Er:YAG激光对恒牙牙本质粘接性能的影响  

Effect of Er: YAG laser irradiation on the bonding strength of permanent teeth

作　　者：魏雅楠 陈筠[1] 李志艳[1] WEI Yanan;CHEN Yun;LI Zhiyan(Department of Oral Medicine,The Affiliated Hospital,Qinghai University,Xining 810001,China)

机构地区：[1]青海大学附属医院口腔内科,青海西宁810001

出　　处：《口腔疾病防治》2020年第10期673-676,共4页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：青海省科技计划项目(2017-ZJ-736);中华口腔医学会西部口腔医学临床科研基金项目(CSA-W2019-04)。

摘　　要："微创牙科"的概念旨在对龋齿进行更为保守的治疗,保留更多健康牙本质。因Er:YAG激光可选择性清除龋质,及表面蚀刻后玷污层消失、牙本质小管暴露,且其精确、安全、无痛等优势深受关注。同时,受Er:YAG激光不同参数影响,致术后被预备牙本质表面和充填材料间所形成的粘接强度有所差异。本文就牙本质粘接原理,Er:YAG激光作用机制,不同参数(功率、能量密度、脉冲持续时间、照射距离)处理牙本质后,其对牙髓有无热损伤,牙本质表面超微形态,不同粘接系统、充填材料与被照射硬组织间的粘接性能作一综述。合适的参数范围(功率≤10 Hz,能量密度≤60 mJ,脉冲持续时间≤50μs)联合喷水冷却,不会对牙髓组织产生热损伤,而较高功率、能量密度及脉冲持续时间的铒激光处理牙本质后,会导致表面组织熔融、碳化、裂纹、原胶原纤维间隙变小等,限制粘接剂渗入,对粘接产生消极影响。但目前各基于玷污层的粘接系统是否适用于激光处理后的牙本质有待进一步研究。The concept of"minimally invasive dentistry"aims to provide conservative treatment of cavities in which sound dentin is removed. Because the Er: YAG laser can selectively remove caries, the smear layer is removed, dentin tubules are exposed after the preparation of substrate conditioning, and its advantages of precision, safety and painlessness are deeply valued. At the same time, the bonding strength between the prepared dentin surface and the filling material is different due to the different parameters of the Er: YAG laser. In this paper, the principle of dentin bonding, the mechanism of Er: YAG laser action, after treatment of dentin with different parameters(power, energy density, pulse duration, and irradiation distance), whether there is thermal damage to pulp tissue, the ultramicro morphology of dentin surface, the bonding properties of different bonding systems and the filling materials between irradiated hard tissues were reviewed. An appropriate parameter range(power ≤ 10 Hz, energy density ≤ 60 mJ, and pulse duration ≤ 50 μs)combined with water spray cooling will not cause thermal damage to the pulp tissue, while the higher power, energy density and pulse duration of laser treatment for dentin will lead to melting, carbonization, cracks, narrowing of the gap between collagen fibers, etc., which will limit the penetration of adhesives and have a negative impact on bonding. However, whether the adhesive systems based on the smear layer are suitable for dentin after laser treatment needs to be further explored.

关 键 词：ER:YAG激光 牙本质 胶原纤维 牙本质小管 充填材料 玷污层 去龋 蚀刻 粘接剂 粘接强度 

分 类 号：R78[医药卫生—口腔医学]