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      Er:YAG 激光對牙本質(zhì)粘接性能影響的研究進展

      2019-11-06 17:26:32王曉侃
      中國保健營養(yǎng) 2019年11期
      關(guān)鍵詞:激光

      王曉侃

      【摘 ?要】 Er:YAG激光屬于中紅外線激光,擁有適合切割牙體硬組織的特點。激光牙體預(yù)備與傳統(tǒng)預(yù)備方法相比具有許多優(yōu)點,可減輕治療過程中的不適感和疼痛,患者更易接受。目前該激光已在臨床逐漸開展使用,同時對該激光在牙體預(yù)備中的應(yīng)用和研究不斷深入,本文就其對牙本質(zhì)粘接強度等的影響進行綜述。

      【關(guān)鍵詞】Er:YAG 激光;牙本質(zhì)粘接;拉伸強度;剪切強度

      【中圖分類號】R249 ??【文獻標(biāo)識碼】A???【文章編號】1004-7484(2019)10-0147-02

      Er:YAG(鉺:釔、鋁、石榴石)激光是一種水動力生物激光系統(tǒng),Hibst等[1]于1989年首次提出該激光能有效切割牙體硬組織,并在1997年獲得美國食品藥品監(jiān)督管理局認(rèn)證[2]。激光避免了傳統(tǒng)渦輪機鉆震動、噪音及產(chǎn)熱高的缺點,并能預(yù)防過多的切削正常牙體組織,已有學(xué)者將其與噴砂、渦輪機鉆相比較,發(fā)現(xiàn)激光去齲產(chǎn)生的疼痛最低[3]。

      牙本質(zhì)在經(jīng)激光照射后其表面形貌、成分以及結(jié)構(gòu)均發(fā)生了改變,關(guān)于這些變化將如何影響其粘接效果,已有眾多學(xué)者展開研究。本文擬就Er:YAG激光對牙本質(zhì)粘接性能影響的研究進展作一簡要綜述。

      1 ??Er:YAG激光切割牙體硬組織的原理

      Er:YAG激光的波長為2.94μm,對紅外線的吸收峰值與水以及羥磷灰石中的OH-接近,激光能量可被照射區(qū)組織中的水分子充分吸收[4],具有超高能量的水分子作用于光照處的牙體組織產(chǎn)生微爆炸從而進行組織切割,但所產(chǎn)生的溫度并未達(dá)到牙體組織的熔點[5]。齲壞牙本質(zhì)含水量可高達(dá)54%[6],經(jīng)鉺激光預(yù)備時會優(yōu)先爆破崩解,雖然該激光切割有效、安全,但熱傳導(dǎo)現(xiàn)象仍不可避免,預(yù)備時需使用水霧冷卻,以免對牙髓組織造成熱損傷[7]。

      2 ??Er:YAG激光對牙本質(zhì)粘接性能的影響

      Er:YAG激光預(yù)備后的洞形,呈現(xiàn)出不規(guī)則邊緣及粗糙的洞壁洞底,且牙本質(zhì)還伴有溶解性和滲透性的改變。有學(xué)者發(fā)現(xiàn),經(jīng)激光預(yù)備的牙本質(zhì)礦物含量及硬度高于傳統(tǒng)方法預(yù)備,牙本質(zhì)表面雖粗糙但未完全脫礦[8]。Guven等[9-10]分析比較了鉺激光和金剛砂車針預(yù)備后牙本質(zhì)上自酸蝕及酸蝕沖洗類粘接劑的牙本質(zhì)剪切強度,發(fā)現(xiàn)激光+AdperSE Plus組獲得的剪切強度顯著高于車針預(yù)備組,而其他兩組間不存在統(tǒng)計學(xué)差異。

      da Silva等[11]也進行了相似的研究,發(fā)現(xiàn)無論使用何種粘接劑,兩種方法所獲得的剪切強度相近。Gurgan等[12]比較了2種粘接劑在激光及車針預(yù)備牙本質(zhì)表面的剪切強度,其中激光+AdheSE組與車針處理組無顯著差異,而激光+Excite組的強度卻明顯偏低,提示自酸蝕粘接系統(tǒng)可能更適合于激光預(yù)備后的牙本質(zhì)。另有學(xué)者比較了5種不同粘接系統(tǒng)在經(jīng)渦輪機和激光預(yù)備的健康牙本質(zhì)上的粘接強度,發(fā)現(xiàn)使用激光并沒有顯著改變其粘接強度[13]。Ding等[1]在經(jīng)Er:YAG激光預(yù)備的牙本質(zhì)上評估了低通量激光和磷酸預(yù)處理對2種自酸蝕粘接劑強度的影響。結(jié)果顯示,磷酸預(yù)處理組的拉伸強度最高,對照組與激光處理組之間不存在顯著差異。Akin等[15]比較了激光和車針處理牙面后,老化過程對自酸蝕粘接劑粘接強度的影響,發(fā)現(xiàn)激光和車針處理組之間不存在顯著差異,兩者可獲得同樣的粘接耐久性。

      又有許多科學(xué)家得出了相反的結(jié)論。Shirani等[16]比較了Single Bond和Clearfil SE Bond在激光預(yù)備后牙本質(zhì)上的剪切強度,結(jié)果顯示后者在激光預(yù)備表面的粘接強度顯著降低。Brulat等[17]的結(jié)果發(fā)現(xiàn),雖然激光預(yù)備過的牙本質(zhì)表面沒有玷污層,但自酸蝕粘接系統(tǒng)只能達(dá)到與車針預(yù)備相同甚至更低的粘接強度。Koliniotou-Koumpia等[18]也得出相似結(jié)論,認(rèn)為激光照射過的牙本質(zhì)表面,無論其深度或粘接劑的種類,均表現(xiàn)出更差的粘接強度。Ferreira[19]等比較了不同酸蝕時間對Single Bond在激光預(yù)備牙本質(zhì)上拉伸強度的影響,發(fā)現(xiàn)改變酸蝕時間未產(chǎn)生顯著變化,均低于傳統(tǒng)方法處理組。此外,Neves等[20]比較了7種常用去齲方法處理后,自酸蝕粘接劑在剩余牙本質(zhì)表面的拉伸強度,發(fā)現(xiàn)激光處理組所得的值最低。也有學(xué)者進行了相似的研究,發(fā)現(xiàn)無論使用自酸蝕或酸蝕沖洗粘接系統(tǒng),激光組與車針組之間的粘接強度均未存在顯著差異[21]。Koyuturk等[22]在乳磨牙上做了類似的研究,認(rèn)為經(jīng)鉺激光處理過的牙本質(zhì)可獲得更高的粘接強度,且當(dāng)使用Clearfil S3 bond時能獲得較好結(jié)果。Yildiz等[23]提出了不同的結(jié)論,認(rèn)為對乳牙而言不論使用自酸蝕或酸蝕沖洗粘接劑,車針去齲所獲得的粘接強度均高于激光。

      3 ?Er:YAG激光參數(shù)的影響

      Baraba等[24]比較了激光不同脈沖寬度對粘接強度的影響,發(fā)現(xiàn)使用短波及中短波并不降低或提升自酸蝕粘接劑的拉伸強度,同時超短波組所得的值最低,可能不適用處理牙本質(zhì)。Gisler等[25]研究了不同激光能量對粘接強度的影響,認(rèn)為當(dāng)激光能量密度稍高于牙本質(zhì)燃燒閾值時會獲得更高的粘接強度。也有學(xué)者在乳牙上得到了相似的結(jié)論,認(rèn)為200mJ及300mJ的激光對乳牙預(yù)備而言是安全有效的,能量過高會損傷牙本質(zhì)[26]。de Oliveira等[27]又分析了不同能量重復(fù)率比的激光對粘接強度的影響,結(jié)果顯示自酸蝕粘接劑的粘接強度均高于酸蝕沖洗類

      還有學(xué)者研究了在經(jīng)渦輪機預(yù)備的牙本質(zhì)表面上激光毛化對粘接強度的影響[28],通過在牙本質(zhì)表面預(yù)備相距一定距離的、大小相同的微坑,發(fā)現(xiàn)間距100?m組所得的剪切強度最高,這為提高粘接效果提供了一種新的解決方法。

      參考文獻

      [1] Hibst R, Keller U. Experimental studies of the application of the Er:YAG laser on dental hard substances:I.Measurement of the ablation rate [J]. Lasers Surg Med,1989, 9(4):338-344.

      [2] Keller U,Hibst R. Experimental studies of the application of the Er∶YAG laser on dental hard substances:Ⅱ. Light microscopic and SEM investigations[J]. Lasers Surg Med,1989,9(4):345-351.

      [3] Okamoto K, Aoki S, Tamura Y. Comparisons of discomfort among cutting instruments for removal of carious dentine in children[J]. Pediatric Dental Journal, 2014.

      [4] Vogel A,Venugopalan V. Mechanisms of pulsed laser ablation of biological tissues[J]. Chem Rev,2003,103(2):577-644.

      [5] Kilinc E, Roshkind D M, Antonson S A, et al. Thermal safety of Er: YAG and Er, Cr: YSGG lasers in hard tissue removal[J]. Photomedicine and laser surgery, 2009, 27(4): 565-570.

      [6] Hibst R,Keller U. Effects of water spray and repetition rate on the temperature evaluation during Er∶YAG laser ablation of dentine[J]. SPIE,1996,2623:139-144.

      [7] Ito S,Saito T,Tay FR,et al. Water content and apparent stiffness of non-caries versus caries-affected human dentin[J]. J Biomed Mater Res B Appl Biomater,2005,72(1):109-116.

      [8] Arbabzadeh F, Birang E, Nazem R, et al. A Comparative Study on Micro Hardness and Structural Changes of Dentin Floor Cavity Prepared by Er: YAG Laser Irradiation and Mechanical Bur[J]. Journal of Dentistry, Shiraz University of Medical Sciences, 2013, 14(2): 73-77.

      [9] Guven Y, Aktoren O. Shear bond strength and ultrastructural interface analysis of different adhesive systems to Er: YAG laser-prepared dentin[J]. Lasers in medical science, 2013: 1-10.

      [10] Moldes V L, Capp C I, Navarro R S, et al. In vitro microleakage of composite restorations prepared by Er: YAG/Er, Cr: YSGG lasers and conventional drills associated with two adhesive systems[J]. J Adhes Dent, 2009, 11(3): 221-229.

      [11] da Silva M P, Barceleiro M O, Dias K R, et al. Shear bond strength of two adhesive systems bonded to Er: YAG laser-prepared dentin[J]. General dentistry, 2010, 59(3): 96-100.

      [12] Gurgan S, Kiremitci A, Cakir F Y, et al. Shear bond strength of composite bonded to erbium: yttrium-aluminum-garnet laser-prepared dentin[J]. Lasers in medical science, 2009, 24(1): 117-122.

      [13] Jiang Q, Chen M, Ding J. Comparison of tensile bond strengths of four one-bottle self-etching adhesive systems with Er: YAG laser-irradiated dentin[J]. Molecular biology reports, 2013, 40(12): 7053-7059.

      [14] Ding J, He Y, Chen Y, et al. Effect of pretreatment on Er: YAG laser-irradiated dentin[J]. Lasers in medical science, 2013: 1-7.

      [15] Akin G E, Herguner-Siso S, Ozcan M, et al. Bond strengths of one-step self-etch adhesives to laser-irradiated and bur-cut dentin after water storage and thermocycling[J]. Photomedicine and laser surgery, 2012, 30(4): 214-221.

      [16] Shirani F, Birang R, Malekipur M R, et al. Adhesion to Er: YAG laser and bur prepared root and crown dentine[J]. Australian dental journal, 2012, 57(2): 138-143.

      [17] Brulat N, Rocca J P, Leforestier E, et al. Shear bond strength of self-etching adhesive systems to Er: YAG-laser-prepared dentin[J]. Lasers in medical science, 2009, 24(1): 53-57.

      [18] Koliniotou-Koumpia E, Kouros P, Zafiriadis L, et al. Bonding of adhesives to Er: YAG laser-treated dentin[J]. European journal of dentistry, 2012, 6(1): 16-23.

      [19] Ferreira L S, Apel C, Francci C, et al. Influence of etching time on bond strength in dentin irradiated with erbium lasers[J]. Lasers in medical science, 2010, 25(6): 849-854.

      [20] Neves A A, Coutinho E, Cardoso M V, et al. Micro-tensile bond strength and interfacial characterization of an adhesive bonded to dentin prepared by contemporary caries-excavation techniques[J]. Dental Materials, 2011, 27(6): 552-562.

      [21] Sirin Karaarslan E, Yildiz E, Cebe M A, et al. Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques[J]. Journal of dentistry, 2012, 40(10): 793-801.

      [22] Koyuturk A E, Ozmen B, Cortcu M, et al. Effects of Er: YAG laser on bond strength of self‐etching adhesives to caries‐affected dentin[J]. Microscopy Research and Technique, 2014,77(4):282-288.

      [23] Yildiz E, Sirinkaraarslan E, Yegin Z, et al. Effect of caries removal techniques on the bond strength of adhesives to caries-affected primary dentin in vitro[J]. European journal of paediatric dentistry: official journal of European Academy of Paediatric Dentistry, 2013, 14(3): 209-214.

      [24] Navarro R S, Gouw-Soares S, Cassoni A, et al. The influence of erbium: yttrium–aluminum–garnet laser ablation with variable pulse width on morphology and microleakage of composite restorations[J]. Lasers in medical science, 2010, 25(6): 881-889.

      [25] Gisler G, Gutknecht N. The influence of the energy density and other clinical parameters on bond strength of Er: YAG-conditioned dentin compared to conventional dentin adhesion[J]. Lasers in medical science, 2014, 29(1): 77-84.

      [26] Zhang S, Chen T, Ge L. Scanning electron microscopy study of cavity preparation in deciduous teeth using the Er: YAG laser with different powers[J]. Lasers in medical science, 2012, 27(1): 141-144.

      [27] de Oliveira M T, Reis A F, Arrais C A G, et al. Analysis of the interfacial micromorphology and bond strength of adhesive systems to Er: YAG laser-irradiated dentin[J]. Lasers in medical science, 2013, 28(4): 1069-1076.

      [28] Samad-Zadeh A, Harsono M, Belikov A, et al. The influence of laser-textured dentinal surface on bond strength[J]. Dental materials, 2011, 27(10): 1038-1044.

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