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標題: | 鉺雅鉻雷射進行雷射激盪根管沖洗在根管塗抹層移除與牙本質酸蝕之效應:口外牙試驗 Effects of Er:YAG laser-activated irrigation on smear layer removal and dentin erosion: in vitro study |
作者: | SHIH-WEI YU 游士緯 |
指導教授: | 李苑玲(YUAN-LING LEE) |
共同指導教授: | 林俊彬(CHUN-PIN LIN) |
關鍵字: | 鉺雅鉻雷射,雷射激盪根管沖洗,雷射輸出頭,塗抹層,牙本質酸蝕, Er:YAG laser,laser-activated irrigation,laser tip,smear layer,dentin erosion, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 鉺雅鉻雷射波長為2940 奈米,其能量恰可為水吸收,且羥基磷灰石對其亦有良好吸收效率。使用鉺雅鉻雷射激盪根管沖洗液時會造成水分子受熱而體積膨脹產生微爆破進而產生渦流及空穴效應而達到良好的清潔效果;然鉺雅鉻雷射雖可協助移除根管系統內的塗抹層,惟亦存有可能導致沖洗液沖出根尖孔外之隱憂。
目前,雷射用於根管沖洗相關研究多使用Fotona鉺雅鉻雷射及其PIPS™專利雷射輸出頭;此外,尚未有使用Morita鉺雅鉻雷射進行雷射激盪根管沖洗之相關文獻。因此,本研究團隊欲使用市售LiteTouch及Morita鉺雅鉻雷射搭配原廠不同尖端設計之雷射輸出頭進行雷射激盪根管沖洗比較其對於根管塗抹層移除之結果是否能近似或達到與Fotona鉺雅鉻雷射及其PIPS™專利雷射輸出頭之優異結果。 本研究共使用100顆口外牙,隨機分組後進行根管製備及後續實驗,研究涵蓋三大部分:一、LiteTouch以及Morita鉺雅鉻雷射,在原廠建議之能量設定下進行雷射激盪根管沖洗與傳統針筒沖洗以及被動超音波沖洗對於根管塗抹層移除效果和牙本質酸蝕程度之比較。二、LiteTouch鉺雅鉻雷射使用三組低於造成牙本質切削之輸出能量(sub-ablation energy)並改變雷射輸出頭放置位置進行雷射激盪根管沖洗相較傳統針筒沖洗、被動超音波沖洗對根管塗抹層移除效果及牙本質酸蝕程度之比較。三、在相同輸出0.6 W雷射能量下,LiteTouch和Morita鉺雅鉻雷射搭配原廠雷射輸出頭(不同尖端設計)並改變其放置位置、採固定或移動之方式來進行雷射激盪根管沖洗以比較傳統針筒沖洗與被動超音波沖洗對根管塗抹層移除效果及牙本質酸蝕程度之差異。 結論:一、各組組內對於根管塗抹層移除之結果均有一致趨勢:冠部較中段清潔;中段又較根尖清潔。然而除了傳統針筒沖洗之冠部及根尖其根管塗抹層移除效果達統計上顯著差異(冠部較佳),其餘組別之組內均未達統計上顯著差異。二、LiteTouch及Morita鉺雅鉻雷射進行雷射激盪根管沖洗相較傳統針筒沖洗及被動超音波沖洗對於根管牙本質酸蝕程度之比較:Morita鉺雅鉻雷射搭配原廠椎狀尖端之雷射輸出頭使用原廠建議之移動方式進行雷射激盪根管沖洗對根管牙本質酸蝕效果較明顯;然各組組內及組間統計上均未達顯著差異。三、LiteTouch以及Morita鉺雅鉻雷射搭配原廠雷射輸出頭,在原廠建議之能量設定下進行雷射激盪根管沖洗相較傳統針筒沖洗及被動超音波沖洗對於根管塗抹層移除,Morita鉺雅鉻雷射雖有較佳之效果,然在統計上並未達顯著差異。四、LiteTouch鉺雅鉻雷射搭配不同輸出能量與改變雷射輸出頭放置位置進行雷射激盪根管沖洗對根管塗抹層移除效果:當雷射輸出頭放置在冠部蓄水槽時,雷射輸出能量越小,其對根管塗抹層移除效果越好,然在統計上並未達顯著差異。反之,當雷射輸出頭在放置根尖時,雷射輸出能量越大,其對根管塗抹層移除效果越好,然在統計上亦未達顯著差異。五、使用相同0.6 W雷射輸出能量時,LiteTouch以及Morita鉺雅鉻雷射搭配原廠不同尖端設計之雷射輸出頭並改變其放置位置與移動方式進行雷射激盪根管沖洗對根管塗抹層移除效果:Morita鉺雅鉻雷射搭配原廠椎狀尖端之雷射輸出頭置於根尖時,其對根管塗抹層移除效果最好,然在統計上並未達顯著差異。Morita鉺雅鉻雷射搭配原廠椎狀尖端之雷射輸出頭使用原廠建議之移動方式進行雷射激盪根管沖洗對根管塗抹層移除效果較差。LiteTouch鉺雅鉻雷射搭配原廠平頭之雷射輸出頭其對根管塗抹層移除與Morita鉺雅鉻雷射搭配原廠椎狀尖端雷射輸出頭相較整體效果較差;LiteTouch鉺雅鉻雷射輸出頭置於冠部蓄水槽時,其對根管塗抹層移除效果又與置於根尖時明顯較差,然上述統計上均未達顯著差異。 The wavelength of Er:YAG laser is 2,940 nm, which can be perfectly absorbed by water, and has excellent absorption rate for hydroxyapatite. The Er:YAG laser-activated irrigation (LAI) can obtain optimal cleansing result due to high resorption in water, which cause water in irrigant vaporizing and vapor bubbles expanding in volume. After the vapor bubbles collapse, they will cause local microstreaming and cavitation to remove the debris on the canal wall surface. Although the Er:YAG laser has a significant effect on removing the smear layer and debris, the potential hazard of extruding irrigant cannot be neglected. To the best of our knowledge, the relevant studies on LAI are mainly based on Fidelis laser and its patent PIPS™ tip. Moreover, none of these studies are based on Morita laser. As a result, our study aims to compare the effects of LiteTouch and Morita Er:YAG lasers with their tips on smear layer removal and dentin erosion with those of Fidelis laser. One hundred extracted teeth were collected, randomized, and prepared for the irrigation study. The purposes of our study are three parts in order to compare the effects of irrigation methods on smear layer removal and dentin erosion: (1)LiteTouch and Morita Er:YAG lasers with manufacturer's recommended settings compared with conventional syringe irrigation (CSI) and passive ultrasonic irrigation (PUI) groups.(2)LiteTouch Er:YAG laser with three sub-ablation energy settings and different tip positions compared with CSI and PUI groups.(3)LiteTouch and Morita Er:YAG lasers with the same energy setting (0.6W) and different tip positions/ motions compared with CSI and PUI groups. Conclusions: (1)Er:YAG LAI groups had a better effect on the smear layer removal but no more evident on the dentin erosion when compared to CSI and PUI groups. However, the variations for each group are not statistically significant (post hoc p>0.05). (2)Er:YAG LAI groups had a better effect on the smear layer removal when the laser tip was placed apically rather than coronally. (3)Morita conical laser tip had a better effect on the smear layer removal than LiteTouch flat-end laser tip. Nevertheless, the post hoc p-value shows there is no statistically significant in overall Er:YAG LAI groups, both inter-group and intra-group. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/73852 |
DOI: | 10.6342/NTU201903346 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床牙醫學研究所 |
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