Rechmann Peter, Charland Daniel A, Rechmann Beate M T, Le Charles Q, Featherstone John D B
Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA 94143, USA.
Lasers Surg Med. 2013 Jul;45(5):302-10. doi: 10.1002/lsm.22141. Epub 2013 Jun 4.
High caries prevalence in occlusal pits and fissures warrants novel prevention methods. An 86% reduction in dental enamel smooth surface demineralization in-vivo following short-pulsed 9.6 µm-CO(2) -laser irradiation was recently reported. The objective of this study was to conduct a blinded 12-month-pilot clinical trial of occlusal pit and fissure caries inhibition using the same CO(2) -laser irradiation conditions.
STUDY DESIGN/MATERIALS AND METHODS: Twenty subjects, average age 14 years, were recruited. At baseline, second molars were randomized into test and control groups, assessed by International Caries Detection & Assessment System (ICDAS-II), SOPROLIFE light-induced fluorescence evaluator in daylight and blue-fluorescence mode and DIAGNOdent. An independent investigator irradiated test molars with a CO(2) -laser, wavelength 9.6 µm, pulse-duration 20 µs, pulse-repetition-rate 20 Hz, beam diameter 800 µm, average fluence 4.5 ± 0.5 J/cm(2), 20 laser pulses per spot. At 3-, 6- and 12-month recall teeth were assessed by ICDAS, SOPROLIFE and DIAGNOdent. All subjects received fluoride varnish applications at baseline and 6-month recall.
All subjects completed the 3-month, 19 the 6-month and 16 the 12-month recall. At all recalls average ICDAS scores had decreased for the test and increased for the control fissures (laser vs. control, 3-month: -0.10 ± 0.14, 0.30 ± 0.18, P > 0.05; 6-month: -0.26 ± 0.13, 0.47 ± 0.16, P = 0.001; 12-month: -0.31 ± 0.15, 0.75 ± 0.17, P < 0.0001; mean ± SE, unpaired t-test) being statistically significantly different at 6- and 12-month recalls. SOPROLIFE daylight evaluation revealed at 6- and 12-months statistically significant differences in changes between baseline and recall for test and control molars, respectively (laser vs. control, 6-month: 0.22 ± 0.13, 0.17 ± 0.09, P = 0.02; 12-month: 0.28 ± 0.19, 0.25 ± 0.17, P = 0.03). For SOPROLIFE blue-fluorescence evaluation mean changes in comparison to baseline for the control and the laser treated teeth were also statistically significant for the 6- and 12-month recall.
Specific microsecond short-pulsed 9.6 µm CO(2) -laser irradiation markedly inhibits caries progression in pits and fissures in comparison to fluoride varnish alone over 12 months.
咬合面窝沟处的高龋齿患病率需要新的预防方法。最近有报道称，短脉冲9.6μm二氧化碳激光照射后，体内牙釉质光滑表面脱矿减少了86%。本研究的目的是在相同的二氧化碳激光照射条件下，进行一项为期12个月的盲法临床试验，以抑制咬合面窝沟龋。
研究设计/材料与方法：招募了20名平均年龄为14岁的受试者。在基线时，将第二磨牙随机分为试验组和对照组，通过国际龋病检测与评估系统（ICDAS-II）、SOPROLIFE光诱导荧光评估仪在日光和蓝光荧光模式下以及DIAGNOdent进行评估。一名独立研究者用波长9.6μm、脉冲持续时间20μs、脉冲重复频率20Hz、光束直径800μm、平均能量密度4.5±0.5J/cm²、每点20个激光脉冲的二氧化碳激光照射试验磨牙。在3个月、6个月和12个月的随访时，通过ICDAS、SOPROLIFE和DIAGNOdent对牙齿进行评估。所有受试者在基线和6个月随访时均接受氟化物漆涂抹。
所有受试者均完成了3个月的随访，19名完成了6个月的随访，16名完成了12个月的随访。在所有随访中，试验组的平均ICDAS评分下降，对照组的窝沟评分上升（激光组与对照组，3个月：-0.10±0.14，0.30±0.18，P>0.05；6个月：-0.26±0.13，0.47±0.16，P=0.001；12个月：-0.31±0.15，0.75±0.17，P<0.0001；均值±标准误，非配对t检验），在6个月和12个月的随访中差异有统计学意义。SOPROLIFE日光评估显示，在6个月和12个月时，试验组和对照组磨牙基线与随访之间的变化分别有统计学意义（激光组与对照组，6个月：0.22±0.13，0.17±0.09，P=0.02；12个月：0.28±0.19，0.25±0.17，P=0.03）。对于SOPROLIFE蓝光荧光评估，对照组和激光治疗组牙齿与基线相比的平均变化在6个月和12个月的随访中也有统计学意义。
与单独使用氟化物漆相比，特定的微秒级短脉冲9.6μm二氧化碳激光照射在12个月内可显著抑制窝沟龋的进展。
