超声波预备根管与Nd：YAG激光照射后根管牙本质的SEM研究

目的：评价超声预备根管及Ｎｄ：ＹＡＧ 激光照射根管壁后,根管内壁的清洁度和管壁牙本质微结构的变化。方法：１２ 个离体成人上前牙分为４ 组制备根管：手用器械、超声根管治疗仪、手用器械＋ Ｎｄ：ＹＡＧ 激光照射、超声波＋ Ｎｄ：ＹＡＧ 激光照射,扫描电镜下观察并照像记录。结果：手用扩锉预备的根管内壁有涂层污染和病理组织残留;超声波预备后根管内壁清洁、涂层消除,牙本质小管口开放;手用器械或超声制备后辅以适当能量激光照射的管内壁牙本质小管口封闭,管间牙本质熔融,并形成空泡状结晶。结论：超声波预备根管可达到理想的清洁效果,但牙本质小管口开放易造成根管术后渗漏。而Ｎｄ：ＹＡＧ 激光照射有利于封闭牙本质小管口,减少根尖孔渗漏,还具有封闭根管内壁死腔的作用。     

激光在根管治疗和根尖手术中的研究和应用进展

激光在根管治疗和根尖手术中的研究和应用正不断深入。本文着重对激光的杀菌和消毒效应、根管内壁作用、根尖封闭、根尖切除效应和根尖周组织反应等方面作了综述。激光因其具有杀菌消毒、熔融牙本质产生封闭效应、减少牙本质通透性等优点,在根管治疗和根尖手术中具有应用潜力。     

激光在根和治疗和根尖手术中的研究和应用进展

激光在根管治疗和根尖手术中的研究和应用正不断深入，本文着重对激光的杀菌和消毒效应，根管内壁作用，根尖封闭，根尖切除效应和根尖周组织反应等方面作了综述。激光因其具有杀菌消毒熔融牙本质产生封闭效应，减少牙本质通透性等优点，在根管治疗和根尖手术中具有应用潜力。     

微波根管治疗一次完成法的临床观察

目的观察微波一次根管治疗的术后反应以及远期效果。方法应用微波热效应和非热效应作用,通过离体牙扫描电镜观察牙体组织变化,对根尖周病的４７例患牙作根管治疗一次完成法的４８ｈ术后反应及１年疗效观察,并与５４例常规多次法对照。结果在急慢性根尖周病应用微波根管治疗能封闭牙本质小管开口,提高根管消毒效果,从而达到缩短疗程。结论微波根管治疗一次法治疗根尖周病是可行的。     

Er,Cr:YSGG激光在根管治疗中的应用进展

铒、铬:钇钪镓石榴石(erbium,chromium:yttrium scandium gallium garnet laser,Er,Cr:YSGG)激光在牙科领域主要应用于根管治疗术、牙周疾病、龋病、牙本质过敏症、牙髓切断术等。本文从根管封闭性、灭菌、空穴效应和对根尖周组织影响四个方面对Er,Cr:YSGG激光在根管治疗中的研究进展作一综述。文献复习结果表明,Er,Cr:YSGG功率为2~4 w,20 Hz时,可以较好清除牙本质小管玷污层,从而提高材料与牙本质之间的密闭性;Er,Cr:YSGG能量产生的热效应具有灭菌作用,而牙体的光导性使冲洗液能够进入更深的组织,进一步提高灭菌效果;Er,Cr:YSGG还具有空穴效应,破坏深处溶液的表面张力,从而可以清除深层的玷污层与细菌;但是在相同功率下Er,Cr:YSGG如果使用不当,Er,Cr:YSGG产生的热效应会对根尖周组织造成一定伤害,因此,合理的Er,Cr:YSGG使用时间长短和在水冷却条件下是重要的。     

铒激光不同参数对牙本质小管即刻封闭影响的实验研究

目的:比较不同工作参数下铒激光处理后牙本质小管封闭的效果,探求铒激光即刻封闭牙本质小管的最佳参数。方法:制备54个牙本质盘,0.5 mol/L EDTA脱矿形成敏感牙本质模型。以铒激光的输出功率、照射时间、照射距离为实验指标,设计正交优化实验表,样本随机分成9组,每组6个样本,铒激光照射后扫描电子显微镜观察,评估各组牙本质小管封闭情况。结果:脱矿组牙本质小管口开放,清晰可见,激光照射组牙本质小管表面有明显熔融物沉积,各组牙本质小管封闭率有显著性差异(P<0.05)。结论:铒激光照射对牙本质小管有一定封闭作用,且受工作参数影响。本实验条件下,照射距离影响最大,最佳工作参数组合是:距离2.0 cm,照射功率0.2 W,照射时间30 s。     

根管内Nd:YAG激光照射后对根尖周组织的作用

目的：观察激光在根管内照射后对根尖周组织的作用。方法：选3只小型猪,全麻下将乳前磨牙开髓、抽髓、根管扩大后,激光照射30秒,做常规根管充填。对照组为常规根管充填。1天、3天、7天和15天后观察根尖周组织的变化。结果：激光照射后1天,根周膜血管充血、轻度炎症,对照组只有根尖周膜充血。激光组织反应比对照组稍重。激光照射后3天和7天,少数病例根周组织有轻度的刺激与对照组的病理表现相近。激光照射后15天部分标本根周膜正常,部分标本有轻度炎症反应,与对照组结果基本相似。结论：本激光照射条件对根尖周组织没有明显损伤作用,可供临床应用时参考。     

根管内Nd:YAG激光照射后对根尖周组织的作用

目的:观察激光在根管内照射后对根尖周组织的作用.方法:选3只小型猪,全麻下将乳前磨牙开髓、抽髓,根管扩大后,激光照射30秒,做常规根管充填.对照组为常规根管充填.1天、3天、7天和15天后观察根尖周组织的变化.结果:激光照射后1天,根周膜血管充血、轻度炎症,对照组只有根尖周膜充血.激光组组织反应比对照组稍重.激光照射后3天和7天,少数病例根周组织有轻度的刺激与对照组的病理表现相近.激光照射后15天部分标本根周膜正常,部分标本有轻度炎症反应,与对照组结果基本相似.结论:本激光照射条件对根尖周组织没有明显损伤作用,可供临床应用时参考.     

Er∶YAG激光在根管治疗中的应用研究进展

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。     

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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。     

Effects of erbium,chromium:YSGG laser irradiation on root canal walls: a scanning electron microscopic and thermographic study

The present study evaluates the morphological changes in root canal walls and temperature changes at root surfaces as a result of intracanal irradiation by erbium,chromium:YSGG laser under various conditions in vitro. Sixty single-rooted human teeth were examined. Root canals were prepared, and laser irradiation was performed using an optic fiber at output powers ranging from 1 to 6 W with or without water spray cooling. Specimens were evaluated by stereoscopy, scanning electron microscopy, and thermography. Carbonization and cracks were observed in all samples irradiated without cooling, whereas little or no carbonization and no smear layer or debris were observed in samples irradiated with cooling. Maximum temperature rise at irradiation without cooling was above 37 degrees C, whereas that at irradiation with cooling was 8 degrees C. Results of the present study indicate that erbium,chromium:YSGG laser irradiation with water spray cooling is a useful method for removal of smear layer and debris from root canals.     

Nd:YAG激光照射根管后的形态学观察

目的：了解感染根管管壁牙本质的病变特点，根管预备及Nd：YAG激光照射对感染根管的作用。方法：选用单根患牙60颗，随机分为5组：对照组（治疗前感染根管）、根管预备组（用手用器械根管预备）、3个激光组（在常规根管预备后，采用3种不同能量参数照射1min），做扫描电镜观察。结果：对照组：感染根管牙本质小管形态不规则，排列紊乱。根管预备组：能去除病变的牙本质层，形成玷污层。50mj 10Hz激光组不能封闭牙本质小管。100mj 10Hz、150mj 10Hz激光照射1min根管壁呈熔融状态，去除了玷污层，牙本质小管封闭和半封闭。结论：激光剂量在100mj 10Hz或在此以上时，能有效清洁根管壁玷污层和封闭牙本质小管。     

The use of the erbium, chromium:yttrium-scandium-gallium-garnet laser in endodontic treatment: the results of an in vitro study

BACKGROUND: The use of the erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser has become accepted in the field of cavity preparation. The development of miniaturized and flexible fiber tips has allowed this device to be used in endodontics. The authors conducted an in vitro study to assess the effects of Er,Cr:YSGG laser irradiation on root canals. METHODS: The authors inoculated root canals with two bacteria, laser irradiated them at two power settings and subjected them to a quantitative microbiological evaluation. They used scanning electron microscopy (SEM) to assess morphological changes in endodontically processed and laser-irradiated root canal walls. They measured temperature increases on the root surface to determine possible thermal side effects. RESULTS: The bacteriological evaluation revealed a disinfecting effect in the root dentin samples that was dependent on the output power but not specific for the bacterial species investigated. SEM showed the removal of the smear layer from the root canal walls and the exposure of dentinal tubules. The temperature rise during irradiation was moderate when standardized power settings were used. CONCLUSIONS: The Er,Cr:YSGG laser can be used to eliminate bacteria in root canals. It also effectively removes smear layer and debris from the canal wall. CLINICAL IMPLICATIONS: Practitioners can use the Er,Cr:YSGG laser to prepare root canals for endodontic therapy.     

牙根表面积测量方法的研究进展

牙周膜作为附着在牙根表面的一层致密结缔组织,具有支持稳固牙列和调节咀嚼压力等重要功能。准确测定牙周膜面积有助于临床医生评估牙周炎患者的牙体预后,或制定牙体缺失后的修复方案。测定牙根表面积（RSA）作为测量牙周膜面积的常用替代方法,具有成膜法、图像分割法、质量转换法、牙根三维扫描法和CT三维重建法等多种测量方法,测量精度高等优点,因此,本文就RSA测定方法发展史和RSA的具体测量方法及RSA测量在临床上的应用等研究进展作一综述。     

2种非金属桩核修复上前牙残冠临床效果的比较

目的：比较计算机辅助设计和计算机辅助制造（CAD/CAM）氧化锆全瓷桩、玻璃纤维桩修复上前牙残冠的临床效果。方法???随机选择18~55岁患者的40颗上前牙残冠为研究对象,在修复前行完善的根管治疗,其中CAD/CAM全瓷桩、纤维桩各20件,均采用CAD/CAM氧化锆全瓷冠修复。于修复完成后2年复查修复体、牙根及牙周情况。结果??全瓷桩组有1例全瓷冠崩瓷,1例桩核折断及1例牙龈炎症;纤维桩组有1例桩核松动脱落,1例桩核折断,2例牙龈炎症。2组患者的患牙均未出现根折和继发性根尖周炎。修复的临床效果无显著性差异（P>0.05）。结论??对于上前牙残冠的氧化锆全瓷冠修复,CAD/CAM全瓷桩与玻璃纤维桩在固位性,抗根折能力和牙周、牙髓疾病控制方面无显著性差异,均可取得较好的临床效果。     

细胞自噬和炎症反应的相互调控与牙周炎

细胞自噬在真核细胞中广泛存在,其通路可将细胞内衰老损伤的蛋白质和细胞器等细胞成分运送至溶酶体进行降解、清除并循环利用降解后的营养物质。炎症反应是机体应答组织损伤和病原微生物感染等有害刺激的一种保护性反应,过度的炎症反应会导致组织损伤和疾病;而自噬可通过降解DNA、活性氧族等内源性刺激来抑制炎性小体聚集,降解白细胞介素（IL）-1β前体来抑制IL-1β等促炎因子的分泌。牙周致病菌的毒力因子参与牙周组织的破坏,通过其自身携带或释放的脂多糖、肽聚糖和细菌DNA等与宿主细胞的Toll样受体（TLR）等相互作用诱发组织局部炎性细胞浸润和释放炎症因子,导致牙周炎。在牙周局部组织中,病原相关分子模式和损伤相关分子模式通过与TRL或核苷酸结合寡聚化结构域蛋白样受体相互作用,在激活先天免疫反应时诱发自噬,而自噬同时可通过负向调控TLR信号来影响炎症反应。本文就自噬与炎症反应的相互调控作用和自噬与牙周炎的相关性等研究进展作一综述,旨在揭示牙周炎等炎症性疾病的发病机制,为其治疗探索新的途径。     

Effect of argon laser irradiation on instrumented root canal wall

Abstract— The objective of the study was to examine whether argon laser has a property to remove debris and smear layer from root canal walls. Twelve endodontically treated human maxillary molar teeth with three root canals were divided into two groups of six teeth. The first group was left unlased as a control; in the second group the root canals were irradiated by argon laser (laser parameters were set at 1 W and pulse duration and pulse frequency fixed at 0.05 s and 5 Hz). After the usual root canal preparation and lasing had been camed out, the teeth were decoronated, bisected longitudinally, observed with a scanning electron microscope and evaluated as to how clean the surfaces of root canal walls were. In most cases control teeth presented surfaces with debris covering the root canals, obscuring the dentinal tubules. Only 1 of 18 specimens was free of debris. In the lased group, root canal surfaces free of debris and vaporized pulpal tissue remnants were observed in 13 of 18 specimens. The results showed sigmficant statistical differences between the control group and the lased groups (P<0.001). These results suggested that argon laser irradiation has an efficient cleaning effect on instrumented root canal surfaces.     

Effect of Er:YAG laser treatment on the root canal walls of human teeth: an SEM study

Abstract— The purposes of the study were to observe the morphological changes on root canal walls after instrumentation and irrigation, and assess the efficacy of conventional cleansing procedures and the effectiveness of Er:YAG laser in removing debris and smear layer from the root canal walls. Thirty-six endodontically treated human mandibular incisor teeth with single root canals were bisected longitudinally and divided into three groups of 12 teeth. Group 1 (Gl) was left unlased as a control. The teeth of group 2 (G2) and group 3 (G3) were irradiated by Er:YAG laser (laser parameters were set at 1 W, 100 mJ/pulse and 10 Hz) for 3 s and 5 s. The teeth were prepared for scanning electron microscope study. Control specimens showed debris and heavy smear layer obscuring the dentinal tubules at all levels in the canals. The root canal walls irradiated by Er:YAG laser were free of debris, with an evaporated smear layer and open dentinal tubules. These results suggested that Er:YAG laser irradiation had an efficient cleaning effect on the prepared root canal walls.     

Evaluation of microleakage of root canal fillings irradiated with different output powers of erbium,chromium:yttrium‐scandium‐gallium‐garnet laser

This study evaluated the root canal seal achieved by irradiation with an erbium, chromium:yttrium‐scandium‐gallium‐garnet laser, and the optimal output power to remove debris and the smear layer were determined. One hundred mandibular premolar teeth were prepared and divided into four groups. Group 1 was not lased but was irrigated with 5 mL of 5.25% NaOCl and 5 mL of 17% ethylenediaminetetraacetic acid. Group 2 was irradiated at a panel setting of 1 W, group 3 at 2 W and group 4 at 2.5 W, with a 50% water level and 48% air‐cooling level. Root canals were obturated by cold lateral compaction, and apical microleakage was measured using a fluid filtration model. The remaining debris and smear layer were evaluated via scanning electron microscopy. Statistically significant differences were detected between groups. Irradiation at 1 and 2 W using an erbium, chromium:yttrium‐scandium‐gallium‐garnet laser produced a seal superior to that of the other treatments.