受牙周炎侵犯的牙根表面經雷射處理後之形態、生物性質、及元素分析

The Morphological, Biological, and Elemental Analysis of Periodontitis Affected Root Surfaces After Laser Treatment

林震濤(Cheng-Tao Lin)

指導教授 ： 劉謙美

共同指導教授 ： 侯連團(Lein-Tuan Hou)

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.02753

摘要

傳統非手術性牙周治療，是以手動器械配合音波器械，針對牙根面的牙菌斑、牙結石和受感染的牙骨質，作機械性的清創，已經被證實有顯著的臨床效果。但是，傳統牙周治療由於牙周組織空間狹窄、牙根結構使傳統器械不易進入。所以，牙醫師使用了各種輔助或是另類治療方式，希望能改善機械性清創不足的地方。利用雷射能量密度高，且光束不擴散、可以集中作用於極小面積的特性，能不需直接接觸組織，針對特別的區域作精密的處理。因此，若能應用在牙周治療上，可以利用雷射的特性，清潔傳統牙周器械無法達到的死角，甚至改變牙根面的特性，進而促進牙周結締組織重新附著。
本研究採用釹釔鋁鈣鈦礦石雷射（Nd:YAP laser）和鉺鉻釔鈧鉫石榴石雷射（Er,Cr:YSGG laser）兩種作用機制不同的雷射，針對體外牙的牙根面照射後，分別以光學及掃描式電子顯微鏡紀錄其表面形態變化；另針對鉺鉻釔鈧鉫石榴石雷射處理後的牙根面，與人類齒齦纖維母細胞一起培養，以評估其細胞親合性；並分別使用傅立葉轉換紅外線光譜儀（FTIR）或表面能量分散光譜儀（EDX）分析雷射照射後，牙根面化學組成的可能變化。
實驗結果顯示，接受釹釔鋁鈣鈦礦石雷射照射的牙根面，不會殘留塗抹層，而產生明顯的形態改變，包括火山口凹陷（crater）和周圍的焦黑碳化（charring）現象；傅立葉轉換紅外線光譜儀則顯示位於1240cm-1、1650cm-1處，代表氨基化合物的吸收峰消失，此官能基的消失代表與蛋白質相關的組成有所改變。
鉺鉻釔鈧鉫石榴石雷射，在牙根表面沉積物清除能力上，可以有效地移除牙根面附著的牙結石，但也同時使牙根產生凹陷和粗糙表面；照射後的牙根，齒齦纖維母細胞的附著數較少，可能代表較差的細胞親合性；表面能量分散光譜儀顯示沒有元素組成比例的改變。
在釹釔鋁鈣鈦礦石雷射的實驗中，照射時為停留於單一位置照射10秒鐘，但臨床應用時並非停留於一點給予雷射能量，因此所得的結果只可以供作臨床操作前的參考。未來，還需要進一步研究，釹釔鋁鈣鈦礦石雷射針對牙根硬組織的適當功率設定和照射模式，以減少升溫效應所產生的碳化現象。
鉺鉻釔鈧鉫石榴石雷射的實驗中，雖然模擬了臨床所可能的操作模式，能在不對牙根面產生焦黑碳化或融熔的情況下，有效的清除牙根表面沉積物，但是細胞附著數仍明顯較低。因此在未來，鉺鉻釔鈧鉫石榴石雷射對牙根深層可能產生的升溫效應，及其對牙根面的細胞親合性的可能影響及機制，還有待探討。

關鍵字

非手術性牙周治療 ； 牙科雷射 ； Nd:YAP ； Er,Cr：YSGG ； 細胞附著分析 ； 掃描式電子顯微鏡 ； 傅立葉轉換紅外線光譜儀 ； 表面能量分散光譜儀

並列摘要

It has been clinically proven that non-surgical periodontal therapy, that is, mechanical debridement of the bacterial plaque, calculus, and infected cementum on the diseased root surfaces by hand and/or ultrasonic instruments, can relieve the inflammation and improve the clinical parameters of periodontal tissues. The nature of narrow and un-accessable deep, diseasd periodontal structure, however, makes thorough cleaning of diseased tissue a difficult issue. Periodontists have developed various alternative treatments, like chemical irrigation, local antibiotics application, or root conditioning to deal with the above problems. The unique characteristics of the laser, such as high energy density, and collimation, make it a potentially useful tool to deal with periodontally affected tissue. But the proper level of energy ouput and its corresponding effect on local periodontal tissue are still uncertain.
In the study, two types of laser apparatus were used to evaluate the morphological, biological, and elemental changes of root surfaces treated in vitro. The samples treated with Nd:YAP laser were examined under light and scanning electronic microscope to see the morphological changes. Besides, they were tested by Fourier transform infrared（FTIR） spectrometer to verify the chemical changes over surface. The Er,Cr:YSGG laser treated root samples were examined with light and scanning electronic microscope to compare the morphological changes and efficiency of calculus removal with other treatment modalities. These samples were incubated in human fibroblast culture to evaluate the biocompatibility of the lased roots. Energy dispersive X-ray（EDX） analysis was used to evaluate the elemental changes.
The results of the study showed that without water cooling, charring and crater-like depressions were noted on Nd:YAP laser treated root surfaces, and changes of chemical bonds were also noted.
The calculus could be removed efficiently with either hand curette or Er,Cr:YSGG laser, without charring or compositional changes. The cell attachment assay, however, showed unfavorable results in laser treated root surfaces.
The proper energy setting and condition for periodontal hard tissue could be explored before applying Nd:YAP laser in the oral cavity. The possible mechanism that leads to the poor cell attachment to Er,Cr,YSGG laser treated root surfaces is also an interesting issue for future study.

並列關鍵字

non-surgical periodontal therapy ； laser ； Nd:YAP ； Er,Cr:YSGG ； cell attachment assay ； SEM ； FTIR ； EDX

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