的优势而逐渐成为种植体周围炎的重要辅助治疗方法之一,并受到广大口腔医生的重视。文章对激光治疗种植体周围炎现状及进展进行综述,旨在为临床医生采用激光治疗种植体周围炎提供参考。     

种植体周围炎的治疗

种植体周围炎在不同种植系统的发病率大约为4%-15%。目前对种植体周围炎的治疗研究大多是建立在动物模型上。在临床应用和动物模型研究的基础上,本文主要就种植体周围炎的治疗方法的研究进展作一综述。     

种植体周围炎治疗方法的研究进展

种植体周围炎是牙种植术后常见的并发症之一,可使支持骨丧失、骨性结合失败,甚至导致已经形成骨结合并行使功能的种植体脱落。目前临床上常用的治疗种植体周围炎的方法主要有手术治疗、激光治疗、超声洁治加局部用药单独或联合治疗等。手术治疗可以恢复因炎症导致的骨缺损,较大程度地治疗种植体周围的各种软硬组织损伤;激光治疗便于操作,副作用小并且除菌彻底,越来越被临床医生所重视;洁治加局部用药治疗是传统的治疗方式,疗效好,创伤小易被广大医生及患者接受。各种治疗方法适应症略有不同,针对不同的患者选择最佳的治疗方式是保证治疗成功的关键。     

种植体周围炎的治疗

种植体周围炎是骨性结合种植体周围软硬组织的炎症,能使支持骨丧失,导致骨性结合失败。种植体周围炎是导致种植义齿修复失败的主要原因。早期治疗利于种植体周围组织恢复到健康状态。种植体周围炎的治疗方法有局部清洁、药物治疗、手术治疗等。本文即从这几方面对种植体周围炎的治疗进行综述。     

种植体周围炎的治疗

随着人们生活水平提高,种植牙修复成为缺失牙患者主要选择之一,与之相应的种植体周围炎患者日趋增多。目前应用的各种治疗方案均有其优缺点,缺少一种治疗种植体周围炎的金标准,本文对各种治疗方案做一综述。     

Er:YAG激光在治疗种植体周围炎中的研究进展

随着种植牙的普遍应用,种植体周围炎也逐渐成为影响种植体稳定的一大隐患,因此引起了诸多学者的关注。种植体周围炎的始动因素是牙菌斑,相关危险因素包括牙周病、高血糖、口腔卫生不良、牙周支持治疗不足、种植牙冠修复体咬合过载等。种植体周围炎的治疗措施总体来说可分为手术与非手术治疗两类。随着无创及微创观念的普及,非手术治疗已渐成主流,包括机械清创（超声洁治、手动刮治、空气喷砂等）、药物治疗（氯己定、碘甘油、盐酸米诺环素等）和激光治疗。然而随着传统治疗方法的缺陷逐渐显现,激光成为口腔学者关注的焦点。Er:YAG激光因其波长位于水和羟基磷灰石的吸收峰值附近,能够直接作用于含水或羟基磷灰石的组织,是目前广泛应用于切割软、硬组织的激光,在种植体周围炎治疗中的有效作用已得到国内外专家的认可。应用合适参数的Er:YAG激光不仅可以有效清除感染植体表面的菌斑微生物,而且对种植体及其周围组织无损伤,有利于种植体周围组织再附着。本文就种植体周围炎的研究现状、Er:YAG激光对种植体表面形态、理化性能、周围软硬组织的影响及治疗种植体周围炎的合适能量参数等作一综述,并展望Er:YAG激光在种植体周围炎治疗中的发展前景。     

抗生素在治疗种植体周围炎中的应用

目的：通过回顾和讨论现有抗生素局部使用和全身使用的文献．研究其在治疗种植体周围炎中的应用。材料和方法：在美国国家医学图书馆的PubMed数据库中使用MEDLINE检索截至2011年的相关文献。关于种植体周围炎病损微生物研究的相关文献采用手工检索。结果和结论：检索到2篇有关全身使用抗生素治疗种植体周围炎的研究,都是病例的系列研究且没有对照组。检索到5篇局部用药治疗种植体周围炎的研究．在5篇研究中．局部抗生素使用的同时都配合了局部的物理治疗和化学冲洗,如过氧化氢溶液（双氧水）和氯己定（洗必泰）。这些研究中都提到了局部使用抗生素的附加作用,但都不显著。这可能与病例的纳入标准有关,所有纳入研究的病例都有深牙周袋和明显的骨吸收。目前关于治疗种植体周围炎的所有研究．不管是全身用药还是局部应用的研究结果．都不特别地推荐抗生素用以治疗种植体周围炎。局部使用米诺环素和强力霉素作为手工刮治的补充以及使用抗菌药物局部;中洗对治疗中度病损有一定的效果。翻瓣刮治术对于治疗深度病损是必要的,能有效地抑制病情,减少骨质丧失。目前的研究中没有证据支持全身使用抗生素能治疗种植体周围炎。目前迫切需要对抗生素治疗种植体周围炎进行临床随机试验。种植术前必要的牙周治疗和种植术后常规的术后维护．能有效地减少感染和其他并发症的发生率。     

细菌与种植体周围炎

现在认为牙周致病 种植体的大量聚积是引起种植体周围炎,致命种植体失败的主要原因。种植体周围细菌的来会着过程与种植体周围炎息息相关的 它们的影响因素在种植体周围炎发生、发展过程中的作用也不容忽视。因此,以上因素的研究地指导临床上种植体周围炎的防治非常重要。     

种植体周围炎的诊断和治疗新进展

种植体周围骨结合区的软组织和硬组织的炎症导致了种植体周围袋形成和骨吸收.微生物学研究发现种植体周围炎的致病微生物与天然牙矛周炎相似，都是由口腔厌氧菌引起.本文着重对种植体周围炎的最新诊断和治疗方法进行综述。     

Management of Temporomandibular Disorders with Low Level Laser Therapy

Purpose

To evaluate the efficacy of low level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD) in relation to pain intensity, tender points, joint sounds and jaw movements.

Materials and Methods

Twenty patients received 6 sessions of LLLT (3 times a week for 2 weeks) with semiconductive diode laser (gallium arsenide; 904 nm, 0.6 W, 60 s, 4 J/cm²). Pain intensity, number of tender points, joint sounds and active range of motion were assessed before and immediately after each session and after 1, 2 weeks, 1, 3 and 6 months.

Results

Statistically significant results were achieved in all study parameters.

Conclusion

LLLT promoted satisfactory results in reducing the pain intensity, number of tender points, joint sounds and improvement in the range of jaw motion. Hence it is an effective and efficient treatment method for TMDs.     

Therapy of peri-implantitis: a systematic review

Aim: The objective of this study was to provide a systematic review of randomized controlled and/or comparative clinical trials published in the international peer-reviewed literature in the English language, up to and including July 2007, concerning the efficacy of all treatment modalities implemented for the therapy of peri-implantitis.
Material and Methods: PubMed and The Cochrane Library databases were searched electronically and numerous journals were examined manually. In the first phase of selection, the titles and abstracts, and in the second phase, complete papers were screened independently and in duplicate by three reviewers (S. K., I. K. K. and M. T.).
Results: The search yielded 1304 possibly relevant titles and abstracts. After the first phase of selection, 13 publications were singled out for a rigorous evaluation. Following the second phase, five studies were selected.
Conclusions: The selected studies are too limited in number and exhibit small sample sizes and short follow-up periods. Therefore, there is a definite need for more well-designed, preferably longitudinal, randomized controlled clinical trials. Within the limitations of the selected studies, mechanical debridement combined with antiseptic/antibiotic therapy, the Er:YAG laser or regenerative techniques may be used for treating peri-implantitis, but the indications for each of these techniques have not been delineated clearly.     

Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial

Introduction

In this clinical trial, we evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in mandibular molar teeth with symptomatic apical periodontitis.

半导体激光照射减轻正畸治疗疼痛的临床观察

目的 观察半导体激光局部照射的方法对减轻正畸治疗中疼痛的临床效果。方法 对戴入初始弓丝的128例正畸患者,其中63例患者应用半导体激光照射其受力前后的牙根部区域,照射次数1～2次。余65例患者作为对照组。通过问卷调查了解疼痛发生的时间、持续时间并进行统计学分析。结果 应用半导体激光照射组疼痛的发生时间迟,疼痛持续时间短。对照组疼痛发生率为96.92％,照射组疼痛发生率为79.37％。结论 半导体激光局部照射对减轻正畸伴发的疼痛有效。     

Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled,Triple-blind,Randomized Clinical Trial

Introduction

Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR).

Effects of Low-Level Laser Therapy and Orthodontic Tooth Movement on Dental Pulps in Rats

Objectives:To describe the microscopic pulpal reactions resulting from orthodontically induced tooth movement associated with low-level laser therapy (LLLT) in rats.Materials and Methods:Forty-five young male Wistar rats were randomly assigned to three groups. In group I (n = 20), the maxillary right first molars were submitted to orthodontic movement with placement of a coil spring. In group II (n = 20), the teeth were submitted to orthodontic movement plus LLLT at 4 seconds per point (buccal, palatal, and mesial) with a GaAlAs diode laser source (830 nm, 100 mW, 18 J/cm²). Group III (n = 5) served as a control (no orthodontic movement or LLLT). Groups I and II were divided into four subgroups according to the time elapsed between the start of tooth movement and sacrifice (12 hours, 24 hours, 3 days, and 7 days).Results:Up until the 3-day period, the specimens in group I presented a thicker odontoblastic layer, no cell-free zone of Weil, pulp core with differentiated mesenchymal and defense cells, and a high concentration of blood vessels. In group II, at the 12- and 24-hour time points, the odontoblastic layer was disorganized and the cell-free zone of Weil was absent, presenting undifferentiated cells, intensive vascularization with congested capillaries, and scarce defense cells in the cell-rich zone. In groups I and II, pulpal responses to the stimuli were more intense in the area underneath the region of application of the force or force/laser.Conclusions:The orthodontic-induced tooth movement and LLLT association showed reversible hyperemia as a tissue response to the stimulus. LLLT leads to a faster repair of the pulpal tissue due to orthodontic movement.     

甲苯胺蓝为光敏剂的光动力疗法对龈下菌斑灭菌效果的研究

目的：研究甲苯胺蓝为光敏剂的光动力疗法对牙周龈下致病菌的灭菌效果。方法：从门诊25例牙周病病人随机提取龈下菌斑各1份,放人装有1mL预还原转送液的离心管,振荡,稀释。2h内送到微生物室,接种于牛心脑浸液平皿,在厌氧环境（含CO2、H1、N2的体积分数分别为10％、10％、80％）培养。培养出黑色菌落并与牙龈卟啉单胞菌标准菌株相鉴别。将菌样随机分为4组,A甲苯胺蓝组,甲苯胺蓝浓度分别为0．1、0．5、1．0、2．5g／L。B组光剂量组,光剂量为53、106、159、212mW／cm^2。C组光强度组,光强度为6、12、24、48J／cm^2。D组空白组。观察比较各组的灭菌效果,并确定最佳治疗组合。结果：光动力疗法的灭菌效果最佳组合为甲苯胺蓝1．0g／L＋光强度48J／cm^2＋光剂量212mW／cm^2,其灭菌效果平均23．45％。结论：本研究发现以甲苯胺蓝为光敏剂的光动力疗法对龈下菌斑有灭菌效果,最佳光敏剂浓度仍为1．0g／L,而龈下组所需光剂量和光强度均比前期研究的龈上组剂量大。不同病人的取菌条件不同,其灭菌效果也有差异。     

Ex Vivo Evaluation of the Efficacy of Photodynamic Therapy in Eliminating Enterococcus faecalis from Dentinal Tubules by Confocal Laser Scanning Microscopy

IntroductionThe aim of the present study was to investigate ex vivo by confocal laser scanning microscopy the antibacterial effect of photodynamic therapy (PDT) on dentinal tubules in the apical 5 mm of human mandibular premolars contaminated with Enterococcus faecalis.MethodsThirty-four teeth were standardized to 20 mm and foraminal anatomic diameters using a #20 K-file (Dentsply Maillefer). Samples were contaminated for 21 days and divided into the following 3 experimental groups (n = 10): the PDT group (instrumented canals and PDT), the passive ultrasonic irrigation (PUI) group (instrumented canals and PUI), and the PUI-PDT group (instrumented canals, PUI, and PDT), along with a control group (n = 4) (noninstrumented canals). The canals in the experimental groups were instrumented with ProTaper Next (Dentsply Maillefer) up to X3 and rinsed with EDTA and sodium hypochlorite. The photosensitizer used was 0.01% methylene blue with a preirradiation time of 5 minutes and a diode laser with 4 J energy and a 660-nm wavelength. Cross sections were made 5 mm from the apex of all samples, which were analyzed using confocal laser scanning microscopy. The results were analyzed using the Shapiro-Wilk and Kruskal-Wallis (Dunn) tests.ResultsThere was a lower percentage of live bacteria in the PUI-PDT group, with a statistical difference compared with the control and PDT groups (P < .05). There was no statistical difference in the percentage of live bacteria between PUI-PDT and PUI (P > .05).ConclusionsIt was concluded that the PUI-PDT association was most effective in disinfecting root canals compared with the control group and PDT.     

Therapy of peri-implantitis with resective surgery. A 3-year clinical trial on rough screw-shaped oral implants. Part I: clinical outcome

The purpose of this randomized clinical trial was to compare the clinical outcome of two different surgical approaches for the treatment of peri-implantitis. Seventeen patients with ITI(R) implants were included consecutively over a period of 5 years. The patients were randomized with a lottery assignment. Ten patients were treated with resective surgery and modification of surface topography (test group). The remaining seven patients were treated with resective surgery only (control group). Clinical parameters (suppuration, modified plaque index - mPI, modified bleeding index - mBI, probing pocket depth - PPD, pseudopocket - DIM, mucosal recession - REC, probing attachment level - PAL) were recorded at baseline, as well as 6, 12, 24 and 36 months after treatment. The cumulative survival rate for the implants of the test group was 100% after 3 years. After 24 months, two hollow-screw implants of control group were removed because of mobility. Consequently, the cumulative survival rate was 87.5%. The recession index in the control group was significantly lower than in the test group at 24 months (Student's t-value of -2.14). On the contrary, control group showed higher PPD, PAL and mBI indexes than test group (Student's t-values of +5.5, +2.4 and +9.61, respectively). The PPD and mBI indexes for the implants of the control group were significantly higher at baseline than 24 months later (Student's t-values of +3.18 and +3.33, respectively). Recession and PAL indexes resulted in values significantly lower than baseline (Student's t-values of -4.62 and -2.77, respectively). For the implants of the test group PPD and mBI indexes were significantly higher at baseline than 36 months after (Student's t-values of +11.63 and +16.02, respectively). Recession index resulted in values significantly lower at baseline (Student's t-value of -5.05). No statistically significant differences were found between PAL index measurement at baseline and 36 months later (Student's t-value of +0.89). In conclusion, resective therapy associated with implantoplasty seems to influence positively the survival of oral implants affected by inflammatory processes.     

Clinical Study of Antimicrobial Efficacy of Laser Ablation Therapy with Indocyanine Green in Root Canal Treatment

IntroductionLaser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment.MethodsSixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05).ResultsThere was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05).ConclusionsLA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.