Er,Cr:YSGG激光照射对根管封闭效果影响的实验研究

探讨常规根管预备后使用不同能量参数Er,C r:YSGG激光进行根管内照射对根管封闭效果的影响,为此激光在根管治疗领域的临床应用提供重要的实验依据。选择新拔除的单根管牙80颗,分成4组,每组20颗牙。常规根管预备后,分别使用1 W、2 W、3 W Er,C r:YSGG激光于有水条件下进行根管内照射,另选一组不做任何处理,作为阴性对照。扫描电子显微镜下观察根管内壁形态学改变后,常规根管充填,检测根管微渗漏情况。采用单因素方差分析及q检验进行统计学处理。结果可见:(1)形态学观察:与对照组相比,激光照射均可有效去除根管内壁的玷污层及碎屑;牙本质小管口清晰可见;未见熔融及炭化等热损伤改变;其中3 W激光处理后根管内壁形态最为理想。(2)微渗漏检测:与对照组相比,各激光组根管微渗漏深度均显著减少(P<0.05);但各激光组间比较无显著性差异(P>0.05)。综上,使用Er,C r:YSGG激光进行根管内照射可达到较为理想的根管清洁目的,显著改善根管充填后的封闭效果,因此有望在临床上应用提高根管治疗的成功率。     

Er,Cr:YSGG激光照射对牙根尖封闭效果影响的实验研究

目的:深入探讨在根尖倒充填术中Er,Cr:YSGG激光照射对牙根尖的封闭效果,为此激光在口腔临床上的应用与推广提供重要的理论与实验依据。方法:将56颗新拔除的单根牙随机分成7组,每组8颗牙。去除牙冠,常规进行根管预备、根管充填。将倒充填的牙根尖进行预备,然后银汞合金倒充填。预备方法:1手机切除根尖后,制备成烧瓶状洞形;2手机处理方法同1,然后Er,Cr:YSGG激光于不同能量(1W、2W)及不同方式(喷水或无水)下对洞内壁进行照射。结合微渗漏检测与扫描电镜观察对Er,Cr:YSGG激光照射后的牙根尖封闭效果进行评估。结果:Er,Cr:YSGG激光可有效去除根切面上的玷污层及碎屑;与手机加银汞倒充填组相比,激光照射后的根尖染料微渗漏深度有所减少;但只有1WEr,Cr:YSGG激光于无水条件下照射时,根尖染料微渗漏深度显著减少(P<0.05)。结论:Er,Cr:YSGG激光应用于根尖倒充填术中可减少微渗漏的发生;促进根尖封闭;在特定的能量参数下可获得优于常规银汞倒充填术的治疗效果。因此我们推荐临床上将Er,Cr:YSGG激光照射与常规银汞倒充填术结合使用,这将有助于提高根尖倒充填术治疗的成功率。     

Er,Cr:YSGG激光处理正常及龋坏牙本质的扫描电镜观察

目的：利用扫描电镜观察Er,Cr：YSGG激光处理龋坏牙本质的形态学改变,并与常规方法进行比较。方法：将24颗新拔除的患龋牙随机分成2组,每组12颗牙。第1组常规处理组：分别用金刚砂石针、碳钢裂钻和挖器处理正常及龋坏牙本质;第2组激光处理组：分别用2WEr,Cr：YSGG激光、4WEr,Cr：YSGG激光处理正常及龋坏牙本质。常规制片,扫描电镜下观察。结果：与常规方法相比,激光处理后的牙本质表面不平,呈鱼鳞状、片状的粗糙外观;表面清洁,无玷污层,牙本质小管口清晰可见;4W激光作用时偶见微裂;激光处理后的牙本质表面具有增加树脂黏结性的形态学改变．结论：Er,Cr：YSGG激光能有效地清除龋坏牙本质及玷污层,并可使牙体组织发生一定的形态学改变。因此,Er,Cr：YSGG激光能够替代常规去龋备洞方法。     

Er,Cr:YSGG激光在口腔医疗中的应用研究进展

Er,Cr:YSGG激光是新一代水动力生物激光系统,其特性和优势正在口腔医疗的应用中越来越受到关注,该文对Er,Cr:YSGG激光对于牙体组织的去龋能力、清除玷污层和蚀刻作用以及对于牙周病变牙根表面的杀菌、去除菌斑和牙石的能力等方面的研究进展进行综述。     

Er,Cr:YSGG激光切割对牙体与充填物粘结力影响的研究

本文用 1千牛电液疲劳实验机检测充填材料与牙面之间的粘结力 ,发现 :在牙釉质组中 ,酸蚀组、6瓦激光切割组及 6瓦激光切割联合酸蚀组抗剪切粘结强度无显著性差异 (P >0 .0 5) ;在牙本质组中 ,酸蚀组、4瓦激光切割组及 4瓦激光切割联合酸蚀组抗剪切粘结强度也无显著性差异 (P >0 .0 5)。并通过SEM观察激光处理后牙体表面结构的变化 ,发现激光切割后牙釉质表面不平呈层状 ,无玷污层 ,釉柱未见破坏 ;牙本质小管开放 ,表面无玷污层 ,达到酸蚀的效果。因此Er,Cr :YSGG激光切割牙体硬组织具有传统钻切割与酸蚀刻的联合作用 ,可以代替传统的酸蚀方法。     

Er:YAG激光处理对牙釉质及牙本质修复效果的影响

研究不同表面处理条件下Er:YAG激光照射对牙釉质及牙本质修复效果的影响。80个样本随机分成牙釉质和牙本质2大组,再根据处理方式随机分为4小组:①酸蚀(37%磷酸);②Er:YAG激光;③自酸蚀粘接处理剂;④Er:YAG激光+自酸蚀粘接处理剂。与树脂加强型玻璃离子水门汀(RMGIC)粘接后37℃水浴中储存24 h,用万能测试机测定粘接剪切强度。牙釉质及牙本质组结果均为3、4小组粘结强度接近(P0.05),显著高于其他组(P0.05),1、2小组间粘结强度差别无统计学差异(P0.05)。Er:YAG激光照射可替代37%磷酸酸蚀处理方法;G-Bond自酸蚀粘接处理剂可提高牙面与RMGIC间的粘结力,Er:YAG激光处理不影响该效果。     

人氟斑牙釉质表面结构及漂白后改变的电镜观察

目的:目前国内外对氟斑牙的研究主要集中在流行病学调查和临床疗效分析,对其漂白后釉质表面脱矿程度的研究却鲜有报道.观察不同程度人氟斑牙电镜下微观结构的特点,了解冷光美白对不同程度人氟斑牙釉质表面的影响,探讨冷光美白对重度氟斑牙的安全性.方法:选择因牙周病拔除的完整无龋坏的正常牙10颗,人各型氟斑牙50颗,选取颊侧典型区域制备标本.氟斑牙标本按Dean氏分类法分为轻、中、重度3组,正常牙标本作为对照组.各组标本随机分为4个亚组,A组:不做任何处理;B组:釉质表面蚀刻;C组:釉质剖面蚀刻;D组:釉质表面冷光美白,扫描电镜下观察标本的表面形貌.结果:轻度氟斑牙釉柱间隙增宽,少量晶体排列紊乱,晶间隙增宽.重度氟斑牙釉质表面凹凸不平,呈弹坑状或蜂窝状,釉柱轮廓不清,晶体排列紊乱甚至消失.中度氟斑牙居于二者之间.冷光美白后,正常牙和氟斑牙釉质表面低倍镜下均未见明显改变,高倍镜下散在浅碟状凹坑;中重度氟斑牙还伴有大量粟粒状小孔.结论:随着氟斑牙严重程度的加重,釉质表层损害程度加重.冷光美白造成釉质表层的轻微脱矿,氟斑牙稍重于正常牙.从结构和漂白后釉质表面脱矿程度方面进一步探讨氟斑牙的表面结构特点,从而为氟斑牙的临床治疗提供基础数据.     

新型激光光敏根管消毒剂在牙本质中渗透性的研究

目的:观察新型激光光敏根管消毒剂、甲苯胺蓝和亚甲基蓝在牙本质中的渗透效果,评价三种光敏剂在牙本质中的渗透性。方法:收集新鲜拔除的离体单根管牙90颗,根管预备后随机分为三组。每组30颗。A组为新型激光光敏根管消毒剂组;B组为甲苯胺蓝组;C组为亚甲基蓝组。A、B、C三组实验根管内分别用浸有饱和的新型激光光敏根管消毒剂、甲苯胺蓝和亚甲基蓝的棉捻在根管内停留60秒。沿牙体长轴颊舌纵向劈开,倒置荧光显微镜下观察并拍照,用Photoshop8.01软件测量三种光敏剂渗透入牙本质的平均深度。结果:新型激光光敏根管消毒剂在牙本质内的渗透平均深度为553.25μm,甲苯胺蓝在牙本质内的渗透平均深度为350.75μm,亚甲基蓝在牙本质内的渗透平均深度为168.25μm。结论:新型激光光敏根管消毒剂在牙本质渗透性明显优于甲苯胺蓝和亚甲基蓝,具有良好的牙本质渗透性。     

光学相干成像技术无创监测Er:YAG激光消融后人牙本质表面变性层

为探讨利用光学相干成像技术(OCT)定量评估Er:YAG激光消融后牙本质表面特征的可行性,以人无龋第三磨牙为试验样品,制备牙本质圆盘,用50μs超短脉宽Er:YAG激光在水喷雾下垂直切削牙本质表面,对照组为金刚砂球钻切削和砂纸抛光组,OCT观察表层性状及测量表层光强改变,组织病理切片分析表层结构;表面切削后使用37%磷酸蚀刻30 s,扫描电镜(SEM)观察表面形貌,能量色散X射线光谱仪(EDX)测量表面元素组成。OCT显示,所有试验组牙本质表层光散射特性均发生改变,可见高亮层形成,激光组高亮层厚度高于砂纸组和球钻组(P0.05)。组织切片显示,激光组表层可见连续的嗜碱性深染改性层,球钻组及砂纸组改性层少且不连续,改性层厚度与OCT高亮层结果相关。SEM显示,酸蚀后激光组牙本质小管开口扩大,但未见胶原纤维网暴露。酸处理后激光组的钙、磷含量均高于砂纸及球钻组(P0.05),这意味着受激光影响的牙本质变得更耐酸。研究结果表明,OCT可能成为一种可精确评估牙本质表层特性的无创性工具,这将有助于牙医确定粘接修复策略。     

间歇性低压低氧预处理对大鼠放射性肝脏损伤的作用及肝脏组织TNF-α、HIF-1α表达的影响

目的:探讨间歇性低压低氧预处理对大鼠放射性肝脏损伤的保护作用及肝脏组织TNF-α、HIF-1α表达的影响。方法:将24只健康SPF级SD大鼠随机分为对照组(C)、照射组(R)、间歇性低压低氧预处理联合照射组(IHHP+R),于照射后6小时处死小鼠切取2块肝脏组织,采用HE染色观察肝脏的病理形态学变化,免疫组化检测肝脏TNF-α、HIF-1α的表达。结果:R组大鼠肝脏切片镜下可见中央静脉充血,肝窦淤血,肝细胞肿大,出现片状嗜酸样变性;IHHP+R组大鼠肝脏切片镜下可见中央静脉充血、肝窦淤血、肝细胞肿大程度均较R组减轻,未见嗜酸样变性。与C组相比,与C组相比,TNF-α在R组表达明显增高(P0.05),IHHP+R组TNF-α表达显著低于R组(P0.05)。C组和R组HIF-1α的表达比较差异无统计学意义(P0.05),但HIF-1α在IHHP+R组高表达,且显著高于R组(P0.05)。IHHP+R组TNF-α、HIF-1α表达呈负相关(r=-0.745,p=0.034)。结论:间歇性低压低氧处理可显著改善大鼠放射性肝脏损伤,可能与其提高HIF-1α的表达,进而抑制TNF-α的表达,减轻炎症反应有关。     

Effect of Er,Cr:YSGG Laser at Different Output Powers on the Micromorphology and the Bond Property of Non-Carious Sclerotic Dentin to Resin Composites

Background

The objective of this study was to investigate the influence of Er,Cr:YSGG laser irradiated at different powers on the micromorphology and the bonding property of non-carious sclerotic dentin to resin composites.

Methods

Two hundred bovine incisors characterized by non-carious sclerotic dentin were selected, and the seventy-two teeth of which for surface morphological analysis were divided into nine groups according to various treatments (A: the control group, B: only treated with the adhesive Adper Easy One, C: diamond bur polishing followed by Adper Easy One, D-I: Er,Cr:YSGG laser irradiating at 1W, 2W, 3W, 4W, 5W, 6W output power, respectively, followed by Adper Easy One). The surface roughness values were measured by the non-contact three-dimensional morphology scanner, then the surface micromorphologies of surfaces in all groups were assessed by scanning electron microscopy (SEM); meanwhile, Image Pro-Plus 6.0 software was used to measure the relative percentage of open tubules on SEM images. The rest, one hundred twenty-eight teeth for bond strength test, were divided into eight groups according to the different treatments (A: only treated with the adhesive Adper Easy One, B: diamond bur polishing followed by the above adhesive, C-H: Er,Cr:YSGG laser irradiating at 1 W, 2 W, 3 W, 4 W, 5 W, 6 W output power, respectively, followed by the above adhesive), and each group was subsequently divided into two subgroups according to whether aging is performed (immediately tested and after thermocycling). Micro-shear bond strength test was used to evaluate the bond strength.

Results

The 4W laser group showed the highest roughness value (30.84±1.93μm), which was statistically higher than the control group and the diamond bur groups (p<0.05). The mean percentages ((27.8±1.8)%, (28.0±2.2)%, (30.0±1.9)%) of open tubules area in the 4W, 5W, 6W group were higher than other groups (p<0.05). The 4W laser group showed the highest micro-shear bond strength not only in immediately tested (17.60±2.55 PMa) but after thermocycling (14.35±2.08MPa).

Conclusion

The Er,Cr:YSGG laser at 4W power can effectively improve the bonding property between non-carious sclerotic dentin and resin composites by increasing the roughness and mean percentage area of open tubules.     

Microbiological study and scanning electron microscopic analysis of root canal wall dentin following pumped Diodium Nd:YAG laser irradiation

The capability of Nd:YAG laser in sterilizing root canals and the alterations of dentinal walls induced by laser treatment were investigated. Thirty root canals were infected by P. aeruginosa ATCC 27853 and thirty canals by A. naeslundii CH-12. Within each infection, 4 groups were selected on the basis of the treatment. Among them, 2 test groups (TGs) were treated by Nd:YAG laser at 15 Hz for 15 s, using 2 different settings: 1 Watt/70 Joule and 1.5 Watt/100 Joule, respectively (n = 10 each). The other 2 groups, used as controls (CGs), were: untreated (positive control, n = 5) and sterilized by 5.25% NaClO group (negative control, n = 5). Observations under scanning electron microscope (SEM) and quantitative bacterial counts were performed. These analyses were performed once per group after infections and treatments. Laser treatments significantly reduced the number of both bacteria. SEM investigation showed melting and crystallization of canal dentin over 1.5 W/100 J. Laser irradiation has a bactericidal effect but it does not completely sterilize the root canal as NaClO 5.25% solution does if the goal of treatment is also to avoid alterations of dentinal walls.     

热牙胶充填与冷牙胶侧方加压在根管充填中应用的临床效果比较

目的:比较热牙胶充填与冷牙胶侧方加压在根管充填中应用的临床效果。方法:选择62例急性牙髓炎和根尖周炎患者,均分后分别选择热牙胶充填与冷牙胶侧方加压的方法进行根管充填,比较两组患者根管充填时间、术后牙周疼痛病例和术后3个月后充填质量及临床疗效。结果:两组患者术后牙周疼痛病例比较,差异无统计学意义(P>0.05);其余各方面比较,差异均均有统计学意义(P>0.05),热牙胶组优于冷牙胶组。结论:临床进行根管充填治疗时,应首选热牙胶充填的方式,可显著提高临床疗效,且不增加患者术后牙周疼痛的发生。     

纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响

摘要 目的：探讨纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响。方法：选取2018年1月至2019年3月期间我院收治的103例患者作为研究对象,按修复材料的不同分为对照组（n=52,患牙62颗）和研究组（n=51,患牙63颗）。对照组给予金属桩核、金属烤瓷冠修复,研究组给予纤维桩、纳米复合树脂结合氧化锆烤瓷冠修复。修复1年后,评价两组的修复成功率和修复效果。比较两组修复前及修复后1年的牙龈指数、菌斑指数、牙周探诊深度、龈沟液量及龈沟液中碱性磷酸酶（ALP）、天门冬氨酸转氨酶（AST）水平。结果：研究组的修复成功率比对照组高（P<0.05）。研究组修复体的表面光滑率、边缘密合性、固定良好率及颜色匹配率均明显高于对照组（P<0.05）。两组治疗后牙龈指数、菌斑指数及牙周探诊深度均明显低于治疗前（P<0.05）,龈沟液量及龈沟液中ALP、AST水平均明显低于治疗前（P<0.05）,同时研究组治疗后牙龈指数、菌斑指数及牙周探诊深度均低于对照组（P<0.05）,但两组治疗后龈沟液量及龈沟液中ALP、AST水平比较无差异（P>0.05）。结论：纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损的修复成功率高,修复后美学效果佳,对牙周组织影响小。     

SEM analysis of dental enamel morphological structures on the basis of their replicas in patients with systemic calcium deficiency

The aim of the present study is to examine microscopically the surface of dental enamel by using a scanning electron microscope (SEM), using their replicas formed in female patients with diagnosed periodontal diseases and systemic calcium deficiency. Replicas of dental enamel surfaces in patients referred for treatment of periodontal diseases were subjected to microscopic analysis. The replicas, after coating with platinum-palladium alloy, were examined under the scanning electron microscope at magnifications of 15–5000 x. Densitometric examinations of spine (L₂ - L₄ segment) revealed bone mineral density BMD T-score lower than −2.5 in 5 patients, in the range of −1.5 to −2.5 in 10 patients, and higher than −1.5 in the remaining patients. Non-homogenous images of surfaces in the form of light and dark areas were observed. Light areas corresponded to damaged surfaces of dental tissues. Patients with higher systemic calcium deficiency had areas lighter in color. More of these areas were found in patients with higher systemic calcium deficiency. It can be assumed that the calcium deficit is likely to appear in the selected dental tissues, particularly in the dental enamel.     

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

Objective: The aim of this study was to describe the oral health status of older adults living in north‐eastern Germany. Materials and Methods: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross‐sectional, population‐based study. Data on 1446 subjects aged 60–79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss. Results: The prevalence of edentulousness varied from 16% in the 60–65‐year‐old group to 30% in the 75–79‐year‐old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60–65 years) to one in the oldest (75–79 years). Among subjects aged 60–69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70–79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70–79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60–69 years: 85% vs. 71% in 70–79‐year‐old men; women aged 60–69 years: 71% vs. 62% in 70–79‐year‐olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern. Conclusions: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.