牙本质敏感症激光治疗的研究进展

Research progress in laser treatment of dentin hypersensitivity

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;CO2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 con. venient 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 CO2 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.