弱激光对正畸过程中牙齿疼痛和牙周炎症的疗效观察  

Effect of Low-intensity Laser on Pain and Relief and Periodontal Inflammation during Orthodontics

作　　者：张婉君 马永平[1] 刘璇[1] 杨茜 高琳青 马文盛[2] 远璐 ZHANG Wan-jun;MA Yong-ping;LIU Xuan;YANG Qian;GAO Lin-qing;MA Wen-sheng;YUAN Lu(Department of Stomatology,the Second Hospital of Baoding,Baoding 071000,China;Department of Orthodontics,Stomatological Hospital Affiliated to Hebei Medical University)

机构地区：[1]保定市第二医院口腔科,保定市071000 [2]河北医科大学附属口腔医院正畸科

出　　处：《中国激光医学杂志》2021年第4期198-204,240,共8页Chinese Journal of Laser Medicine & Surgery

基　　金：河北省高等学校科学技术研究项目(ZD2017054)。

摘　　要：目的探讨弱激光对正畸治疗过程中牙齿疼痛和牙周炎症的影响,为其临床应用奠定数据支撑。方法前瞻性研究2017~2018年,AO自锁托槽正畸治疗患者65例,分为研究组和对照组,两组患者均在拔除上颌第一前磨牙后置入AO自锁托槽。其中对照组患者32例,正畸治疗过程中采用常规口腔管理;研究组患者33例,正畸后1、3和7 d予以波长810 nm激光照射,能量密度15.9 J/cm2,每个点照射时间20 s。之后每月照射1次,直至取出微种植体。两组患者分别于AO自锁托槽和植入微种植体后1、3和7 d比较正畸治疗过程中的疼痛程度;正畸治疗后6个月口腔探诊,比较两组的牙龈指数、菌斑指数、改良龈沟出血指数(sulcus bleeding index,SBI)、微种植体周探诊深度(probing depth,PD)及尖牙远中移动距离(movedistance,MD);正畸治疗后7 d,1、3和6个月取龈沟液,采用ELISA实验测定炎性因子肿瘤坏死因子(tumor necrosis factorα,TNF-α)、白细胞介素1β(interleukin-1β,IL-1β)水平;疼痛介质前列腺素E_(2)(prostaglandin E_(2),PGE_(2))、前列腺素F2α(prostaglandin F2α,PGF2α)水平;牙周改建标志物骨碱性磷酸酶(bone alkaline phosphatase,BALP)、核因子κB受体活化因子配体(receptor activator of nuclear factorκB ligand,RANKL)、核因子κB受体活化因子(receptor activator of nuclear factorκB,RANK)以及骨保护素(osteoprotegerin,OPG)水平。结果研究组置入自锁托槽7 d、植入微种植体3 d和7 d的疼痛评分均低于对照组,差异具有统计学意义(P<0.05)。治疗6个月时,两组间的牙龈指数、菌斑指数、PD及出血指数差异均无统计学意义(P>0.05);但研究组MD高于对照组,差异具有统计学意义(P<0.05)。研究组治疗7 d和3个月时的TNF-α、IL-1β和PGE_(2)水平低于对照组(P<0.05),治疗3和6个月时的BALP和OPG水平高于对照组,差异具有统计学意义(P<0.05)。结论弱激光能较好的缓解正畸过程中牙齿疼痛与牙周炎症,为牙周�Objective To investigate the effect of low-energy laser on pain and periodontal inflammation during orthodontics,for the sake of providing data support for its clinical application.Methods Totally 65 adult patients scheduled for orthodontic treatment from 2017 to 2018 were randomly divided into two groups in a controlled trial.All of them were placed into AO self-locking brackets after the extraction of the maxillary first premolars.The patients in the control group(n=32)were treated with conventional oral management after microimplant implantation and microimplant load correction.The patients in the study group(n=33)were given weak laser irradiation on the 1st,3rd and 7th day after the three invasive operations(implanting of AO self-locking bracket,microimplant and microimplant load)on the basis of oral management,which had an energy density of 15.9 J/cm and a irradiation time of 20 s at each point.The microimplant was then irradiated once a month until the microimplant was removed.The pain scores during orthodontic treatment on the 1st,3rd and 7th day after AO self-locking bracket and microimplant implantation were compared between the two groups respectively.The oral probing results[gingival index,plaque index,sulcus bleeding index(SBI),probing depth(PD),and(move distance,MD)of fangs]were compared between the two groups 6 months after the orthodontic treatment.The gingival crevicular fluid was collected 7 days and 1,3 and 6 months after the treatment.Then,the inflammatory factors tumor necrosis factor(TNF-α)and interleukin 1 beta(IL-1β)levels,pain mediums prostaglandin E_(2)(PGE_(2))and prostaglandin F2 alpha(PGF2α)levels,periodontal rebuilding markers bone alkaline phosphatase(BALP),nuclear factor kappa B receptors predominate activation factor(RANK)and its ligand(RANKL),and bone protection(OPG)in gingival sulcus liquid were compared between the two groups.Results The pain scores of the study group were lower than those of the control group on the 7th day after the self-locking bracket placement,on the 3rd

关 键 词：激光 正畸治疗 疼痛 炎性反应 组织改建 

分 类 号：R454.2[医药卫生—治疗学] R783.5[医药卫生—临床医学]