脱敏剂和激光脱敏对牙本质表面形态、硬度和成分的影响

doi:10.13481/j.1671-587x.20200121

摘要/Abstract

摘要： 目的：探讨采用奥敏清脱敏剂和掺铒钇铝石榴石（Er：YAG）激光及掺钕钇铝石榴石（Nd：YAG）激光分别处理牙本质后对其表面形态、硬度、钙（Ca）和磷（P）含量以及Ca/P比值的影响，并阐明其可能的机制，为其用于临床牙本质敏感症的治疗提供参考。方法：收集18~20岁志愿者因阻生而拔除的新鲜第三磨牙32颗，制备2 mm厚的牙本质片32个，将样本分为空白对照组、奥敏清组、Er：YAG组和Nd：YAG组，每组8个样本。除空白对照组外，其余各组样本采用17% EDTA去除玷污层建立牙本质敏感症模型，每个样本被线性切割机从中间对称分割为2个半圆形牙本质盘，一半采用显微硬度计测量各组牙本质表面显微硬度（SMH）值，一半采用扫描电子显微镜（SEM）观察其表面形态表现，并采用X射线能谱仪（EDS）分析样本牙本质表面Ca和P含量。结果：各组样本牙本质SMH值比较差异均无统计学意义（P>0.05）。SEM下观察，空白对照组样本牙本质表面无涂片层，小管较宽，表面光滑清洁；奥敏清组样本牙本质小管部分封闭，小管内可见阻塞物；Er：YAG组样本牙本质小管很少或没有开放，大部分为部分或完全封闭的小管，表面可见熔融状改变；Nd：YAG组样本牙本质小管部分或完全封闭，开放小管极少，表面呈熔融状。与空白对照组和奥敏清组比较，Er：YAG组和Nd：YAG组样本牙本质表面Ca和P含量明显升高（P<0.05）；与空白对照组比较，奥敏清组样本牙本质表面Ca和P含量差异无统计学意义（P>0.05）；与Nd：YAG组比较，Er：YAG组样本牙本质表面Ca和P含量差异也无统计学意义（P>0.05）；各组样本Ca/P比值比较差异均无统计学意义（P>0.05）。结论：奥敏清脱敏剂、Er：YAG激光和Nd：YAG激光的应用不会引起牙本质表面硬度和Ca/P比值的变化，但Er：YAG和Nd：YAG激光可增加牙本质表面的Ca和P含量，改变牙本质表面的形态、组成和结构。

关键词: 掺铒钇铝石榴石激光, 掺钕钇铝石榴石激光, 奥敏清脱敏剂, 牙本质敏感症, 钙, 磷

Abstract: Objective: To investigate the effects of Aominqing desensitizer and two laser (Er: YAG and Nd: YAG)treatments on the dentin surface morphology, hardness,and calcium(Ca) and phosphorus(P) contents and Ca/P ratio, to clarify the possible mechanisms, and to provide reference for its clinical application in the treatment of dentin sensitivity. Methods: The fresh third molars extracted because of impaction from the volunaeers aged 18-20 years old were collected.A total of 32 dentin slices of 2 mm were prepared; the samples were divided into blank control group, Aominqing group Er: YAG group and Nd: YAG group,and there were eight samples in each group.Except blank control group,the samples in other groups were used to establish the dentin hypersensitivity models by purifying the polluted layer with 17% EDTA. Each sample was cut by linear cutting machine from the middle symmetry into two semicircle dentin; the half was used to detect the dentin surface microhardness(SMH) values by microhardness meter,another half was used to observe the surface morphology and analyze the Ca and P contents with SEM and EDS was observed. Results: There were no significant differences in the SMH values of dentin samples between various groups (P>0.05). In blank control group, there was no smear layer on the dentin surface with wide tubules and smooth and clean surface;the dentin tubules of the samples in Aominqing group were partially closed, and obstructions were seen in the tubuless in Er: YAG group the dentin tubules were little or no open, most of them were partially or completely closed tubules, the surface had the melting changes in Nd: YAG group, the dentin tubules were partially or completely closed with few open tubules and the surface was molten.Compared with blank control group and Aominging group,the Ca and P contents in the samples in Er: YAG group and Nd: YAG were significantly increased; there was no statistically significant difference in the contents of Ca and P between and blank control group and Aclinsing group (P>0.05), and the difference between Er: YAG group and Nd: YAG group was not significant (P>0.05).The differences in the Ca/P ratios between various groups were not statistically significant (P>0.05). Conclusion: The application of Aominqing desensitization agent, Er: YAG laser and Nd: YAG laser can not cause the changes of dentin SMH and the Ca/P ratio, but the application of Er: YAG and Nd: YAG laser to dentin can significantly increase the contents of Ca and P and change the morphology, composition and structure of dentin surface.

Key words: Er：YAG laser, Nd：YAG laser, Aominqing desensitizer, dentin sensitivity, calcium, phosphate

中图分类号:

R781.2

朱亚平, 王成坤, 吴庆翠, 李怡然, 马昂, 秦娇娇, 焦珊, 王静. 脱敏剂和激光脱敏对牙本质表面形态、硬度和成分的影响[J]. 吉林大学学报(医学版), 2020, 46(01): 121-126.

ZHU Yaping, WANG Chengkun, WU Qingcui, LI Yiran, MA Ang, QIN Jiaojiao, JIAO Shan, WANG Jing. Effects of desensitizer and laser desensitization on surface morphology, hardness and composition of dentin[J]. Journal of Jilin University(Medicine Edition), 2020, 46(01): 121-126.

参考文献

[1] 樊明文.牙体牙髓病学[M].北京:人民卫生出版社,2012:157-160.
[2] QUE K H, RUAN J P, FAN X, et al. A multi-centre and cross-sectional study of dentine hypersensitivity in China[J]. J Clin Periodontol, 2010, 37(7):631-637.
[3] SALUJA M, GROVER H S, CHOUDHARY P. Comparative morphologic evaluation and occluding effectiveness of Nd:YAG, CO₂ and diode lasers on exposed human dentinal tubules:An invitro SEM study[J]. J Clin Diagn Res, 2016, 10(7):ZC66-ZC70.
[4] DILBER E, MALKOC M A, OZTURK A N, et al. Effect of various laser irradiations on the mineral content of dentin[J]. Eur J Dent, 2013, 7(1):74-80.
[5] LIMA D M, TONETTO M R, DE MENDONÇA A A, et al. Human dental enamel and dentin structural effects after Er:YAG laser irradiation[J]. J Contemp Dent Pract, 2014, 15(3):283-287.
[6] STEEN W,MAZUMDER J.Laser processes and equipment[J].Laser Material Processing,2010,22(7):441-445.
[7] YAMADA M K, UO M, OHKAWA S, et al. Three-dimensional topographic scanning electron microscope and Raman spectroscopic analyses of the irradiation effect on teeth by Nd:YAG, Er:YAG, and CO₂ lasers[J]. J Biomed Mater Res Part B Appl Biomater, 2004, 71(1):7-15
[8] MALEKI-POUR M R, BIRANG R Z, KHOSHAYAND M, et al. Effect of Nd:YAG laser irradiation on the number of open dentinal tubules and their diameter with and without smear of graphite:An in vitro study[J]. J Lasers Med Sci, 2015, 6(1):32-39.
[9] XIAO S M, LIANG K N, LIU H L, et al. Effect of water-cooled Nd:YAG laser on dentinal tubule occlusion in vitro[J]. Photomed Laser Surg, 2017, 35(2):98-104.
[10] ATHULURU D, REDDY C, SUDHIR K M, et al. Evaluation and comparison of efficacy of three desensitizing dentifrices on dentinalhypersensitivity and salivary biochemical characteristics:A randomized controlled trial[J]. Dent Res J (Isfahan), 2017,14(2):150-157.
[11] 葛翘诚, 于莉, 吴佩玲. 两种药物联合治疗老年人牙本质敏感症的临床疗效观察[J]. 中华老年口腔医学杂志, 2017, 15(5):276-279.
[12] 张德辉, 孙海涛, 周昆. Desensitizer Oravive联合Er:YAG激光治疗牙本质敏感的疗效观察[J]. 实用口腔医学杂志, 2015, 31(6):837-840.
[13] CHINELATTI M A, RAUCCI-NETO W, CORONA S A, et al. Effect of erbium:yttrium-aluminum-garnet laser energies on superficial and deep dentin microhardness[J]. Lasers Med Sci, 2010, 25(3):317-324.
[14] HAJIZADEH H, NEMATI-KARIMOOY A, BABAEE-RISHKHORI P. Effect of erbium:yttrium-aluminum-garnet laser combined with mineralizing agents on microhardness of demineralized dentin[J]. Eur J Dent, 2019, 13(1):11-16.
[15] AL-OMARI W M, PALAMARA J E. The effect of Nd:YAG and Er, Cr:YSGG lasers on the microhardness of human dentin[J]. Lasers Med Sci, 2013, 28(1):151-156.
[16] BELAL M H, YASSIN A. A comparative evaluation of CO₂ and erbium-doped yttrium aluminium garnet laser therapy in the management of dentin hypersensitivity and assessment of mineral content[J]. J Periodontal Implant Sci, 2014, 44(5):227-234.
[17] SOARES L E, MARTIN O C, MORIYAMA L T, et al. Relationship between the chemical and morphological characteristics of human dentin after Er:YAG laser irradiation[J]. J Biomed Opt, 2013, 18(6):068001.
[18] CONTRERAS-ARRIAGA B, RODRÍGUEZ-VILCHIS L E, CONTRERAS-BULNES R, et al. Chemical and morphological changes in human dentin after Er:YAGlaser irradiation:EDS and SEM analysis[J]. Microsc Res Tech, 2015, 78(11):1019-1025.
[19] TOPÇUOGLU H S, KÖSEOGLU M. Effect of Er:YAG and Nd:YAG lasers on the mineral content of root canal dentin[J]. Lasers Med Sci, 2015, 30(2):809-813.
[20] DU Q,GE L H, ZHANG S, et al. Effects of erbium:yttrium-aluminum-garnet laser irradiation on bovine dentin contaminated by cariogenic bacteria[J].Photobiomodul Photomed Laser Surg, 2019, 37(5):305-311.
[21] 崔蜜,马惠珍,孙斌,等.不同类型牙本质保护膜对牙本质粘接性能的影响[J].西安交通大学学报(医学版),2019,40(5):774-777.