使用低能量雷射治療的矯正臨床研究

Abstract

本實驗使用波長970 nm低能量雷射分別對於（1）牙齒移動速率、（2）疼痛控制及（3）矯正後牙齒固位做臨床上的研究。在加速牙齒移動速率實驗中目前收入的病患為7位，病患納入條件為對稱拔除上腭第一小臼齒，在拉動犬齒後退時期，除了原定期每月例行回診外，能每週固定一次回診，以低能量雷射照射。雷射輸出為脈衝模式，模式一平均輸出功率為100 mW，單點照射能量密度為0.5 W/cm2（4 J/cm2），單顆牙齒接受總能量為8 J。模式二平均輸出功率為125 mW，單點照射能量密度為0.64 W/cm2（5.12 J/cm2），單顆牙齒接受總能量為為10 J。最終結果在統計學上有無照射對於牙齒移動並無顯著差別。 在疼痛控制方面，目前納入統計病患為34位，男性19位，平均年齡為25.42 yr ± 4.58 mon；女性15位，平均年齡為25.33 yr ± 5.20 mon。病患在換完矯正主線後採split mouth方法照射雷射，並回家填寫VAS問卷。使用的雷射設定為脈衝模式，模式一平均輸出功率為100 mW，單點照射能量密度為0.5 W/cm2（4 J/cm2），單顆牙齒接受總能量為6.4 J。模式二平均輸出功率為125 mW，單點照射能量密度為0.64 W/cm2（5.12 J/cm2），單顆牙齒接受總能量為8 J。最終結果發現在換完線後的第6小時、第12小時、第24小時男性的VAS數值顯著較女性大；而放置軟線後的第0天、第1天、第3天、第5天、第14天的疼痛指數也較硬線來得高；在換完線後有無照射雷射目前結果顯示對於病患疼痛指數則是沒有顯著影響。 在固位穩定度方面，目前納入實驗病人數為6人。病患納入條件為在未接受矯正治療前下顎雙側齒列擁擠或旋轉程度幾乎對稱。使用的雷射設定為脈衝模式，模式一平均輸出功率為100 mW，單點照射能量密度為0.5 W/cm2（4 J/cm2），單顆牙齒接受總能量為6.4 J。模式二平均輸出功率為125 mW，單點照射能量密度為0.64 W/cm2（5.12 J/cm2），單顆牙齒接受總能量為8 J。照射方式為split mouth，就目前結果發現有無照射雷射對於牙齒拆除矯正器後的維持度是沒有顯著影響的。

In this clinical orthodontic study, we evaluate the benefits of 970 nm low level laser using a split mouth design on patients with permanent dentition for its effects on the 1) rate of tooth movement, 2) pain control, and 3) tooth stability after debonding. Numbers of patients recruited in tooth movement study were seven. Inclusion criteria was maxilla bilateral first bicuspid extraction, and patients needed to come back once a week for laser irradiation. The settings of low level laser were pulse wave ; average output power in mode 1 was 100 mW; energy density per irradiated point was 0.5 W/cm2 (4 J/cm2); total energy each tooth received was 8 J. The average output power in mode 2 was 125 mW; energy density per irradiated point was 0.64 W/cm2 (5.12 J/cm2); total energy each tooth received was 10 J. The final results revealed that there was no significant difference in tooth movement rate between laser group and placebo group. In pain control study, of 34 participants included in the data analysis, 19 were male, mean age was 25.42 yr ± 4.58 mon; as for female, the total number was 15, mean age was 25.33 yr ± 5.20 mon. We used split mouth method to divide single arch into exposure side and placebo side. Low level laser was applied on exposure side at the timing of main wire changed, and patient needed to fill the VAS questionnaire after the irradiation. The settings of low level laser were pulse wave ; average output power in mode 1 was 100 mW; energy density per irradiated point was 0.5 W/cm2 (4 J/cm2); total energy each tooth received was 6.4 J. The average output power in mode 2 was 125 mW; energy density per irradiated point was 0.64 W/cm2 (5.12 J/cm2); total energy each tooth received was 8 J. The final results reveled that the VAS scores in male were larger than in female at the time points 6 hr, 12 hr, 24 hr after changing main wire. The VAS scores was higher in soft wire group than in hard wire group at the moment of changing wire, 1st day, 3rd day, 5th day and 14th day; however there was no significant difference in exposure group and placebo group. As for retention study, the laser settings were the same as pain control study. Patients recruited in this part of study should have almost symmetry crowding dentition in mandible before orthodontic treatment. In current results, there was no significant difference between exposure group and placebo group in retention after debonding. The definite protocols of lower level laser to achieve different orthodontic effects await more efforts in the future.