RU2132210C1 - Method of preparing tooth hard tissues - Google Patents

Abstract

FIELD: medicine, in particular, stomatology. SUBSTANCE: different modes of laser effect are used for preparation of tooth enamel, intact dentin, softened dentin and indurate dentin and for removal of pulp thermal irrigation. EFFECT: reduced traumatic injuries. 1 cl, 2 ex

Description

 The invention relates to medicine, namely to dentistry for use in wide practice in the treatment of the most common dental diseases: caries, pulpitis, periodontitis.

 In modern dentistry, various modifications are known of the methods for preparing hard tooth tissues - enamel and dentin using a laser beam with different wavelengths - from 1.63 to 10.6 μm (1). Recently, the most widespread are laser devices with neodymium emitters activated by erbium or holmium (2).

 However, the known methods have significant disadvantages, the main of which are the following due to the different optical density of the tooth enamel and dentin, due to the unequal content of mineral and organic components in them (enamel contains up to 97-98% of mineral components and 2-3% of organic; dentin contains 65-68% mineral and 32-35% organic) the speed and most importantly, the quality of preparation of these tissues at the same wavelength of the laser beam does not allow preparation without the formation of macro- and microt Eshina, charring and the excessive heating of dental hard tissue and pulp, which may cause damage to the latter until its necrosis.

 Compared with the above prototypes, a new solution is proposed for the method of preparing hard tooth tissues using a laser beam of different wavelengths, which is adequate in its absorption spectrum for hard tooth tissues with different optical densities. Specially conducted studies made it possible to determine the optical absorption spectra of enamel and dentin (3), which substantiated the initial data for the technical solution of the proposed method for the preparation of enamel and dentin.

 The essence of the proposed method lies in the optimal conditions for the preparation of tooth enamel and dentin, adequate to their optical density and, accordingly, the optimal absorption spectrum of these tissues of laser beams with different wavelengths.

 Specially conducted experimental and clinical studies have shown that for the preparation of tooth enamel the most effective are laser beams with wavelengths of 1.69 - 1.94 microns, in a pulsed generation mode with frequencies of 3 - 15 Hz and a power of 1 - 5 J / pulse.

 Since tooth decay (medium and deep), dentin can practically be in two states - softened (more often) or densified (the so-called transparent dentin), it turned out to be reasonable, justified, to prepare it with a laser beam of different wavelengths: softened dentin is prepared with a laser beam with a length waves of 1.06 - 1.3 microns at frequencies of 2 - 20 Hz and a power of 1 to 3 J / imp, and compacted (transparent) dentin with a wavelength of 2.94 microns, a frequency of 3 to 15 Hz and a power of 1 to 5 J / imp

 Since tooth pulp irritation occurs during the preparation of enamel and dentin, especially during deep caries, pulp is irradiated immediately after completion of the preparation of hard tooth tissues (the rays are directed to the bottom of the cavity) with laser light with a wavelength of 0.63 - 0.67 μm (continuous generation) with a power of 20-25 J / cm with an exposure of 2 min.

 In addition to the preparation of carious cavities using the proposed method, it is possible to open the tooth cavity in the treatment of pulpitis, as well as the removal (methods of ablation, sublimation, evaporation) of the coronal and root pulp, and if necessary, the passage and expansion of the root canals and coagulation of the root granules with a laser beam with a length waves 1.06 - 1.3 microns with the following generally accepted methods of filling root canals and cavities.

 A laser beam with a wavelength of 1.06 - 2.94 microns also removes the rest of the fillings from cement and polymers.

 Specific clinical examples of the application of the proposed method.

. Лечение: после удаления экскаватором размягченных тканей лазерным лучом с длиной волны 1,94 мкм, частотой 5 Гц, мощностью 2Дж/имп. обработаны и сформированы края полости (в пределах эмали), затем лазерным лучом с длиной волны 1,3 мкм, мощностью 2 Дж/имп., частотой 4 Гц обработан дентин стенок и дна кариозной полости. Лазерным лучом с длиной волны 0,63 мкм, мощностью 20 Дж/см с экспозицией 2 мин облучена (через дно кариозной полости) пульпа зуба. Полость закрыта повязкой из кальмецина с последующим наложением пломбы из стомадента. Рентгенологический контроль через 7 мес. патологических изменений твердых тканей и пульпы зуба не обнаружил.1. Patient N., 36 years old. Diagnosis: deep caries on chewing surface

. Treatment: after removal by the excavator of softened tissues with a laser beam with a wavelength of 1.94 μm, a frequency of 5 Hz, and a power of 2 J / imp. the edges of the cavity were processed and formed (within the enamel), then a laser beam with a wavelength of 1.3 μm, a power of 2 J / imp., and a frequency of 4 Hz was used to treat the dentin of the walls and the bottom of the cavity. A laser beam with a wavelength of 0.63 μm, a power of 20 J / cm and an exposure of 2 min was irradiated (through the bottom of the cavity) of the tooth pulp. The cavity is closed with a dressing made of calmecin, followed by the application of a filling from the stodent. X-ray control after 7 months. pathological changes in hard tissues and tooth pulp were not found.

. Лечение лазерным лучом с длиной волны 1,3 мкм, частотой 6-8 Гц мощностью 3 Дж/имп удалены остатки цементной пломбы и вскрыта полость зуба, коронковая и корневая пульпа удалена способом абляции, пройден корневой канал. Края полости (в пределах эмали) обработаны и сформированы лазерным лучом с длиной волны 2,94 мкм частотой 5 Гц, мощностью 2 Дж/имп. Корневой канал запломбирован эндометазоновой пастой, полость запломбирована стомадентом. Для устранения раздражения периапикальных тканей после лазерной и медикаментозной обработки корневого канала проведена процедура облучения (на слизистую оболочку по проекции верхушки корня зуба) лазерным светом с длиной волны 0,63 мкм, мощность 25 Дж/см, экспозиция 2 мин. Субъективно - жалоб нет. Контрольные рентгеновские снимки через 2 и 4 месяца показали состояние периапикальных тканей без признаков патологии.2. Patient I., 24 years old. The diagnosis of chronic pulpitis in the acute stage

. Treatment with a laser beam with a wavelength of 1.3 μm, a frequency of 6-8 Hz with a power of 3 J / imp leftovers of the cement filling were removed and the tooth cavity was opened, the coronal and root pulp was removed by ablation, and the root canal was passed. The edges of the cavity (within the enamel) are processed and formed by a laser beam with a wavelength of 2.94 μm, a frequency of 5 Hz, and a power of 2 J / pulse. The root canal is filled with endometasone paste, the cavity is sealed with stodent. To eliminate irritation of periapical tissues after laser and drug treatment of the root canal, an irradiation procedure was performed (on the mucous membrane according to the projection of the apex of the tooth root) with laser light with a wavelength of 0.63 μm, power 25 J / cm, exposure 2 min. Subjectively - no complaints. Control x-rays after 2 and 4 months showed the state of periapical tissues without signs of pathology.

Used sources
1. Nazyrov Yu.S. The use of lasers for the preparation of hard tooth tissues. Inf. bull. "Computers and lasers in dentistry", M., 1992, v.1. with. 55 - 59.

 2. German patent N 40 14 303. A 61 C 1/08. Device for removing carious tooth material with laser light. Ref. w "Inventions of the countries of the world", M., 1992, N 10, p. 63.

 3. Baskakova L. I. Spectral characteristics of hard tissues of the tooth and oral mucosa. In the book: Lasers in surgical dentistry (edited by A.A. Prokhonchukov). M., 1982, p. 10 - 15.

Claims (1)

 A method of preparing hard tooth tissues with laser beams, characterized in that when preparing the tooth enamel, pulsed laser light with a wavelength of 0.69 - 1.95 μm, a power of 1 - 8 J / imp frequency of 3 - 12 Hz is used, for the preparation of intact dentin use a laser beam with a wavelength of 2.94 μm, a power of 1 to 3 J / imp, a frequency of 2 to 8 Hz, a laser beam with a wavelength of 1.06 to 1.3 microns, a power of 2 to 4 J / imp is used to prepare softened dentin , with a frequency of 4 - 6 Hz, for the preparation of compacted (transparent) dentin using a laser beam with for wavelength of 1.94 μm, a power of 3 - 6 J / pulse, a frequency of 5 - 10 Hz, to eliminate thermal irritation of the pulp of the tooth, it is irradiated with continuous laser light with a wavelength of 0.63 - 0.67 μm, a flux density of 20 - 25 J / cm for 2 min.