本文選題：Er:YAG激光 + 牙釉質(zhì)��； 參考：《第三軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：研究背景齲病是人類的常見(jiàn)病與高發(fā)病,它嚴(yán)重影響人類的口腔健康。目前,臨床常用的齲病治療方法為充填治療,但是渦輪機(jī)在切割牙體組織時(shí)所產(chǎn)生的負(fù)壓會(huì)導(dǎo)致牙本質(zhì)敏感甚至疼痛,而噪聲及震動(dòng)又增加了患者的牙科畏懼。1997年,美國(guó)食品藥品管理局(FDA)批準(zhǔn)摻鉺釔鋁石榴石(Er:YAG)激光可用于治療牙體硬組織疾病,自此,Er:YAG激光逐漸被應(yīng)用于齲病的治療當(dāng)中。Er:YAG激光切割牙體組織具有無(wú)噪聲、無(wú)震動(dòng)、無(wú)痛、精準(zhǔn)切割等優(yōu)點(diǎn),得到了越來(lái)越多患者的接受和認(rèn)可。雖然Er:YAG激光具備有上述優(yōu)點(diǎn),但是如何提高Er:YAG激光對(duì)牙體硬組織的切割效率也是當(dāng)前研究的熱點(diǎn)。Er:YAG激光對(duì)牙體硬組織的切割主要取決于能量、頻率、照射時(shí)間、噴水量等因素。目前的實(shí)驗(yàn)研究和臨床操作多通過(guò)改變Er:YAG激光的能量來(lái)提高切割能力,然而關(guān)于頻率對(duì)牙體硬組織切割能力的影響則鮮有報(bào)道。目的本研究通過(guò)測(cè)量Er:YAG激光不同頻率和照射時(shí)間下牙釉質(zhì)和牙本質(zhì)表面凹坑直徑、深度的變化,同時(shí)觀察表面形態(tài)學(xué)變化,得出Er:YAG激光切割牙體硬組織最佳的頻率和時(shí)間參數(shù),為提高Er:YAG激光備洞的效率和安全性提供依據(jù)。材料與方法1.收集離體前磨牙80顆,要求離體牙表面無(wú)齲壞、無(wú)裂紋、無(wú)釉質(zhì)發(fā)育不全、非氟斑牙,制備牙釉質(zhì)樣本和牙本質(zhì)樣本各80個(gè)(4mm×4mm×2.5mm)。根據(jù)Er:YAG激光照射時(shí)間不同,將80個(gè)牙釉質(zhì)樣本和80個(gè)牙本質(zhì)樣本按隨機(jī)數(shù)字表法分為照射10s和照射20s兩個(gè)大組,每組40個(gè)樣本,然后每大組再分為5個(gè)亞組(按Er:YAG激光頻率10Hz、15Hz、20Hz、25Hz、30Hz),每組8個(gè)樣本。按以上分組對(duì)每個(gè)樣本進(jìn)行Er:YAG激光照射,Er:YAG激光能量固定為200m J。Er:YAG激光照射后,使用體視顯微鏡觀察樣本表面的凹坑,并測(cè)量其直徑和深度。2.收集離體前磨牙80顆,要求同上,制備牙釉質(zhì)樣本和牙本質(zhì)樣本各80個(gè)(4mm×4mm×2.5mm),分組同上,使用Er:YAG激光照射,然后各亞組抽取2個(gè)樣本,在掃描電鏡下觀察表面形態(tài)學(xué)變化,選取代表性的區(qū)域進(jìn)行拍照。3.選取2015年10月至2016年3月到本院口腔內(nèi)科就診的年齡為12-55周歲齲病患者30例,要求患者口內(nèi)同頜或?qū)︻M至少有2顆磨牙的齲壞程度相似(以樊明文主編的《牙體牙髓病學(xué)》診斷標(biāo)準(zhǔn)為準(zhǔn)),有牙髓炎、根尖周炎等癥狀患者以及不愿意接受Er:YAG激光治療的患者排除。將30名患者分為兩組:Er:YAG激光組(Er:YAG激光的能量為200m J、頻率為20Hz)及高速渦輪機(jī)組,對(duì)患牙齲壞進(jìn)行去除,分別記錄兩組去齲所用的時(shí)間,使用視覺(jué)模擬評(píng)分法(VAS)記錄患者的疼痛程度,墊底后Z350復(fù)合樹(shù)脂充填窩洞,調(diào)合,拋光。囑患者1、3、6、12個(gè)月后復(fù)查,觀察充填體的邊緣是否著色、有無(wú)充填體脫落及繼發(fā)齲。結(jié)果1.Er:YAG激光照射后,牙釉質(zhì)和牙本質(zhì)表面凹坑直徑及深度隨著激光頻率增加和照射時(shí)間延長(zhǎng)呈增加趨勢(shì)。當(dāng)照射時(shí)間一致時(shí),Er:YAG激光頻率為10-20Hz時(shí),凹坑直徑和深度的增加速度快,差異有統(tǒng)計(jì)學(xué)意義(P0.05);而頻率增加到25-30Hz時(shí),凹坑直徑和深度增加則相對(duì)平緩,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);當(dāng)激光頻率相同時(shí),照射10s后的牙釉質(zhì)和牙本質(zhì)表面凹坑直徑及深度均顯著小于照射20s后的凹坑直徑及深度,兩者差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.掃描電鏡下觀察顯示,當(dāng)Er:YAG激光頻率為10-20Hz時(shí),牙釉質(zhì)表面粗糙、不規(guī)則,可見(jiàn)魚(yú)鱗樣的釉柱結(jié)構(gòu),隨著頻率增加,當(dāng)頻率達(dá)到25-30Hz時(shí),凹坑表面稍顯平坦,魚(yú)鱗樣的釉柱結(jié)構(gòu)消失,凹坑局部可見(jiàn)裂紋及部分熔融現(xiàn)象;Er:YAG激光照射后,牙本質(zhì)凹坑表面清潔、無(wú)玷污層,牙本質(zhì)小管開(kāi)放,隨著激光頻率增加和照射時(shí)間延長(zhǎng),牙本質(zhì)小管開(kāi)放的數(shù)目增多,Er:YAG激光頻率25Hz,照射時(shí)間為20s時(shí),牙本質(zhì)凹坑表面可見(jiàn)裂紋,當(dāng)頻率繼續(xù)增加到30Hz、照射時(shí)間為10s及20s時(shí),裂紋更深,可見(jiàn)局部熔融的牙本質(zhì)堵塞部分牙本質(zhì)小管,使牙本質(zhì)小管開(kāi)放的數(shù)目減少。3.Er:YAG激光組去齲的平均時(shí)間(158.4±32.8s)顯著大于高速渦輪機(jī)組去齲的平均時(shí)間(93.6±42.5s),差異有統(tǒng)計(jì)學(xué)意義(P0.05);VAS顯示患者更容易接受Er:YAG激光去齲(P0.05);充填1、3、6、12個(gè)月后患者復(fù)查,Er:YAG激光組和高速渦輪機(jī)組去齲后充填體邊緣著色、充填體脫落及繼發(fā)齲情況無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.Er:YAG激光照射牙體硬組織時(shí),選擇激光能量200m J,頻率10-30Hz,照射時(shí)間10s及20s,牙體硬組織表面凹坑的直徑和深度隨著激光頻率增加和照射時(shí)間延長(zhǎng)呈增加趨勢(shì)。2.Er:YAG激光照射牙體硬組織時(shí),選擇激光能量200m J,頻率10-20Hz,照射時(shí)間10s及20s,牙釉質(zhì)和牙本質(zhì)表面不會(huì)出現(xiàn)裂紋、熔融等熱損傷現(xiàn)象;而使用較高頻率的Er:YAG激光(25-30Hz)照射牙釉質(zhì)和牙本質(zhì)10s及20s后,表面有裂紋、熔融等熱損傷現(xiàn)象產(chǎn)生。3.Er:YAG激光頻率為20Hz、照射時(shí)間為20s時(shí),牙體硬組織表面可獲得有效、安全的切割。4.和高速渦輪機(jī)去齲相比較,Er:YAG激光去齲可明顯減輕患者的痛苦,而且兩者去齲后充填體的療效沒(méi)有統(tǒng)計(jì)學(xué)差異。
[Abstract]:Background caries is a common and high incidence of human disease. It seriously affects human oral health. Currently, dental caries are commonly used in the treatment of dental caries. However, the negative pressure produced by turbine in cutting tooth tissue causes dentin sensitivity and even pain, while noise and vibration increase the patient's dental fear for.1997 years, The US Food and Drug Administration (FDA) approves that erbium - doped yttrium aluminum garnet (Er:YAG) laser can be used to treat dental hard tissue diseases. Since the Er:YAG laser is gradually applied to the treatment of dental caries, the.Er:YAG laser cutting tooth tissue has the advantages of no noise, no vibration, painless, accurate cutting and so on, which has been accepted and accepted by more and more patients. Although the Er:YAG laser has the above advantages, how to improve the cutting efficiency of Er:YAG laser for tooth hard tissue is also a hot spot of current research. The cutting of hard tissue of the tooth is mainly dependent on the factors of energy, frequency, time of irradiation, and the amount of water, and so on. The current experimental research and clinical operation are mostly by changing the Er:YAG laser. Energy is used to improve the cutting ability. However, the effect of frequency on the ability of tooth hard tissue cutting is rarely reported. Objective the purpose of this study was to measure the depth changes of the surface of the enamel and dentin surface in different frequencies and exposure time of Er:YAG laser, and to observe the changes in surface morphology, and to obtain the hard tissue of the tooth by Er:YAG laser. The optimum frequency and time parameters provide the basis for improving the efficiency and safety of Er:YAG laser cavity. Material and method 1. collect 80 premolar teeth in vitro, require no dental caries, no crack, non enamel development, non fluorosis, 80 dental enamel samples and 80 dentine samples (4mm x 2.5mm). According to Er:YAG laser The 80 dental enamel samples and 80 dentin samples were divided into two groups of irradiated 10s and 20s, each group was divided into 40 samples, and then each group was divided into 5 subgroups (10Hz, 15Hz, 20Hz, 25Hz, 30Hz) in each group (Er:YAG laser frequency 10Hz, 15Hz, 20Hz, 25Hz, 30Hz), and each group was irradiated with Er:YAG laser, Er:Y. After AG laser energy was fixed to 200m J.Er:YAG laser, a stereoscopic microscope was used to observe the pits on the surface of the sample, and the diameter and depth of.2. were measured to collect 80 premolars in vitro. It was required that the enamel samples and dentin samples were prepared with 80 (4mm * 4mm x 2.5mm) samples, with the same group, the Er:YAG laser irradiation, and then 2 subgroups. The samples were examined under scanning electron microscope, and the representative area was selected to take a photo of.3. to select 30 cases of dental caries aged 12-55 years from October 2015 to March 2016, and the degree of dental caries was similar to that of at least 2 molars in the mouth of the mouth or at the maxillary. (with Fan Mingwen's editor's "tooth tooth" 30 patients were divided into two groups: the Er:YAG laser group (the energy of 200m J, the frequency of 20Hz) and the high speed turbine unit to remove the dental caries and record the two groups of decayed caries, respectively, in the patients with pulpitis, periapical periodontitis and other patients who were not willing to receive Er:YAG laser treatment. A visual analogue scale (VAS) was used to record the degree of pain in patients with Z350 composite resin filling pit, blending, and polishing. The patients were reviewed after 1,3,6,12 months to observe whether the edge of the filling body was coloured, the filling body fell off and secondary caries. Results the diameter and depth of the enamel and dentine surface pits after the 1.Er:YAG stimulated light irradiation With the increase of laser frequency and exposure time, when the frequency of Er:YAG laser is 10-20Hz, the diameter and depth of the concave pit increase faster, and the difference is statistically significant (P0.05); while the increase of the frequency to 25-30Hz, the diameter and depth of the pits is relatively flat, and the difference is not statistically significant (P0.05). When the laser frequency is the same, the diameter and depth of the concave pit of the enamel and dentin surface after 10s irradiation are significantly less than the diameter and depth of the pits after the irradiation of 20s. The difference has statistical significance (P0.05). Under the.2. scanning electron microscope, when the Er:YAG laser frequency is 10-20Hz, the enamel surface is rough and irregular, and the scale like glaze column can be seen. As the frequency increases, when the frequency reaches 25-30Hz, the surface of the pit is slightly flat, the structure of the enamel like glaze disappears, the cracks and partial melting can be seen in the pits. After the Er:YAG laser irradiation, the surface of the dentine pit is clean, the defiling layer is untarnished, the dentinal tubule opens, and the dentine is small with the increase of the frequency of the laser and the prolongation of the time of the laser irradiation. When the number of open tubes increased, the Er:YAG laser frequency 25Hz and the irradiation time were 20s, the surface of the dentine dent was visible. When the frequency continued to increase to 30Hz, the time of irradiation was 10s and 20s, the crack was deeper, and the partially fused dentin blocked the partial dentinal tubules and reduced the number of open dentine tubules to decrease the decayed caries in the.3.Er:YAG laser group. The average time (158.4 + 32.8s) was significantly greater than the average time (93.6 + 42.5s) for high speed turbo caries, and the difference was statistically significant (P0.05); VAS showed that patients were more likely to accept Er:YAG laser decayed caries (P0.05); after filling 1,3,6,12 months, patients were rechecked, Er:YAG laser group and high speed turbine set after caries filling body edge coloring, filling body fall off There is no significant difference in the secondary caries (P0.05). Conclusion when 1.Er:YAG laser irradiated the hard tissue of the tooth, the laser energy 200m J, the frequency 10-30Hz, the irradiation time 10s and 20s, the diameter and depth of the hard tissue surface pits of the tooth body are increased with the increase of the laser frequency and the irradiation time, and the.2.Er:YAG laser irradiation on the hard tissue of the tooth body is selected. Selective laser energy 200m J, frequency 10-20Hz, irradiation time 10s and 20s, the tooth enamel and dentin surface will not appear crack, melting and other thermal damage phenomena, while the high frequency Er:YAG laser (25-30Hz) irradiate the tooth enamel and dentin 10s and 20s, the surface cracks, melting and other thermal damage phenomenon of.3.Er:YAG laser frequency is 20Hz, irradiation. At the time of 20s, the surface of the hard tissue of the tooth can be effective. The safe cutting.4. and the high speed turbine are compared. The Er:YAG laser decayed caries can obviously reduce the sufferings of the patients, and there is no statistically significant difference in the curative effect of the two cases after the decayed caries.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.1

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