半导体激光在牙周非手术治疗的应用研究进展

Clinical application progress on the diode laser in nonsurgical periodontal treatment

慢性牙周炎是由菌斑微生物引起得慢性炎症性疾病,去除菌斑结石是牙周非手术治疗的金标准。然而彻底清创难度较大,尤其在一些复杂的解剖位点,过度刮治又可能造成健康牙骨质的丧失导致术后根面敏感。研究表明半导体激光因其波长(630~1064 nm)接近血红素和黑色素的吸收峰值,在有血液的环境中能发挥最佳性能,在口腔领域具有广泛的应用前景。在牙周非手术治疗时半导体激光有软激光疗法、光动力疗法及低能量激光疗法3种治疗模式,可单一使用也可组合使用。虽然半导体激光无法代替机械治疗去除结石,但是其通过光热效应、光化学效应、生物刺激等作用可以去除感染的牙周袋上皮、改变微循环促进创面愈合及止血止痛等。半导体激光治疗效果取决于合适的治疗剂量,需精准掌控输出强度,控制照射时间,避免引起组织的热损伤。未来还需在分子水平上对其进行广泛的研究,了解组织的反应,同时还需更多高质量、大样本的随机对照试验来规范激光在牙周炎中的使用。

Chronic periodontitis is a chronic inflammatory disease caused by plaque microorganisms,and removal of plaque and calculus is the gold standard for nonsurgical periodontal treatment.However,complete debridement is diffi⁃cult,especially in some complex anatomical sites.Excessive scaling may result in the loss of healthy cementum and lead to dental hypersensitivity.Studies have shown that a diode laser can exhibit the best performance in an environ⁃ment with blood because its wavelengths(630⁃1064 nm)are close to the absorption peaks of heme and melanin and they have broad application prospects in the oral field.In nonsurgical periodontal treatment,diode lasers have three treatment modes:soft diode laser,antimicrobial photodynamic therapy and low⁃level laser therapy,which can be used alone or in combination.Although diode lasers cannot replace mechanical treatment to remove calculus,they can re⁃move infected periodontal pocket epithelium,change the microcirculation to promote wound healing,reduce bleeding and relieve pain through photothermal effects and biological stimulation.The effect of diode laser treatment depends on the treatment dose.It is necessary to precisely control the output intensity and control the irradiation time to avoid ther⁃mal damage to the tissue.In the future,extensive research at the molecular level is needed to reveal the tissue response.At the same time,more high⁃quality,large⁃sample randomized controlled trials are needed to standardize the use of la⁃sers for different stages and grades of periodontitis.