- 學位論文
低能量雷射對減輕齒顎矯正疼痛之臨床評估
Clinical Evaluation of Using Low-Power Laser to Reduce Orthodontic Pain
摘要
齒顎矯正治療期間，裝置調整後之疼痛常是患者和醫師最大的困擾。而近期，低能量雷射用於臨床止痛療效上，有其正面意義。故本研究之目的是要評估低能量雷射對減輕齒顎矯正裝置調整後疼痛之療效。實驗對象為47名志願參加研究的牙科學生；將橡皮separator放置於四個象限之各被選定小臼齒的近遠心接觸面來引起矯正疼痛；再將功率50mw的鎵─砷半導體雷射（波長904nm）之光纖頭置於頰側牙齦緣下四公厘處照射之。同一受測者，各顆牙齒照射時間長短為30秒（安慰劑組）、30秒、60秒、90秒；雷射照射前後均以「視覺類比尺度」（Visual Analogue Scale─V.A.S.）評估受測者的疼痛程度；實驗連續進行五天，再以統計學方法來評估實驗結果。在每日治療前後V.A.S.差值的中位值（median）的比較中；照射雷射90秒的牙齒在第二、第三天雖比其他三組的牙齒明顯有較高的中位值，但其他天的比較中，並沒有相同的現象。此外，由無母數分析得知，在第五天的照射前後差的比較中，90秒組有最大的止痛效果，且有統計學上的差異（p<0.001）。但在其他天的比較結果中，並無統計學上的一致差異來證明照射組比安慰劑組有較大的止痛療效。故根據本研究得知，低能量雷射對齒顎矯正調整後疼痛的後期具有立即抒解疼痛的療效且以照射90秒效果較佳，但仍無法完全排除安慰劑的效應。
並列摘要
Postadjustment pain has been the big problem that bothered the patients and the orthodontists during the period of orthodontic treatment. Recently, low-power laser therapy has been shown to produce the analgesic effect in clinical application. The purpose of this study was to evaluate the efficacy of using low-power laser in reducing orthodontic pain. Forty-seven voluntary dental students were included in this study. Elastomeric separators were placed at the proximal contacts in each quadrant to induce orthodontic pain. The tip of a 50 mW Gallium-Arsenic (904 nm) semiconductor laser probe was placed at the buccal gingiva and directed at the area, 4 mm gingivally from the gingival margin. Three different treatment durations of 30, 60, 90 seconds and one placebo treatment of 30 seconds were performed within each subject. Visual Analogue Scale (V.A.S.) was used to quantify the intensity of the pain perceived by the subjects before and after laser applications for each day. All the testing procedure was proceeded for five days. The results were analyzed statistically. In comparing with the median scores of V.A.S. difference in other groups, before and after laser therapy, those in the treatment group of 90 seconds laser application showed lower level of pain in the second and third days. However, there wasn't the similar tendency of the analgesic effect in the comparisons of those above in other days. On the other hand, the data was processed with the nonparametrically statistical analysis. There was the significantly maximal analgesic efficacy statistically with the 90 seconds radiation of laser application, in the difference between the pre-treatment and post-treatment scores of the fifth day. (P<0.001) Nevertheless, there weren't concomitant significant difference statistically between the treatment and placebo groups in other analyses to prove that the treatment could alleviate the orthodontic pain absolutely. According to this study, the orthodontic postadjustment pain could be reduced immediately by the low-power laser therapy in the late stage, and the treatment duration of 90 seconds was the better choice in the analgesic purpose. However, the placebo effect could not be excluded completely.