Department of Operative Dentistry and Endodontology, Dental School, Ghent University, Ghent University Hospital, Gent, Belgium.
J Adhes Dent. 2009 Dec;11(6):427-38. doi: 10.3290/j.jad.a18136.
The use of the ruby laser (693.4 nm) was first described in 1960, and it was applied for hard tissue ablation in 1964. Different wavelengths [Nd:YAG (1.065 microm), CO2 (9.6 microm), Ho:YAG (2.12 microm)] were consequently explored. Due to massive thermal side effects, these wavelengths caused increased temperature in dental pulp, as well as microcracks and carbonization. The use of this laser for dental hard tissue preparation was eventually abandoned. At the end of the 1980s, excimer lasers (ultraviolet) and the erbium laser (infrared) were developed, with the advantages of improved temperature control and smaller penetration depths. With the development of smaller devices and improved knowledge of how to limit damage to the surrounding tissues, new ablation techniques were established in the 1990s. There is still contradiction in the current literature, however, in that different wavelengths are advocated for hard tissue removal, and heterogeneity in laser parameters and power densities remain. In this review, the effects of the wavelengths presently used for cavity preparation are evaluated. We conclude that erbium lasers (Er:YAG and Er,Cr:YSGG) are most efficient and, with the right parameters, the thermal side effects are small. There is a substantial need for "gold standards", although this is difficult to establish in practice owing to different laser parameters (including pulse repetition rate, amount of cooling, energy delivered per pulse, and types of pulses) and target specificity (tissue interaction with sound or decayed enamel or dentin, and the extent of (de)mineralization) which influence tissue interaction.
红宝石激光(693.4nm)于 1960 年首次被描述,并于 1964 年被应用于硬组织消融。随后探索了不同波长[Nd:YAG(1.065μm)、CO2(9.6μm)、Ho:YAG(2.12μm)]。由于大量的热副作用,这些波长导致牙髓温度升高,以及微裂纹和碳化。因此,该激光最终被放弃用于牙科硬组织制备。在 20 世纪 80 年代末,开发了准分子激光器(紫外线)和铒激光器(红外线),具有改进的温度控制和更小的穿透深度的优点。随着更小设备的发展和对如何限制周围组织损伤的认识的提高,新的消融技术在 20 世纪 90 年代建立。然而,目前的文献中仍然存在矛盾,即不同的波长被提倡用于硬组织去除,并且激光参数和功率密度的异质性仍然存在。在这篇综述中,评估了目前用于腔制备的波长的效果。我们的结论是,铒激光器(Er:YAG 和 Er,Cr:YSGG)效率最高,并且在适当的参数下,热副作用很小。尽管由于不同的激光参数(包括脉冲重复率、冷却量、每个脉冲传递的能量和脉冲类型)和目标特异性(组织与声音或腐烂的牙釉质或牙本质的相互作用,以及(脱)矿化的程度)影响组织相互作用,很难建立“黄金标准”,但仍然存在很大的需求。
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