牙本质敏感症激光治疗的研究进展
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摘要
牙本质敏感症的发生主要与磨耗、磨损、酸蚀症、隐裂、楔状缺损、牙釉质发育不全、龋病以及牙龈退缩导致牙颈部无牙釉质或牙骨质遮挡的牙本质小管直接暴露于口腔环境中相关。对于牙本质敏感症的治疗主要是封闭暴露的牙本质小管和降低牙髓神经的兴奋性,激光治疗作为一种安全、快捷、方便的治疗措施,单独使用或与其他药剂联合应用均获得了良好的疗效,越来越受到大家的重视。本文从几种常用激光治疗的机制、参数选择及适用范围综述其在牙本质敏感症治疗中的研究进展,文献复习结果表明,Nd:YAG激光穿透力强,热效应高,极短时间内使牙本质小管中蛋白质变性凝固;CO_2激光对牙髓损伤小且即刻疗效明显,通过对羟基磷灰石中水分子的高吸收使牙本质表面发生熔融和再结晶;Er:YAG激光吸水性和热效应高,通过使牙本质管液蒸发、盐类沉积从而堵塞小管;Er,Cr:YSGG激光能量可以被羟基磷灰石和水充分吸收,通过同时切削牙体硬组织和熔融管周牙本质从而脱敏;Ga-Al-As半导体激光和He:Ne激光属于低能量激光,主要改变神经纤维对钾离子和钠离子的通透性,使神经纤维去极化从而产生镇痛作用。激光联合脱敏剂可提高牙本质敏感症的临床治疗效果。以上几种激光在牙本质敏感症的治疗中具有重要应用前景。
Dentin hypersensitivity is mainly associated with abrasion,wear,acid etching,cracking,wedge-shaped defects,enamel hypoplasia,caries,a lack of neck enamel,and cementum coverage accompanied by gingival recession,resulting in direct exposure of dentin tubules to the oral environment.Dentin hypersensitivity is mainly treated by sealing the exposed dentin tubules and reducing the excitability of the pulpal nerves.Laser therapy,as a safe,fast and convenient treatment measure,has achieved good results both alone and in combination with other medicines and has attracted increasing attention.This paper reviews the research progress in the treatment of dentin hypersensitivity using several common laser therapy mechanisms with parameter selections in various scopes of application.A review of the literature shows that the Nd:YAG laser has a strong penetrating power and a large thermal effect and can denature and coagulate proteins in dentin tubules in a very short time; while the CO_2 laser causes little damage to the dental pulp and has an obvious immediate curative effect by high absorption of water molecules in hydroxyapatite and the dentin surface is melted and recrystallized; the Er:YAG laser has high water absorption and a large thermal effect and can block the tubules by evaporating the fluid in the tubules and depositing salts; Er,Cr:YSGG laser energy can be fully absorbed by hydroxyapatite and water and result in desensitization by cutting hard tissues and melting periodontal dentin of the tube simultaneously; The Ga-Al-As semiconductor laser and He:Ne laser are low energy.The laser dosage mainly changes the permeability of nerve fibers to potassium and sodium ions and depolarizes the nerve fibers,producing an analgesic effect.The combination of a laser with a desensitizer can improve the clinical efficacy of treating dentin hypersensitivity.
Dentin hypersensitivity is mainly associated with abrasion,wear,acid etching,cracking,wedge-shaped defects,enamel hypoplasia,caries,a lack of neck enamel,and cementum coverage accompanied by gingival recession,resulting in direct exposure of dentin tubules to the oral environment.Dentin hypersensitivity is mainly treated by sealing the exposed dentin tubules and reducing the excitability of the pulpal nerves.Laser therapy,as a safe,fast and convenient treatment measure,has achieved good results both alone and in combination with other medicines and has attracted increasing attention.This paper reviews the research progress in the treatment of dentin hypersensitivity using several common laser therapy mechanisms with parameter selections in various scopes of application.A review of the literature shows that the Nd:YAG laser has a strong penetrating power and a large thermal effect and can denature and coagulate proteins in dentin tubules in a very short time; while the CO_2 laser causes little damage to the dental pulp and has an obvious immediate curative effect by high absorption of water molecules in hydroxyapatite and the dentin surface is melted and recrystallized; the Er:YAG laser has high water absorption and a large thermal effect and can block the tubules by evaporating the fluid in the tubules and depositing salts; Er,Cr:YSGG laser energy can be fully absorbed by hydroxyapatite and water and result in desensitization by cutting hard tissues and melting periodontal dentin of the tube simultaneously; The Ga-Al-As semiconductor laser and He:Ne laser are low energy.The laser dosage mainly changes the permeability of nerve fibers to potassium and sodium ions and depolarizes the nerve fibers,producing an analgesic effect.The combination of a laser with a desensitizer can improve the clinical efficacy of treating dentin hypersensitivity.
引文
[1]Trushkowsky RD,Garcia-Godoy F.Dentin hypersensitivity:differential diagnosis,tests,and etiology[J].Compend Contin Educ Dent,2014,35(2):99-104.
[2]West N,Seong J,Davies M.Dentine hypersensitivity[J].Monogr Oral Sci,2014,25:108-122.
[3]Brannstrom M,Linden LA,Astrom A.The hydrodynamics of the dental tubule and of pulp fluid.A discussion of its significance in relation to dentinal sensitivity[J].Caries Res,1967,1(4):3 10-317.
[4]Ozlem K,Esad GM,Ayse A,et al.Efficiency of lasers and a desensitizer agent on dentin hypersensitivity treatment:a clinical study[J].Niger J Clin Pract,2018,21(2):225-230.
[5]Saluja M,Grover HS,Choudhary P.Comparative morphologic evaluation and occluding effectiveness of Nd:YAG,CO2 and diode lasers on exposed human dentinal tubules:an in vitro SEM study[J].J Clin Diagn Res,2016,10(7):ZC66-ZC70.
[6]Asnaashari M,Moeini M.Effectiveness of lasers in the treatment of dentin hypersensitivity[J].J Lasers Med Sci,2013,4(1):1-7.
[7]李雪英,林敏,从丛,等.Nd:YAG激光作用下牙本质脱敏机制的研究[J].西安交通大学学报:医学版,2015,36(2):275-279.
[8]Talesara K,Kulloli A,Shetty S,et al.Evaluation of potassium binoxalate gel and Nd:YAG laser in the management of dentinal hypersensitivity:a split-mouth clinical and ESEM study[J].Lasers Med Sci,2014,29(1):61-68.
[9]雷科,王伦昌,李龙江,等.多乐氟-氟化钠护齿剂与Nd:YAG激光联合治疗牙本质过敏症的临床研究[J].口腔材料器械杂志,2015,24(1):19-22.
[10]Tosun S,Culha E,Aydin U,et al.The combined occluding effect of sodium fluoride varnish and Nd:YAG laser irradiation on dentinal tubules-A CLSM and SEM study[J].Scanning,2016,38(6):619-624.
[11]Dilsiz A,Canakci V,Ozdemir A,et al.Clinical evaluation of Nd:YAG and 685-nm diode laser therapy for desensitization of teeth with gingival recession[J].Photomed Laser Surg,2009,27(6):843-848.
[12]Cunha SR,Garofalo SA,Zezell DM,et al.The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity[J].Lasers Med Sci,2017,32(4):873-880.
[13]Zhang C,Matsumoto K,Kimura Y,et al.Effects of CO2 laser in treatment of cervical dentinal hypersensitivity[J].J Endod,1998,24(9):595-597.
[14]Moritz A,Gutknecht N,Schoop U,et al.The advantage of CO2-treated dental necks,in comparison with a standard method:results of an in vivo study[J].J Clin Laser Med Surg,1996,14(1):27-32.
[15]张晋,陈曼丽,高晓蔚.CO2激光联合氟化亚锡凝胶治疗牙颈部敏感症的疗效分析[J].中国美容医学,2015,24(18):50-52.
[16]Chen CL,Parolia A,Pau A,et al.Comparative evaluation of the effectiveness of desensitizing agents in dentine tubule occlusion using scanning electron microscopy[J].Aust Dent J,2015,60(1):65-72.
[17]Belal MH,Yassin A.A comparative evaluation of CO2 and erbium-doped yttrium aluminium garnet laser therapy in the management of dentin hypersensitivity and assessment of mineral content[J].J Periodontal Implant Sci,2014,44(5):227-234.
[18]Mohammed AA,Ali SM,Tamara SA,et al.The effects of CO2 laser with or without nanohydroxyapatite paste in the occlusion of dentinal tubules[J].Sci World J,2014:798732.
[19]Yu CH,Chang YC.Clinical efficacy of the Er:YAG laser treatment on hypersensitive dentin[J].J Fonnos Med Assoc,2014,113(6):388-391.
[20]Schwarz F,Arweiler N,Georg T,et al.Desensitizing effects of an Er:YAG laser on hypersensitive dentine[J].J Clin Periodontol,2002,29(3):211-215.
[21]董菁杰,丁亚娟,陈亚明.Er:YAG激光联合生物活性玻璃治疗牙本质过敏症的体外研究[J].中国激光医学杂志,2015,24(2):64-68,115-116.
[22]Tunar OL,Gursoy H,Cakar G,et al.Evaluation of the effects of Er:YAG laser and desensitizing paste containing 8%arginine and calcium carbonate,and their combinations on human dentine tubules:a scanning electron microsc:opipic analysis[J].Photomed Laser Surg,2014,32(10):540-545.
[23]Al-Omari WM,Palamara JE.Effec:t of Er,Cr:YSGG laser on human dentin fluid flow[J].Lasers Med Sci,2013,28(6):1445-1451.
[24]刘思婧,李埙.不同能量Er,Cr:YSGG激光照射对牙体硬组织抗酸作用的体外研究[J].实用口腔医学杂志,2017,33(4):464-468.
[25]Tengrungsun T,Sangkla W.Comparative study in desensitizing efficacy using the GaAlAs laser and dentin bonding agent[J].J Dent,2008,36(6):392-395.
[26]Apel C,Meister J,Schmitt N,et al.Calcium solubility of dental enamel following sub-ablative Er:YAG and Er:YSGG laser irradiation in vitro[J].Lasers Surg Med,2002,30(5):337-341.
[27]Umberto R,Claudia R,Gaspare P,et al.Treatment of dentine hypersensitivity by diode laser:a clinical study[J].Int J Dent,2012.2012:858950.
[28]Suri I,Singh P,Qj S,et al.A comparative evaluation to assess the efficacy of 5%Sodium fluoride varnish and diode laser and their combined application in the treatment of dentin hypersensitivity[J].J Indian Soc Periodontol,2016,20(3):307-314.
[29]Kawakami T,Ibaraki Y,Haraguchi K,et al.The effectiveness of GaAlAs semiconductor laser treatment to pain decrease after irradiation[J].Higashi Nihon Shigaku Zasshi,1989,8(1):57-62.
[30]Gelskey SC,White JM,Pruthi VK.The effectiveness of the Nd:YAG laser in the treatment of dental hypersensitivity[J].J Can Dent Assoc,1993,59(4):383-386.
[31]Senda A,Gomi A,Tani T,et al.A clinical study on"soft laser632",a He-Ne low energy medical laser.1:pain relief immediately after irradiation[J].Aichi Gakuin Daigaku Shigakkai Shi,1985.23(4):773-780.
[32]尚君兰,苏萍,王贺伟.氦氖激光和氟化钠甘油治疗牙本质过敏症的疗效比较[J].临床医学,1999,19(12):33-34.
[2]West N,Seong J,Davies M.Dentine hypersensitivity[J].Monogr Oral Sci,2014,25:108-122.
[3]Brannstrom M,Linden LA,Astrom A.The hydrodynamics of the dental tubule and of pulp fluid.A discussion of its significance in relation to dentinal sensitivity[J].Caries Res,1967,1(4):3 10-317.
[4]Ozlem K,Esad GM,Ayse A,et al.Efficiency of lasers and a desensitizer agent on dentin hypersensitivity treatment:a clinical study[J].Niger J Clin Pract,2018,21(2):225-230.
[5]Saluja M,Grover HS,Choudhary P.Comparative morphologic evaluation and occluding effectiveness of Nd:YAG,CO2 and diode lasers on exposed human dentinal tubules:an in vitro SEM study[J].J Clin Diagn Res,2016,10(7):ZC66-ZC70.
[6]Asnaashari M,Moeini M.Effectiveness of lasers in the treatment of dentin hypersensitivity[J].J Lasers Med Sci,2013,4(1):1-7.
[7]李雪英,林敏,从丛,等.Nd:YAG激光作用下牙本质脱敏机制的研究[J].西安交通大学学报:医学版,2015,36(2):275-279.
[8]Talesara K,Kulloli A,Shetty S,et al.Evaluation of potassium binoxalate gel and Nd:YAG laser in the management of dentinal hypersensitivity:a split-mouth clinical and ESEM study[J].Lasers Med Sci,2014,29(1):61-68.
[9]雷科,王伦昌,李龙江,等.多乐氟-氟化钠护齿剂与Nd:YAG激光联合治疗牙本质过敏症的临床研究[J].口腔材料器械杂志,2015,24(1):19-22.
[10]Tosun S,Culha E,Aydin U,et al.The combined occluding effect of sodium fluoride varnish and Nd:YAG laser irradiation on dentinal tubules-A CLSM and SEM study[J].Scanning,2016,38(6):619-624.
[11]Dilsiz A,Canakci V,Ozdemir A,et al.Clinical evaluation of Nd:YAG and 685-nm diode laser therapy for desensitization of teeth with gingival recession[J].Photomed Laser Surg,2009,27(6):843-848.
[12]Cunha SR,Garofalo SA,Zezell DM,et al.The association between Nd:YAG laser and desensitizing dentifrices for the treatment of dentin hypersensitivity[J].Lasers Med Sci,2017,32(4):873-880.
[13]Zhang C,Matsumoto K,Kimura Y,et al.Effects of CO2 laser in treatment of cervical dentinal hypersensitivity[J].J Endod,1998,24(9):595-597.
[14]Moritz A,Gutknecht N,Schoop U,et al.The advantage of CO2-treated dental necks,in comparison with a standard method:results of an in vivo study[J].J Clin Laser Med Surg,1996,14(1):27-32.
[15]张晋,陈曼丽,高晓蔚.CO2激光联合氟化亚锡凝胶治疗牙颈部敏感症的疗效分析[J].中国美容医学,2015,24(18):50-52.
[16]Chen CL,Parolia A,Pau A,et al.Comparative evaluation of the effectiveness of desensitizing agents in dentine tubule occlusion using scanning electron microscopy[J].Aust Dent J,2015,60(1):65-72.
[17]Belal MH,Yassin A.A comparative evaluation of CO2 and erbium-doped yttrium aluminium garnet laser therapy in the management of dentin hypersensitivity and assessment of mineral content[J].J Periodontal Implant Sci,2014,44(5):227-234.
[18]Mohammed AA,Ali SM,Tamara SA,et al.The effects of CO2 laser with or without nanohydroxyapatite paste in the occlusion of dentinal tubules[J].Sci World J,2014:798732.
[19]Yu CH,Chang YC.Clinical efficacy of the Er:YAG laser treatment on hypersensitive dentin[J].J Fonnos Med Assoc,2014,113(6):388-391.
[20]Schwarz F,Arweiler N,Georg T,et al.Desensitizing effects of an Er:YAG laser on hypersensitive dentine[J].J Clin Periodontol,2002,29(3):211-215.
[21]董菁杰,丁亚娟,陈亚明.Er:YAG激光联合生物活性玻璃治疗牙本质过敏症的体外研究[J].中国激光医学杂志,2015,24(2):64-68,115-116.
[22]Tunar OL,Gursoy H,Cakar G,et al.Evaluation of the effects of Er:YAG laser and desensitizing paste containing 8%arginine and calcium carbonate,and their combinations on human dentine tubules:a scanning electron microsc:opipic analysis[J].Photomed Laser Surg,2014,32(10):540-545.
[23]Al-Omari WM,Palamara JE.Effec:t of Er,Cr:YSGG laser on human dentin fluid flow[J].Lasers Med Sci,2013,28(6):1445-1451.
[24]刘思婧,李埙.不同能量Er,Cr:YSGG激光照射对牙体硬组织抗酸作用的体外研究[J].实用口腔医学杂志,2017,33(4):464-468.
[25]Tengrungsun T,Sangkla W.Comparative study in desensitizing efficacy using the GaAlAs laser and dentin bonding agent[J].J Dent,2008,36(6):392-395.
[26]Apel C,Meister J,Schmitt N,et al.Calcium solubility of dental enamel following sub-ablative Er:YAG and Er:YSGG laser irradiation in vitro[J].Lasers Surg Med,2002,30(5):337-341.
[27]Umberto R,Claudia R,Gaspare P,et al.Treatment of dentine hypersensitivity by diode laser:a clinical study[J].Int J Dent,2012.2012:858950.
[28]Suri I,Singh P,Qj S,et al.A comparative evaluation to assess the efficacy of 5%Sodium fluoride varnish and diode laser and their combined application in the treatment of dentin hypersensitivity[J].J Indian Soc Periodontol,2016,20(3):307-314.
[29]Kawakami T,Ibaraki Y,Haraguchi K,et al.The effectiveness of GaAlAs semiconductor laser treatment to pain decrease after irradiation[J].Higashi Nihon Shigaku Zasshi,1989,8(1):57-62.
[30]Gelskey SC,White JM,Pruthi VK.The effectiveness of the Nd:YAG laser in the treatment of dental hypersensitivity[J].J Can Dent Assoc,1993,59(4):383-386.
[31]Senda A,Gomi A,Tani T,et al.A clinical study on"soft laser632",a He-Ne low energy medical laser.1:pain relief immediately after irradiation[J].Aichi Gakuin Daigaku Shigakkai Shi,1985.23(4):773-780.
[32]尚君兰,苏萍,王贺伟.氦氖激光和氟化钠甘油治疗牙本质过敏症的疗效比较[J].临床医学,1999,19(12):33-34.