Nd�� YAG �������ƶ����������׻������ܴ���Ⱥ͸���ɥʧ�ĸ���Ч���о�

目的    评价脉冲Nd：YAG激光治疗慢性牙周炎患者牙周袋深度（PD）和附着丧失（AL）的效果。方法    选择2008年1—6月在福建医科大学附属协和医院就诊的45例慢性牙周炎患者,每例患者至少有4个以上≥6 mm的牙周袋并且分布在2个以上口腔区域内,在接受基础检查和龈上洁治术后,随机分成3组。A组（15例）：单纯接受龈下刮治和根面平整（SRP）治疗;B组（15例）：SRP+1次激光照射治疗（Nd： YAG激光,输出功率2 W,照射时间40 s）;C组（15例）：SRP+2次激光照射治疗（Nd： YAG激光,第1次照射输出功率2 W,照射时间40 s;第2次照射输出功率1 W,照射时间20s）。每组各选择40个位点。统计在基础检查,治疗2、4和12周时各组的PD和AL。结果    从第2周时,3组的PD均明显减小。而AL的改善在第4周时可以明显观察到,且C组的效果最为明显,并一直延续到12周。结论    SRP基础上辅助2次不同能量的激光治疗对慢性牙周炎PD和AL的改善效果均明显优于单独SRP使用。     

Nd��YAG��������ȫ��ʴ��ϵͳ����ĥ�����ٴ���Ч�۲�

目的探讨Nd：YAG激光联合全酸蚀黏结系统治疗磨损牙的术后敏感情况及,临床疗效。方法选取2011年2—5月在中国医科大学口腔医学院牙体牙髓科门诊就诊、符合纳入标准的20例患者的Ⅲ级以下磨损牙（前磨牙或磨牙）40颗,每例患者有2颗同名牙有相似病损,按照随机数字表将同一患者的2颗患牙分为试验组和对照组。试验组使用Nd：YAG激光联合全酸蚀黏结剂Scotchbond处理后,用Z350复合树脂充填修复;对照组直接使用Scotchbond处理后,用Z350复合树脂充填修复,以改良美国公共卫生署（USPHS）标准评价修复后1年的随访结果。结果治疗后6个月随访,牙齿敏感情况试验组好于对照组,差异有统计学意义（P〈0．05）;1午后试验组成功率高于对照组,差异有统计学意义（P〈0．05）。结论Nd：YAG激光联合全酸蚀黏结剂处理磨损牙表面后进行复合树脂修复,可在一定程度上减轻术后敏感症状,增强黏结强度,改善修复治疗效果,对Ⅲ级以下磨损牙的修复有较大的意义。     

Nd��YAG���������������������

提要：牙周炎是指发生在牙周支持组织的慢性感染性疾病,可导致牙周组织的附着丧失和牙槽骨的进行性破坏。近些年来,国内外学者们致力于激光在慢性牙周炎治疗中的研究。本文就不同能量的激光在牙周炎治疗中的应用做一综述。     

Nd��YAG����������Ʒ������������׻����е�Ӧ��ǰ��

随着我国进入老龄化社会,如何提高老年人生活质量成为困扰我们的难题。慢性牙周炎是老年人普遍存在的口腔疾病,不仅影响咀嚼,还影响消化以及全身的营养摄入。由于老年人常合并多种全身疾病,各项机能指标、免疫能力下降,现有的牙周治疗技术如刮治术、手术、药物治疗等应用时会存在一些不足。考虑到老年人对复杂治疗的耐受能力,一般首选非手术治疗,目前Nd∶YAG激光已广泛运用于牙周治疗。本文将从老年牙周炎特点、牙周非手术治疗技术、Nd∶YAG激光在牙周治疗中的优越性等方面进行阐述,为Nd∶YAG激光在老年牙周炎治疗的应用提供理论依据。     

Er��YAG�������ϲ�ͬ�����Ӧ��������ֱ�Ӹ������ٴ������о�

??Objective    To compare clinical success rates of Er??YAG laser combined with different capping agents for direct pulp capping in primary teeth and evaluate the pain during treatment. Methods    A total of 60 teeth of 60 children between the age of 3 and 5 years were selected for this study. All the samples were randomly assigned to the following 4 groups??n=15???? Er??YAG laser+MTA??the exposed area was sealed with MTA after Er??YAG laser for caries removal and cavity preparation??Er??YAG laser+calcium hydroxide??CH????the treated area was sealed with CH paste after Er??YAG laser for caries removal??dental handpiece+MTA??the exposed pulp was sealed with MTA after dental handpiece for caries removal??dental handpiece+CH??CH was applied after dental handpiece for caries removal. The depth of cavity preparation was recorded while the child felt painful. At the 3-??6-??12-and 24-month recall examiations??the effect was observed by X-ray. Results    The proportion of the depth of cavity preparation??superficial dentin??middle dentin??deep dentin??by handpiece and Er??YAG laser was 50%??40%??10% and 0.67%??20%??79.33%??respectively. The two patterns of cavity preparation revealed significant difference??P < 0.05??. At the 3-??6-??12-month recall examiations??the success rates of the laser groups were higher than the handpiece groups??while they had no significant difference??P > 0.05??. At the 24 months??the success rates of the laser groups were 93.3%. They showed significantly higher success rates than the handpiece groups??P < 0.05??. The success rates of handpiece+MTA and handpiece+CH were 80%??12/15??and 73%??11/15????which did not reveal any significant difference. Conclusion        Er??YAG laser combined with pulp capping agents can be recommended for direct pulp therapy in primary teeth??and Er??YAG laser will result in a slight pain??thus the children will be inclined to accept and complete the treatment. The clinical effect of MTA shows no statistical difference compared with CH.     

������մɱ�����ɰ�������ʱ���Er��YAG���⴦�����֬��ǿ��Ӱ���о�

目的探讨氧化锆陶瓷表面不同粒径Al2O3颗粒喷砂及牙本质表面Er：YAG激光处理对树脂黏结强度的影响。方法2011年2—10月在山西医科大学口腔医院选取25颗完整人前磨牙,制作50个牙块,暴露牙本质。其中10个牙块表面用35％磷酸酸蚀处理,40个牙块表面用Er：YAG激光蚀刻处理。制作氧化锆陶瓷片50个,20个不做处理,其余30个（每组10个）在0．4MPa压力下分别接受120、80、40μm粒径Al2O3颗粒喷砂20s。试件分为5组（每组10个）：A、B组分别由35％磷酸酸蚀和Er：YAG激光蚀刻的牙块与未做处理的陶瓷片黏结;C、D和E组分别由120、80、40μm粒径Al2O3颗粒喷砂的陶瓷片与Er：YAG激光蚀刻的牙块黏结。各组分别进行黏结强度测试？结果A组的黏结强度[（8．71±0．86）MPa]低于B组[（10．94±0．93）MPa],两组差异有统计学意义（P〈0．05）;C、D和E组的黏结强度[（13．49±1．53）、（13．97±0．83）、（17．11±1．51）MPa]均高于B组,差异有统计学意义（P〈0．01）;C、D组的黏结强度低于E组,差异有统计学意义（P〈0．01）;但C与D组间差异无统计学意义（P〉0．05）。结论氧化锆陶瓷片表面Al2O3颗粒喷砂和牙本质表面Er：YAG激光蚀刻处理可增加氧化锆陶瓷与牙本质间的树脂黏结强度。     

��ͬʱ��Er��YAG�������䴦���������ճ��ǿ��Ӱ���о�

目的探讨不同时间Er：YAG激光照射处理对正常牙本质粘接的影响,得出牙本质粘接时最佳照射时间参数,以提高牙冠使用寿命。方法选择2012年5—10月在山西医科大学口腔医院就诊的15～30岁患者因正畸原因拔除的牙根发育完整、无修复体、无折裂的前磨牙60颗,随机分为A、B、C、D、E、F6组,每组10颗牙,经保留颌面牙本质处理后分别接受Er：YAG激光照射0、1、2、3、4、5s,与树脂粘接制作拉伸试件,测试粘接强度,并用扫描电镜观察剖面。结果 Er：YAG激光照射组（B～F组）树脂粘接强度明显大于未照射组（A组）;在激光照射组中,B～D组粘接强度递增,D组达峰值,但随着照射时间继续延长,E、F组粘接强度随之降低。扫描电镜观察显示,A组表面光滑、平整,与黏结剂嵌合程度差;B～E组牙本质表面清洁、粗糙、无热损伤痕迹;F组表面粗糙度最明显,有热损伤痕迹,部分区域甚至出现焦化或碳化的迹象。结论 Er∶YAG激光处理正常牙本质的最佳照射时间应该为3～4s。     

Er��YAG�������������������������ٴ�Ч���Ƚ��о�

目的比较Er:YAG激光排龈法和排龈线排龈法的临床效果。方法选择2010年6—8月到山西医科大学口腔医院口腔修复科就诊因美观要求或固位需要采用龈下边缘金属烤瓷单冠修复的36例患者的62颗患牙,随机分为两组:Ⅰ组采用排龈线排龈法,Ⅱ组采用Er:YAG激光排龈法。对两组的牙预备体、牙龈止血效果、印模和模型清晰程度以及1周后牙龈健康状况进行评价。使用数字分级法(NRS)调查患者的疼痛程度。结果两种排龈法获得的牙预备体、印模和模型满意度以及1周后牙龈健康状况差异均无统计学意义(P>0.05),而牙龈止血效果满意度差异有统计学意义(P<0.05),Er:YAG激光排龈法牙龈止血效果优于排龈线排龈法。Er:YAG激光排龈法90.3%的患者无疼痛,而排龈线排龈法83.9%的患者有轻度疼痛。结论排龈线排龈法和Er:YAG激光排龈法均为较好的排龈方法。而在牙龈止血方面,Er:YAG激光排龈法明显优于排龈线排龈法。     

Er��YAG��������Gluma���������������С��Ч���о�

目的探讨Er:YAG激光与Gluma脱敏剂联合应用对牙本质小管的封闭作用。方法选取2010年3—6月于山西医科大学口腔医院口腔颌面外科因正畸拔除的24颗前磨牙,制成厚约2mm的牙本质片。根据其表面处理方式的不同随机分为4组:对照组、Er:YAG激光组、Gluma脱敏剂组、联合应用组(Er:YAG激光联合Gluma脱敏剂),每组6颗前磨牙。处理后,扫描电镜观察各组牙本质小管形态特征,并测量牙本质小管口的直径和相对面积。结果联合应用组中牙本质小管口的直径和相对面积均明显小于其他各组,且差异有统计学意义(P<0.05)。结论 Gluma和Er:YAG联合应用对牙本质小管的封闭作用优于单独应用Gluma脱敏剂或Er:YAG激光。     

���ֲ�ͬ����Ԥ�����ܺ�Ը��ⲿ���̶ȵıȽ��о�

目的比较5种不同方法预备根管后对根尖1／3根管壁的清洁能力。方法将2007年12月至2008年3月在大连市口腔医院颌面外科门诊拔除的60颗离体牙随机分为6组,每组10颗。各组的牙齿先使用Protaper进行根管预备,然后使用不同的方法处理根管壁,分别为：A组H2O2和生理盐水（对照组）、B组EDTA凝胶和5．25％的NACLO,C组超声波荡洗根管、D组Nd：YAG激光、E组超声波（蒸馏水）＋EDTA、F组：超声波（5．25％NAcL0）＋EDTA。完成之后将样本纵向剖开,扫描电镜观察根管壁的界面,比较根尖1／3根管壁的清洁程度和牙本质小管的状态。结果对照组（A组）牙齿根尖部被玷污层全部覆盖,未见开放的牙本质小管;各实验组（B、C、D、E、F组）牙齿根尖部根管壁玷污层不同程度被去除。B、C、D、E、F组根尖1／3玷污层的评分与A组比较,差异有统计学意义（P〈0．05）;5个实验组间根尖1／3玷污层的评分比较,D组与E组差异无统计学意义（P〉0．05）,其余各组间差异均有统计学意义（P〈0．05）。结论5种不同的方法在一定程度上可去除根尖部的玷污层,以超声波（5．25％NACLO）＋EDTA处理根管壁的效果最佳。     

Er��YAG�����ڶ�ͯ��ǻ�ٴ����о���Ӧ��

??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.     

Er��YAG�����ڸ��������е�Ӧ���о���չ

由于根管系统的复杂性。传统的根管预备器械与冲洗剂难以达到完全清理根管的目的。Er：YAG激光联合根管冲洗剂使用,既可以采取更保守的根管预备,又能增强去除玷污层、开放牙本质小管和杀菌的能力,有利于根管封闭剂和根管内黏结剂的渗透而减少微渗漏;且在一定的激光参数范围内,其不会引起冲洗剂的根尖渗出;产热作用也极小,不会引起根尖周组织损伤。因此,Er：YAG激光的应用能使根管预备过程变得简单、高效、安全。本文综述了Er：YAG激光在根管治疗中的应用研究进展。     

�뵼�弤�������߲����������������ʵ���о�

??Objective    To evaluate the antibacterial effect of the semiconductor laser irradiation on P. gingivalis. Methods    P. gingivalis on the titanium surface was irradiated with the semiconductor laser. The energy parameters were respectively 1.5??2.0??3.0 and the irradiation time was 40s and 80s with intermittent irradiation. The scanning electron microscope??SEM??and film coating method were used to observe the changes of number and morphology of the bacteria after irradiation. Results    The number of bacteria decreased significantly??and the bacteria appeared to be dissolved and broken by laser irradiation. The antibacterial effect was gradually increased with the increase of irradiation energy and irradiation time. Conclusion    The semiconductor laser has a good antibacterial effect on P. gingivalis??which increases with the energy and the time.     

Angle��1�����Ϸǰ�������ǰ��������ʸ״�������λ�ñ仯�ٴ��о�

??Objective    To investigate the effect of the combination of face bow and class??traction on upper airway sagittal dimension and the position of hyoid in non-extraction patients with Angle??1 malocclusion . Methods    Fixed appliance with the combination of face bow and class??traction was performed in 60 patients with deep overjet. The patients were divided into two groups according to different treatment plan ??Group A: only class??traction; Group B: face bow and class??traction??. Twenty-six indexes of cephalometric radiograph before and after treatment were measured, intra-group and inter-group comparison was performed by pair t-test and independent t-test, respectively. Results    After treatment, 13 indexes??V-LPW??PNS-V??PNS-U??T-V?? AH-SN??AH-FH??AH-PP??AH-OP??AH-PNS??AH-C3??AH-Npo??AH-CVP??C3-Me??significantly increased in group A??and 11 indexes in group B??V-LPW??PNS-V?? PNS-U??T-V??AH-SN??AH-FH??AH-PP??AH-PNS??AH-Npo??AH-CVP??C3-Me??increased significantly. No difference was found between groups before and after treatment. Conclusion    The upper airway sagittal demension isn’t decreased by face bow and class??traction for the overjet patients. Hyoid can move downward and forward by class??traction.     

��沿ײ����������Ĥ�������ʵ���о�

??Objective    To investigate the characteristics of indirect injury of periodontal membrane caused by maxillofacial impact injury. Methods    The study was carried out at the laboratory of oral and maxillofacial trauma in Fourth Military Medical University??from November 2013 to January 2014. Totally 18 dogs were divided equally into six groups with random allocation??the right mandible of each dog was impacted by a cylindroid iron cap whose weight was 0.26kg??but teeth were not injured directly??the animals were killed 6 h??24 h??3 d??7 d??2 wk and 4 wk later??respectively??the histopathologic manifestations of periodontal membrane of the fourth premolar of right mandible??the second premolar of right mandible and the second premolar of left mandible were observed. Results    The injury of periodontal membrane of the fourth premolar of right mandible was relatively obvious??but the pathologic changes were reversible??periodontal membrane of the second premolar of right mandible was injured slightly??yet no obvious histopathologic change could be observed in periodontal membrane of the second premolar of left mandible. Conclusion    Maxillofacial impact injury can cause indirect injuries of periodontal membrane of adjacent teeth??but the pathologic changes are reversible??traumatic severity decreases as the distance of the tooth to the wound area increases.     

��ù������������ԭ����������ʹ��Ч�о�

目的观察阿霉素神经阻滞治疗原发性三叉神经痛的临床效果。方法选择2008年4月至2011年3月濮阳市油田总医院口腔科收治的原发性三叉神经痛患者175例(209支),随机分为阿霉素组(87例,104支)和无水乙醇组(88例,105支)。阿霉素组用1%阿霉素神经阻滞,无水乙醇组用无水乙醇神经阻滞,观察治疗后7d临床疗效及局部反应,并随访2年。结果治疗后7d并发症比较,阿霉素组局部肿胀9支、疼痛10支、神经分布区域麻木26支;无水乙醇组局部肿胀19支、疼痛20支、神经分布区域麻木36支,组间比较差异有统计学意义(P<0.05)。临床疗效比较,治疗后7d阿霉素组有效率为93%,与无水乙醇组(91%)比较差异无统计学意义(P>0.05);治疗后2年阿霉素组有效率为81%,无水乙醇组为65%,组间差异有统计学意义(P<0.05)。结论阿霉素神经阻滞治疗原发性三叉神经痛远期疗效明显优于无水乙醇,且尤其适用于不能接受手术的三叉神经痛患者。     

��ͬ������¶�������ӳ����Բ�ͬ��λ��Ч�о�

目的 评价不同牙根暴露量的牙冠延长术对不同牙位的疗效.方法 选择2007年1月至2011年1月沈阳市口腔医院拟行牙冠延长术的患者122例,共148颗患牙(前牙68颗、前磨牙48颗和磨牙32颗).各牙位根据牙冠延长术中牙根暴露量(3或4 mm)随机等分.检查术前及术后1个月、6个月和1年的出血指数、牙齿松动度、牙周袋深度和附着丧失,并进行比较.结果 牙冠延长术中牙根暴露量为3 mm时,术后各患牙均未出现松动,在术后1个月时均出现牙龈出血,术后6个月和1年牙龈出血得到改善;牙根暴露量为4 mm时,术后1个月前牙出现松动,在术后6个月及1年恢复稳定,前磨牙和磨牙在术后均未出现松动.所有患牙的牙周袋深度和附着丧失在治疗后均有较明显的改善.结论 术中牙根暴露3 mm和4mm远期疗效均满意;为了获得更多的临床牙冠实现更好的修复条件,暴露牙根最好在4mm左右;而考虑到前牙美观问题,建议在前牙区术中牙根暴露量最好控制在3 mm以内.     

���˵�����ƽ��ù������沿Ѫ�ܻ�����������Χ�񾭱��������ٴ��о�

??The lateral femoral circumflex artery system perforator flaps include anterolateral thigh perforator flap supplied by the lateral descending branch and oblique branch of lateral femoral circumflex artery??anteromedial thigh perforator flap supplied by the medial descending branch of lateral femoral circumflex artery??and tensor fascia lata perforator flap by the ascending branch of lateral femoral circumflex artery. The advantages of these flaps include the low donor site morbidity?? the convenient donor site??the good vascular quality??the large soft tissue volume??the ability to be harvested as a chimeric flap with multiple various tissue components??and being far from the head and neck region which is fit for two-team approach. The lateral femoral circumflex artery system perforator flaps can be flexibly chosen according to the different defects??so as to obtain the best effect in oral and maxillofacial reconstruction.     

Nd��YAG ���⸨������������ֲ����Χ�׶�����Ч�۲�

??Objective    To evaluate the clinical outcomes of non-surgical mechanical and Nd??YAG laser therapy plus local applied minocycline hydrochloride on initial peri-implantitis. Methods    Totally 40 implants from 26 patients diagnosed with initial peri-implantitis in the Department of Periodontology??Hospital of Stomatology??China Medical University from February 2013 to June 2014??were enrolled and randomly assigned to 2 groups??laser  therapy group and control group??and 20 implants per group. Implants in control group were treated with non-surgical periodontal therapy and local applied minocycline hydrochloride. Implants in laser therapy group received Nd??YAG laser therapy based on the control group. Modified plaque index??mPLI????modified sulcus bleeding index??mSBI??and probing depth??PD??were measured at baseline and 8 weeks after therapy. Results    After 8 weeks??implants of both groups yielded a statistically significant reduction??P < 0.05??in mPLI??mSBI and PD??when compared with baseline. Between-group comparisons revealed statistically significant differences in mSBI and PD ??P < 0.05?? at 8 weeks after therapy. Conclusion    Non-surgical mechanical and Nd??YAG laser therapy plus local applied minocycline hydrochloride is effective for initial peri-implantitis.     

��ͬģʽ�³�����������������Ӱ���о�

??Objective    To evaluate the influence of various ultrasonic power setting??working range and working depth on fracture resistance of teeth in vitro. Methods    Totally 64 extracted human single-rooted mandible premolars were collected to construct the Root canal post’s model. Factorial design with three factors and two levels was used. All the 64 teeth were randomly divided into 8 groups??8 in each group. Remove dentin around the post with P5 Newtron ultrasonic device and ET-20 ultrasonic tip. All teeth were mounted on the universal mechanical testing machine??and loaded vertically at 0.5 mm per minute until fracture. Fracture force and fracture patterns were recorded. The results were analyzed by three-factor factorial design ANOVA and chi-square test. Results    There was a significant difference in fracture resistance among various ultrasonic power setting??working range and working depth??P < 0.05??. The ultrasonic working range affected the direction of fracture and the ultrasonic working depth affected the site of frature??P < 0.05??. Conclusion    The different ultrasonic power setting??working range and working depth have significant influence upon fracture resistance of teeth. There are interactive effects between ultrasonic power setting and working range or ultrasonic power setting and working depth respectively.