EP1617774A1 - Systeme et procede de traitements buccaux - Google Patents

Systeme et procede de traitements buccaux

Info

Publication number
EP1617774A1
EP1617774A1 EP03714192A EP03714192A EP1617774A1 EP 1617774 A1 EP1617774 A1 EP 1617774A1 EP 03714192 A EP03714192 A EP 03714192A EP 03714192 A EP03714192 A EP 03714192A EP 1617774 A1 EP1617774 A1 EP 1617774A1
Authority
EP
European Patent Office
Prior art keywords
liquid
tissue
handpiece
gas
spray
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP03714192A
Other languages
German (de)
English (en)
Other versions
EP1617774A4 (fr
Inventor
Wolfgang Neuberger
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
BIOLITEC PHARMA IP & INVESTMENT LTD.
Original Assignee
Ceramoptec GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ceramoptec GmbH filed Critical Ceramoptec GmbH
Priority claimed from PCT/US2003/008085 external-priority patent/WO2004082499A1/fr
Publication of EP1617774A1 publication Critical patent/EP1617774A1/fr
Publication of EP1617774A4 publication Critical patent/EP1617774A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/24—Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/0046—Dental lasers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00017—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids with gas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A61B2018/00029—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids open
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00321—Head or parts thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B2018/206—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the laser light passing along a liquid-filled conduit

Definitions

  • the present invention relates to the field of treatment of oral tissues using laser radiation of an especially effective wavelength and having a handpiece with means for delivery of this laser radiation and for spraying a liquid/gas mixture onto the treatment area to improve the treatment effects.
  • a variety of laser treatments are used in the field of oral and maxillofacial surgery. Such treatments offer many advantages, especially because of their high coagulation properties, high incision quality, and post-operative benefits for the surgeon and the patient.
  • WO 99/39652 it is described how to treat periodontal pockets with laser light without heating the surrounding tissue by spraying a coolant of mixed water and air onto the tissue.
  • the device used comprises a handpiece with a combined water and fiber duct whereby the spray is generated at the output end of the handpiece.
  • this disclosure does not teach how to avoid unwanted heating of deeper tissue layers.
  • the invention provides for conducting the laser delivery fiber and the water in one duct. This configuration is disadvantageous because the water at the fiber tip absorbs laser energy and thus renders the energy delivered to the tissue undeterminable, and moreover, the tip heats up and can cause unwanted burnings. Further the position of the fiber and therefore the aiming of the laser light is not defined.
  • WO 99/39652 mandates the use of a "wavelength that is moderately absorbed in water".
  • the invention claims the use of wavelengths ranging from 1-1.2 microns or 1.06 to 1.07 microns, which are moderately absorbed in water. Using wavelengths that are more highly absorbed in water would presumably lower the effectiveness of the treatment and is therefore avoided.
  • U.S. Patent No. 5,374,266 describes a laser device consisting of a handpiece with a special fiber and fiber duct for small cavities and uniform irradiation.
  • This device features a cooling fluid spray that is fed along the fiber probe to clean the treatment area and cool the fiber probe after irradiation or to cool the probe during irradiation. The water is then blown peripherally from the probe so as to avoid any moisture damage to the probe fiber.
  • the use of water in this invention is for cooling the probe, not the treatment site during irradiation.
  • the prior art has contemplated the use of cooling liquid or sprays in conjunction with irradiation treatments to avoid thermally damaging surrounding tissues.
  • Those wavelengths are those that are not highly absorbed in water.
  • the prior art contemplates the use of wavelengths, such as those on the order of 1 micron, that have relatively low absorption in water so as not to inhibit treatment.
  • U.S. Patent 6,129,721 although describing an irradiation handpiece featuring a fiber and delivery means for spraying fluid and gas that would at first seem similar to the present invention, limits its invention to those wavelengths between 1 and 5.5 microns.
  • U.S. Patent No. 5,290,274 by Levy et al. describes the use of radiation with two different wavelengths in conjunction with a step of directing cooling fluid to the treatment site during irradiation.
  • the first wavelength is between 0.7 and 1 micron
  • the second wavelength is in the vicinity of 3 microns.
  • Nd: YAG radiation in combination with a liquid cooling source is effective, because fundamental frequency radiation with a wavelength of 1.06 microns and frequency doubled radiation with a 0.532 micron wavelength are essentially not absorbed in water.
  • the effectiveness of an Er: YAG laser is considerably reduced when used in conjunction with a cooling liquid spray because it produces radiation of a wavelength that is highly absorbed by water.
  • the prior art teaches that the use of a wavelength that is highly absorbed by water, such as a 980 nm laser, in conjunction with a liquid cooling spray would be ineffective.
  • the present invention addresses the above mentioned drawbacks of the prior art by providing a method and system that avoids unwanted heating of surrounding tissue by different means and provides a very precise incision quality by a combination of laser light of a wavelength of approximately 980 nm and a cooling liquid spray.
  • pulsed laser light is used to provide localized energy deposition and heating, therefore avoiding unwanted heating of underlying tissue.
  • Additional liquid spray flushes away tissue debris and provides additional cooling of treated tissue.
  • An object of the present invention is to provide a system and method for improved treatment of oral tissue using laser light and without heating the surrounding tissue and without carbonization.
  • Another object of the present invention is to avoid unwanted tissue heating and significantly improve treatment results by using an advantageous wavelength for irradiation and by spraying a liquid/gas mixture onto the tissue.
  • Still another object of the present invention is to use laser light of a wavelength of 980 nm.
  • Yet another object of the present invention is to provide a handpiece with a laser fiber duct and liquid/gas ducts.
  • a further object of the present invention is to provide a handpiece with a changeable sterile fiber tip.
  • the present invention provides a system and method for improved treatment of oral tissues using 980nm laser radiation and a handpiece with means for concurrently delivering the laser radiation and a liquid/gas spray onto the treatment area to improve the treatment effects. Unwanted heating and carbonization of surrounding tissues is reduced.
  • the liquid/gas spray may be mixed inside the handpiece or in a separate device.
  • the combination of cooling sprays with radiation wavelengths having high absorption in water has previously been avoided due to the thought that energy absorption by the cooling fluid would render the energy delivered to the tissue uncontrollable and of minimal benefit.
  • pulsed laser light provides a localized energy deposition and heating to avoid unwanted heating of underlying tissue.
  • the liquid spray flushes way tissue debris in addition to cooling the treated tissue.
  • Figure 1 handpiece with one spray duct and changeable fiber tip
  • Figure 2 fiber with ducts
  • the energy delivered to the tissue during laser therapy is defined by several parameters such as power density, radiation duration and wavelength.
  • Laser wavelengths of 2 or 3 ⁇ m, 1064 nm, 980 nm or 810 nm are all used for dental applications.
  • the 980 nm laser was found to be advantageous when compared to treatments applying other wavelengths, because the 980 nm wavelength seems to offer a unique balance between the desired level of water absorption and limited penetration depth.
  • the water absorption curve shows a local maximum at the wavelength of 980 nm which indicates that 980 nm radiation is well absorbed by water.
  • irradiation with a 980 nm laser results in a superior tissue cutting and coagulation effect that is accomplished optically rather than thermally, unlike other wavelengths currently used.
  • Shorter wavelengths have a lower water absorption and thus penetrate too deeply.
  • Longer wavelengths (such as that produced by an Er: YAG) are not well absorbed in blood components such as hemoglobin and oxyhemoglobin, and are much more difficult to deliver because suitable optical fibers for transmission are not available and commonly used mirror arms are not easy to handle.
  • longer wavelengths such as those produced by Nd: YAG lasers [1064nm] exhibit low water and blood component absorption and unacceptably high depth penetration.
  • the 980 nm wavelength has the additional advantage of having a lower penetration depth than in commonly used wavelengths such as visible wavelengths or 1064 nm, and can thereby avoid undesired and uncontrolled heating of deeper tissue layers. Coagulation with 980 nm laser radiation can be controlled very precisely. Postoperative advantages such as lack of swelling, bleeding, pain, or scar tissue formation and good wound healing, are observed in all clinical applications.
  • This wavelength can also be used to uncover submerged implants to treat peri- implantitis without damaging the surface of the implants as it is the case with longer wavelengths or other methods (Romanos, Everts, Nentwig, "Effects of Diode and Nd:YAG Laser Irradiation on Titanium Discs: A Scanning Electron Microscope Examination", J Periodontol 2000, 71, 810-815 (2000)).
  • very high energies can be applied to a small and defined treatment site to enhance the effectiveness of the treatment.
  • the pulsed mode is especially advantageous for avoiding unwanted heating of healthy tissue because the irradiation period is shorter than the time it takes for the transport of heat into deeper tissue layers to begin. However, it has been determined that certain power levels must not be exceeded with this wavelength.
  • the additional application of a liquid/gas spray improved the results of treatment with 980 nm radiation significantly.
  • the use of a spray has been described for treatments with other wavelengths but has not been used with 980 nm due to the high absorption of this wavelength by water relative to other wavelengths.
  • the use of a water spray was initially expected to lead to energy losses and reduced effectiveness of the treatment. However, it has been found that this is not the case.
  • the spray acts as a cooling means for preventing unwanted tissue heating and for keeping the incised tissue wet to prevent drying and carbonization.
  • the liquid/gas spray has the additional benefit of removing tissue debris produced by the treatment that would potentially absorb irradiation and cause carbonisation on the tissue as well as on the fiber tip. Therefore, the spray has to intersect with the fiber tip on the plane of the treatment site to achieve enhanced results.
  • the combined advantageous wavelength of 980 nm and liquid/gas spray provide excellent surgical and aesthetic results in various oral applications. Specific examples of these results, including a lack of swelling, bleeding, pain, or scar tissue formation and good wound healing, have been observed in all clinical applications.
  • the aesthetic outcome of the method of the present invention due to a limited coagulation zone and a lack of scar tissue formation or receding tissue is of importance for such treatments as surgical treatment of the gum line at crowns.
  • the tissue recedes after the surgery thereby rendering metal or other support structures of the crown/implant visible and thus compromising the aesthetic result of the treatment.
  • the present invention provides a system and method for an improved treatment of oral tissue.
  • the system includes a radiation source such as a laser emitting the advantageous wavelength of 980 nm and a delivery device for the radiation and the liquid/gas spray.
  • the term "liquid/gas spray” may denote either a spray incorporating some combination of a liquid and a gas, or may denote a spray consisting entirely of one or more liquids.
  • a handpiece directs the radiation and the spray to the treatment site.
  • the shape of the handpiece can be formed in many different ways to allow the practitioner to comfortably work at several treatment sites.
  • the delivery device consists of a handpiece incorporating a fiber duct and means to conduct liquid and gas.
  • the fiber duct contains one or more optical fibers to deliver 980 nm radiation to a treatment site.
  • additional wavelengths could be delivered through the duct via separate optical fibers.
  • an additional fiber could be added to deliver visible radiation that would give the user greater visibility, or to deliver radiation of a wavelength suitable for biostimulation or wound healing.
  • handpiece 101 features disposable fiber tip 102 that can be changed in order to use new and sterilized fibers for every patient.
  • the connection of changeable fiber tip 102 with fiber 103 in the handpiece is designed in a way that radiation is efficiently transferred, preferably by direct contact of the surfaces of the fibers.
  • the duct for the fiber tip is short in order to avoid damaging the fiber during insertion.
  • the fiber tip is stored with protecting cap 104 to maintain sterility of the tip before it is removed prior to treatment.
  • the liquid/gas spray is conducted as a spray through the handpiece in one duct 105 and originating in spraying device 106.
  • Spraying device 106 may contain a fixed gas and liquid mixture or, as seen in Figure 1, can be fed variable amounts through liquid feeding means 107 and gas feeding means 108. hi this way, the liquid amount and flow rate as well as the gas pressure are individually controllable to produce a spray consisting of a controllable ratio of liquid to gas or to produce a spray that is purely liquid.
  • the handpiece is provided with separate ducts for gas and liquid respectively, which are then combined within the handpiece and released through nozzles 109 as a liquid/gas mixture, hi either embodiment, the handpiece is provided with at least two nozzles 109 to assure uniform spraying onto the tissue.
  • liquid gas conducting duct 201 within the fiber is located coaxially with the fiber either in the center of the fiber with the radiation being conducted in outer ring 202 ( Figure 2a), or with liquid/gas duct 201 in cladding 203 surrounding fiber core 202 ( Figure 2b).
  • the liquid gas mixture preferably is a mixture of air and water or physiologic salt solutions or disinfecting fluids. Also other inert gases like nitrogen can be used to generate the spray.
  • the handpiece can be sterilized, and especially the fiber tip is replaceable, so that new sterilized fiber tips can be inserted into the handpiece for every new treatment.
  • the system and method provided by the invention can successfully be used for several applications in oral surgery, e.g. periodontitis, peri-implantitis, implant recovery, endodontia, hyperplasia, vestibular plastic, incision in oral surgery.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Optics & Photonics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Otolaryngology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Dentistry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Electromagnetism (AREA)
  • Epidemiology (AREA)
  • Pulmonology (AREA)
  • Laser Surgery Devices (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

L'invention concerne un système et un procédé de traitement amélioré de tissus buccaux faisant appel à un rayonnement laser de 980 nm et une pièce à main (101) avec un moyen permettant d'administrer simultanément le rayonnement laser et une pulvérisation liquide/gazeuse sur la zone de traitement pour améliorer les effets du traitement. Le chauffage et la carbonisation non recherchées des tissus périphériques sont réduits. Ladite pulvérisation peut être mélangée à l'intérieur de la pièce à main (101) ou dans un dispositif séparé (106). La combinaison de pulvérisations de refroidissement avec des longueurs d'ondes de rayonnement à absorption élevée dans l'eau a été antérieurement évitée du fait que l'on estimait que l'absorption d'énergie par le fluide de refroidissement rendrait incontrôlable l'énergie administrée au tissu et son intérêt serait minime. De préférence, la lumière laser pulsée fournit un dépôt et un chauffage énergétiques localisés, ce qui permet d'éviter le chauffage non recherché des tissus sous-jacents. La pulvérisation liquide évacue les débris tissulaires tout en refroidissant les tissu traités.
EP03714192A 2003-03-18 2003-03-18 Systeme et procede de traitements buccaux Withdrawn EP1617774A4 (fr)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2003/008085 WO2004082499A1 (fr) 2002-01-24 2003-03-18 Systeme et procede de traitements buccaux

Publications (2)

Publication Number Publication Date
EP1617774A1 true EP1617774A1 (fr) 2006-01-25
EP1617774A4 EP1617774A4 (fr) 2010-04-28

Family

ID=38977006

Family Applications (1)

Application Number Title Priority Date Filing Date
EP03714192A Withdrawn EP1617774A4 (fr) 2003-03-18 2003-03-18 Systeme et procede de traitements buccaux

Country Status (2)

Country Link
EP (1) EP1617774A4 (fr)
CN (1) CN101076294B (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109567931A (zh) * 2018-12-07 2019-04-05 中聚科技股份有限公司 一种末端带光热材料的可更换激光刀头及激光治疗装置

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5290274A (en) * 1992-06-16 1994-03-01 Laser Medical Technology, Inc. Laser apparatus for medical and dental treatments
WO1997007928A2 (fr) * 1995-08-31 1997-03-06 Biolase Technology, Inc. Combinaison programmable par l'utilisateur de particules atomisees pour decoupage par procede electromagnetique
US5825958A (en) * 1996-01-25 1998-10-20 Pharos Optics, Inc. Fiber optic delivery system for infrared lasers
WO1999039652A1 (fr) * 1998-02-06 1999-08-12 Eigil Moelsgaard Systeme dentaire de traitement des poches parodontales par faisceau laser
US6343174B1 (en) * 1999-07-30 2002-01-29 Ceramoptec Industries, Inc. Laser delivery system with optical fibers having fluid delivery channels

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5409376A (en) * 1993-03-10 1995-04-25 Murphy; Quentin M. Apparatus and process for laser-assisted driling
US6350123B1 (en) * 1995-08-31 2002-02-26 Biolase Technology, Inc. Fluid conditioning system
US5855577A (en) * 1996-09-17 1999-01-05 Eclipse Surgical Technologies, Inc. Bow shaped catheter
US5941701A (en) * 1998-07-14 1999-08-24 Ceramoptec Ind Inc Device and method to treat oral disease in felines

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5290274A (en) * 1992-06-16 1994-03-01 Laser Medical Technology, Inc. Laser apparatus for medical and dental treatments
WO1997007928A2 (fr) * 1995-08-31 1997-03-06 Biolase Technology, Inc. Combinaison programmable par l'utilisateur de particules atomisees pour decoupage par procede electromagnetique
US5825958A (en) * 1996-01-25 1998-10-20 Pharos Optics, Inc. Fiber optic delivery system for infrared lasers
WO1999039652A1 (fr) * 1998-02-06 1999-08-12 Eigil Moelsgaard Systeme dentaire de traitement des poches parodontales par faisceau laser
US6343174B1 (en) * 1999-07-30 2002-01-29 Ceramoptec Industries, Inc. Laser delivery system with optical fibers having fluid delivery channels

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
MICHAEL D. SWICK: "Comparative study of two intraoral laser techniques for soft tissue surgery", PROCEEDINGS OF SPIE, vol. 4950, 1 January 2003 (2003-01-01), pages 11-17, XP55026653, ISSN: 0277-786X, DOI: 10.1117/12.476498 *
See also references of WO2004082499A1 *

Also Published As

Publication number Publication date
EP1617774A4 (fr) 2010-04-28
CN101076294A (zh) 2007-11-21
CN101076294B (zh) 2011-08-17

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