脉冲 Er:YAG 激光与常规涡轮高速车针治疗楔状缺损的效果比较

摘要

目的：比较Er：YAG激光与常规涡轮机高速车针治疗楔状缺损的效果。方法收集我院口腔科就诊的、双侧多个同名牙楔状缺损患者85例382颗牙，随机分为激光组和涡轮机组各191牙，其中每位患者每侧至少2颗牙采用激光表面预备，对侧高速涡轮机预备，脉冲照射采用激光剂量为300 mJ，20 Hz间歇操作。涡轮机组采用高速车针制备固位型，自体对照，两组均预备后光固化树脂黏充填。比较两组治疗后1周、1个月、6个月、12个月术后充填物保存率、边缘着色、继发龋等指标，评价其临床治疗效果。结果两组术中疼痛牙齿发生率激光组（16．7％）显著少于涡轮机组（74．8％），差异有统计学意义（P＜0．05）；术后1周、1个月激光组分别有35牙和12牙出现冷热刺激痛，而涡轮机组发生刺激痛分别为83牙和44牙，两者差异有统计学意义（ P＜0．05）；术后6个月和12个月修复体保存率激光组显著高于涡轮机组，差异有统计学意义（ P＜0．05）；但边缘适合性、边缘着色和继发龋发生率两组差异无统计学意义。结论激光组较涡轮机组在楔状缺损治疗中疼痛发生率低、治疗后疼痛反应轻；修复体保存率高。300 mJ，20 Hz的Er：YAG激光治疗楔状缺损具有无痛、安全、高效的优点。%Objective To compare the effects of Er: YAG laser and conventional high-speed burr in treatment of wedge-shaped tooth defects and to evaluate its applicability and reliability .Methods 382 bilateral multiple teeth with wedge-shaped defects in 85 patients were randomly divided into two groups with 191 teeth in each:laser group and the turbine burr group .At least two teeth of one side in all patients were irradiated by pulsed Er:YAG laser with doses of 300 mj, 20 Hz.Meanwhile, the caries cavities on the contralateral were prepared by high-speed burr .Then the prepared caries defects in both groups were filled with composite resin .Sub-sequently, the clinical effects were evaluated based on several clinical indications including retention rate of fillings , edges staining, secondary caries after 1 week, 1 month, 6 months and 12 months.Results The Intraoperative pain rate during operation in laser group (32/191) was significantly lower than that in turbine burr group (143/191).There were 35 teeth and 12 teeth in the laser group respectively suffered from sharp pain stimulated by cold or hot water .On the contrary , the rates of stimulated pain in the turbine burr group were 83 teeth and 44 teeth respectively .There was a significant difference between these two groups .After 6 months and 12 months, the preserving rate in laser group was significantly higher than that in turbine burr group .However, No significant differences were found in the incidence rates of margins sealed , edge stained and the incidence of secondary caries .Conclusions Compared with the turbine burr group , the laser group shows comparatively lower incidence of pain during the treatment and a higher preserving rate of filling materials.The laser group also has lower intraoperative pain .300 mJ, 20 Hz Er: YAG laser treatment has the advantages of painless, safe and efficient remedy of tooth wedge-shaped defects.