二极管激光在牙本质敏感症治疗中的应用

牙本质敏感症是一种常见、多发的临床症状,具有较高的发生率。研究表明,在18岁～35岁间约有42%的人具有牙本质敏感的症状,50岁以上具有牙本质敏感症状的人为70.8%。目前,治疗牙本质敏感症的主要方法以流体动力理论为基础,采用各种手段来封闭或阻塞暴露的牙本质小管,或封闭牙本质表面以隔绝各种外部刺激,避免小管内液体的异常流动而产生压力变化导致牙髓神经的刺激。然而临床中真正理想的脱敏剂是不存在的,没有一种有效的方法可以达到快速安全、永久性牙本质脱敏的目的。二极管激光是口腔临床常用激光,具有机体小、轻便,造价低廉、治疗波长可调控等优点,已应用于口腔临床多种疾病的治疗。目前,二极管激光已成为治疗牙本质敏感症的一项新技术,并取得了良好的效果,同时经二极管激光照射后牙本质小管管壁粗糙不平,且厚薄不一,容易使药物附着在表面,加速渗透,较单独的使用二极管激光具有更好的封闭效果。本文就国内外有关二极管激光在牙本质敏感症中的治疗及应用的研究进展作一综述。     

高露洁脱敏抛光膏即刻改善牙本质敏感的疗效观察

目的评估临床应用高露洁脱敏抛光膏后牙本质敏感的即刻改善效果。方法牙本质敏感患者122例患牙215颗,洁治术后应用高露洁脱敏抛光膏,分别于抛光前、抛光后即刻采用冷空气喷吹法检测患牙的敏感程度,记录视觉模拟疼痛评分（visual analogue scale,VAS）值。结果 122例受试者,男性61例,女性61例,平均年龄（44.20±13.20）岁。患牙215颗,其中前牙86颗,前磨牙63颗,磨牙66颗。应用脱敏抛光膏后,73.95%的患牙敏感症状即刻完全缓解或部分缓解,所有患牙抛光前VAS值为56.52±19.68,抛光后VAS值下降为33.07±22.75,抛光前后差异有统计学意义（P〈0.001）。结论洁治术后应用高露洁抛光膏对即刻改善牙本质敏感有一定的疗效。     

牙本质通透性与牙本质敏感症

牙本质敏感症是口腔临床常见疾病之一，其机制至今仍不十分清楚。液体动力学说认为全程牙本质小管开放，牙本质通透性增加，是影响牙本质敏感的至关重要因素。本文对牙本质通透性和牙本质敏感的关系进行综述。     

含精氨酸和碳酸钙的脱敏抛光膏治疗超声龈下刮治后根面敏感症的疗效观察

目的：评价含质量分数为8%精氨酸和碳酸钙脱敏抛光膏治疗超声龈下刮治后根面牙本质敏感症的疗效。方法???依据石川修二评定标准冷空气刺激评分,将超声龈下刮治术后1周内至少2颗前牙或前磨牙出现2~3度的根面牙本质敏感的82名患者随机分为2组,试验组40名（用含质量分数为8%精氨酸和碳酸钙脱敏抛光膏）,对照组42名（用不含脱敏剂的普通抛光膏）,进行脱敏治疗,观察即刻脱敏效果。结果???82名受试者参加并完成了治疗。试验组即刻冷空气刺激评分为1.34±0.48,对照组的即刻冷空气刺激评分为2.24±0.55,两组疗效差异有统计学意义（P<0.05）。结论含质量分数为8%精氨酸和碳酸钙脱敏抛光膏,对超声龈下刮治后根面牙本质敏感症有较好的疗效。     

激光治疗牙本质敏感症的研究进展

牙本质敏感症作为一种口腔临床的常见病,其发病机制尚未完全清楚,目前较公认的是流体动力学说。脱敏治疗方法以封闭牙本质小管和降低牙髓神经敏感性为主,现阶段临床上仍无十分理想的脱敏手段。研究表明,激光治疗能弥补传统方法的不足,提高脱敏效果,特别是激光联合药物脱敏已成为近年牙本质敏感症治疗研究的焦点。文章对近年来国内外各种激光治疗牙本质敏感症的研究进展做一概述。     

牙本质粘结剂治疗牙本质敏感症的疗效观察

目的 了解光固化牙本质粘结剂治疗牙本质敏感症的效果。方法 比较光固化牙本质粘结剂和局部涂氟化钠即刻、１月、１２月的疗效。结果 酸处理牙面后再行粘结剂治疗牙本质敏感症的近、远期疗效明显优于氟化钠甘油糊剂脱敏法（Ｐ〈０．０１）,非酸处理牙面行粘结剂脱敏的疗效也显著高于氟化钠甘油糊剂（Ｐ〈０．０５）,但远期疗效不如酸处理组（Ｐ〈０．０１）。结论光固化粘结剂治疗牙本质敏感症疗效好于传统的氟化钠甘油糊剂脱敏     

激光和脱敏剂治疗牙本质敏感症的临床疗效对比

目的对比Nd：YAG激光和Gluma脱敏剂治疗牙本质敏感症的临床疗效。方法 20例牙本质敏感症患者,两例对称的同名患牙分别随机分到激光组和Gluma组。激光组选用的参数为120 mJ,5 Hz,照射时间1 min,Gluma组药物涂擦时间为2 min。记录患者在治疗后即刻、术后1周、术后1个月对探针和气流刺激的视觉模拟评分（visual analogue scale,VAS）。结果术后即刻激光组、Gluma组VAS分别为4.05±0.95、4.75±1.33（P〉0.05）,术后1周激光组、Gluma组VAS分别为3.10±0.91、3.70±1.03（P〉0.05）,提示短期内激光和Gluma对牙本质敏感症的疗效无差异。术后1个月激光组、Gluma组的VAS分别为2.35±0.75、3.20±0.83（P〈0.01）,提示随着时间延长,激光照射可以显著缓解患者的牙本质敏感症状。结论 Nd：YAG激光（120 mJ,5 Hz）照射1 min与脱敏剂Gluma涂擦2 min相比,脱敏效果1周内两者无差异,术后1个月疗效以激光为优。     

YAG激光治疗牙本质敏感症的疗效观察

目的：观察YAG激光治疗牙本质敏感症的疗效。方法：随机选择牙本质敏感症88例,共100对左右对称的同名牙,一侧采用激光脱敏,另侧采用药物脱敏,比较他们的疗效。结果：YAG激光治疗牙本质敏感症疗效明显超越药物脱敏,而且见效快,疗效维持时间长。结论：激光脱敏是目前较为理想的牙本质敏感症的治疗方法。     

Nd：YAG激光照射治疗牙本质敏感症的能量密度范围的离体牙研究

目的：探索Nd：YAG激光照射牙本质后,既能显著降低其通透性,又不引起表面形态破坏的能量密度范围。方法：10个离体磨牙均切成6个2mm×3mm×4mm的牙本质块,随机分为：空白对照组、Gluma组、50、100、200、450J/cm2激光组。37%磷酸处理,每组随机取8个标本浸入2%亚甲蓝溶液5h,体视显微镜下测量染液渗透深度,另2个标本观察表面形态变化。结果：1）染液渗透深度,空白对照组、Gluma组、50J/cm2,100J/cm2,200J/cm2,450J/cm2激光组分别为（3.211±0.345）、（1.714±0.475）、（3.058±0.193）、（2.603±0.389）、（1.979±0.380）、（1.156±0.397）mm。50J/cm2激光组牙本质通透性与对照组无差异,其余各组与对照组相比均明显下降,且随着激光能量升高,通透性降低。其中200J/cm2激光组的牙本质通透性与Gluma组相当。2）牙本质表面观察,450J/cm2激光组牙本质表面有显著改变,可见大小不一,形态不规则的凹坑。结论：Nd：YAG激光用于治疗牙本质敏感症时,考虑到有效性和安全性,建议能量密度为200~450J/cm2。     

光固化粘结剂治疗牙本质敏感症的初探

采用单盲自身配对对照法，用光固化粘结剂和局部涂布氟化钠治疗牙颈部敏感症，平均疗效分别是７８．５％，６４．６％，经统计学处理ｐ＜０．０１，有高度显著性差别。故认为用光固化粘结剂治疗牙颈部牙本质敏感症优于氟化钠甘油糊剂脱敏法。实验组３月、６月、９月疗效分别为７４．２％、６１．３％、５８．７％，经统计学处理ｐ＞０．０５，表明其远期疗效较佳。     

中药抗敏剂治疗牙本质过敏症的临床研究及扫描电镜观察

目的:探讨中药抗敏剂治疗牙本质过敏症的疗效及作用机制。方法:将中药抗敏剂制备成漱口剂、涂擦剂和糊剂 3种剂型,分组进行临床应用,与对照组进行对比,观察各组治疗后即刻、3个月及半年的临床疗效。通过扫描电镜观察中药抗敏剂对牙本质小管的作用。结果:糊剂联合载药牙列托盘治疗牙本质过敏症与漱口剂、涂擦剂和对照组对比有显著统计学差异(P<0. 05)。扫描电镜观察中药抗敏剂作用后,牙本质小管开口基本消失。结论:中药抗敏剂可有效堵塞牙本质小管,治疗牙本质过敏症,联合载药牙列托盘疗效更为持久。     

奥威尔牙膏抗牙本质过敏的疗效研究

目的:评价家庭日常使用奥威尔牙膏后牙本质过敏症状的改善情况。方法:将60名受试者随机分成2组:实验组使用奥威尔牙膏,对照组使用普通牙膏。两组受试者每天刷牙2次共8周,采用VAS记分评价基线0、2、4周和8周受试者的牙本质敏感程度。结果:实验组基线0周时记分为5.92±1.04,4周和8周后为4.39±1.30、3.98±1.19,可显著减少牙本质过敏症状(P<0.05);与对照组4周和8周后记分5.08±1.17、4.65±1.18相比,有显著性差异(P<0.05)。结论:奥威尔牙膏有抗牙本质过敏的效果。     

3种脱敏剂治疗牙本质敏感症的疗效比较

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三种脱敏剂治疗牙本质过敏症的临床研究

目的:探讨有效治疗牙本质过敏症的临床药物。方法:将105例患者完全随机分为3组,每组35例,分别采用硝酸银、极固宁、中药脱敏糊剂3种药物进行脱敏治疗,观察各组治疗后即刻、3个月、半年的临床疗效。结果:在即刻、3个月,50ml/L硝酸银与脱敏糊剂、极固宁组无显著差异,而在半年50ml/L硝酸银与另2组差异有显著性。结论:50ml/L硝酸银、脱敏糊剂、极固宁均可堵塞牙本质小管治疗牙本质过敏症,但50ml/L硝酸银疗效更为持久、有效。     

Dye-assisted diode laser ablation of carious enamel and dentine

Carious dentine and enamel from extracted human teeth were ablated using a semiconductor diode laser in conjunction with an applied dye, indocyanine green. This technique offers selective ablation with minimal risk of thermal damage to surrounding dental tissues because uptake of the dye and its irradiation by the laser together control the ablation. In this study, various laser powers and dye concentrations were used to ablate previously extracted human teeth with moderate caries. The mass of material ablated and the temperature rise in the pulp and at the surface were recorded, and the ablated surface was examined by microscopy. The ablation was efficient and the rise in the pulp temperature slight. Ablation efficiency and surface temperature were both found to increase with laser irradiance and with dye concentration. No surface cracks or fissures were seen in electron microscope examination and the hardness of the laser-treated surfaces was comparable to that of healthy tissue. The dye-assisted laser ablation technique offers considerable potential for clinical caries removal and dentine, enamel and pulp sterilization, whilst leaving healthy tissue intact. The diode laser can deliver its energy via simple optical fibre and is cheaper and much smaller than the conventional high power lasers used in other studies.     

Cytotoxicity of 45S5 bioglass paste used for dentine hypersensitivity treatment

Objectives

45S5 bioglass mixed with 50% phosphoric acid has been suggested to treat dentine hypersensitivity and incipient enamel caries. This study is going to evaluate the biocompatibility of using the aforementioned technique with the rat pulpal cells.

Methods

The relative cytotoxicity of 45S5 bioglass on rat dental pulp cells was compared to the cytotoxicity of a temporary filling material (Caviton; GC, Japan), Type 1 glass ionomer cement (Fuji I; GC, Tokyo, Japan) and commercial desensitising agent (SuperSeal; Phoenix Dental, Fenton, MI, USA) using a transwell insert model. Cell viability was measured by means of a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The number of viable cell counts were compared using one way ANOVA (p < 0.05). The morphological alterations of the pulp cells were observed directly by phase contrast microscope.

Results

The results of this study indicated that cell viability recorded by the 45S5 bioglass paste group did not differ significantly from those of the Caviton, glass ionomer or superseal, moreover pulpal cells microscopic analysis revealed that 45S5 bioglass elicited minimal toxic effect.

Conclusions

45S5 bioglass paste can serve as a biocompatible material that can potentially be used safely on dentine.     

Treatment of dentinal hypersensitivity using a dentine bonding system

AIMS AND OBJECTIVES: Many agents have been used in treatment of dentinal hypersensitivity in the past, but dentine bonding systems have recently been suggested as being effective. This study examined the effectiveness of a dentine bonding system in the treatment of dentinal hypersensitivity in dental practice conditions. METHODS: Dentists in two dental practices agreed to carry out the project. One practice was in the UK, the other in India. A total of 34 patients who were diagnosed to have dentinal hypersensitivity were treated using the dentine bonding system. Patients were requested to record their perception of their pain on a 100mm linear scale, pre-treatment, one day and one week post-treatment. RESULTS: All patients experienced relief of pain, both 1 day and 1 week after treatment. Profile plots of the patients' perceived pain scores for the two practices separately indicated that there was a general trend across both practices for these to fall quite sharply one day after treatment and then generally level out one week post-treatment. There was evidence indicating a possible difference in pain perception in the two communities from which the patients were drawn. CONCLUSION: The dentine bonding system evaluated was successful in reducing the pain of dentinal hypersensitivity, at least in the short term.     

Treatment of dentine hypersensitivity by lasers: a review

BACKGROUND, AIMS: Since the development of the ruby laser by Maiman in 1960, a variety of papers on potential applications for lasers in dentistry have been published. The purpose of this paper is to summarise laser applications for the treatment of dentine hypersensitivity. The effects of laser on pulp tissue and problems on laser treatment are also reviewed. This article reviews the role of lasers for the treatment of dentine hypersensitivity since 1985, summarises many research reports from the last decade, and surmises what the future may hold for lasers in this treatment. METHOD: To date, 4 kinds of lasers have been used for the treatment of dentine hypersensitivity, and the effectiveness ranged from 5.2 to 100%, which was dependent on the laser type and parameters used. The mechanism involved in laser treatment of dentine hypersensitivity are relatively unknown. RESULTS: These require clarification to result in safely effective treatment optimization. In general, the efficiency for the treatment of dentine hypersensitivity using lasers is higher than other methods, but in severe cases, it is less effective. CONCLUSION: It is necessary to consider the severity of dentine hypersensitivity before laser use.     

Prime&Bond(R)NT粘接剂治疗牙本质过敏症的临床观察

目的 探讨有效治疗牙本质过敏症的方法.方法 将120例患者的356颗牙本质过敏牙随机分为实验组和对照组,每组178颗.实验组用Prime&Bond(R)NT粘接剂脱敏,对照组用脱敏糊剂脱敏.观察两组牙齿脱敏治疗的即刻、3个月后和半年后的临床效果.结果 在脱敏治疗的即刻、3个月后和半年后,实验组患牙牙本质过敏症的治疗效果都优于对照组,实验组治疗牙本质过敏症的有效率超过94%.结论 Prime&Bond(R)NT粘接剂是一种治疗牙本质过敏的理想脱敏剂.     

Immediate efficacy of diode laser application in the treatment of dentine hypersensitivity in periodontal maintenance patients: a randomized clinical trial

Background: To evaluate the immediate efficacy in the reduction of dentine hypersensitivity (DH) when applying an 810 nm diode laser (DL), and a 10% potassium nitrate bioadhesive gel (NK10%).
Material and Methods: Forty-five consecutive periodontal maintenance patients of both sexes, with a DH≥2 on the verbal rating scale (VRS) in one or more teeth, were randomly allocated into three equal groups: 15 patients received DL and placebo gel; 15 patients were tested with a placebo laser and NK10%; and the remaining 15 received a placebo laser and placebo gel. The DH was evaluated at the start of the study, 15 and 30 min. after the laser application, and on days 2, 4, 7, 14, 30 and 60 by a blind examiner.
Results: After 15 min., observations showed a reduction in DH after an evaporative stimulus (ES) of 36.9% (0.86), three times greater than that of the control group (0.23) ( p =0.008). After 14 days, this effect was even greater [DL 71.7% (1.67)/NK10% 36.3% (1.73)/control 28.1% (0.73); p =0.004], and lasted until day 60 [65.7% (1.53)/30.4% (0.73)/25.8% (0.67); p =0.01].
Conclusions: The DL and NK10% gel were proven effective in the treatment of DH. A significantly greater immediate response was observed with DL.