Berg Britt-Isabelle, Peyer Michael, Kuske Lorenz, Augello Marcello, Schötzau Andreas, Steineck Markus, Deibel Waldemar, Mathys Daniel, Jürgens Philipp, Kunz Christoph, Goldblum David
Department of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland.
Advanced Osteotomy Tools AG (AOT), Basel, Switzerland.
Lasers Surg Med. 2019 Aug;51(6):531-537. doi: 10.1002/lsm.23053. Epub 2019 Jan 15.
The osteo-odonto-kerato-prosthesis (OOKP) procedure is a complex, multi-stage, multidisciplinary surgical intervention for the treatment of severe corneal blindness. One step of the OOKP consists of creating a precise hole into a tooth in which an optic cylinder is subsequently inserted; its shape must ensure a perfect watertight fit. The Er: YAG laser (L) used in this study is part of CARLO®, the first laser osteotome that enables surgical planning based on computed tomography data, robot guidance, and a precise execution of laser cuts in teeth and bone tissue, using laser photoablation rather than conventional mechanical methods. The purpose of this study was to assess whether the Er: YAG laser is non-inferior compared to a conventional drill.
Thirty-two bovine incisors were grounded to a thickness of 1.5 mm. In 16 teeth, a 3.5 mm hole was drilled progressively into each tooth, using dental burs (B) of increasing diameter that were attached to a fixed drill machine. In the other 16 teeth, a hole was created using an Er: YAG laser at a wavelength of 2.94 µm (Part of CARLO®). In seven teeth of each group, the cylinder was inserted and fixated with polymethylmethacrylate (PMMA) bone cement. In the remaining seven teeth of each group, the cylinder was inserted without fixation material (press-fit). After bonding and drying, all specimens were stored in water until force measurements were recorded using a uniaxial traction machine. The force required to move the optical cylinder out of the hole in the tooth was measured using an Instron 3344 testing system. Scanning electron microscope (SEM) and light microscope (LM) visualization of the holes created with the laser and the drill were performed in two teeth (SEM)/four teeth (LM) per method.
Significant differences (P < 0.001) were found for the following parameters: B PMMA versus B press-fit; B PMMA versus L press-fit; L PMMA versus B press-fit; L PMMA-L press-fit. This shows that PMMA bone cement fixation is superior to press-fit. No significant differences were found between B PMMA-L PMMA (P = 0.93) and B press-fit-L press-fit (P = 0.83). The SEM pictures showed a smoother surface using L.
The laser cut holes were as strong as bur-drilled holes, although SEM pictures showed a smoother surface of the laser cut holes. Hence, laser osteotomes open the possibility to custom fit the hole exactly to the width of the cylinder, which represents a potential advantage of the laser over the conventional bur. Lasers Surg. Med. 51:531-537, 2019. © 2019 Wiley Periodicals, Inc.
骨牙角膜移植术（OOKP）是一种复杂的、多阶段的、多学科的外科手术，用于治疗严重角膜盲。OOKP的其中一个步骤是在牙齿上精确钻出一个孔，随后将一个视柱体插入其中；其形状必须确保完美的水密配合。本研究中使用的铒钇铝石榴石激光（L）是CARLO®的一部分，这是第一台激光骨钻，它能够基于计算机断层扫描数据进行手术规划、机器人引导，并使用激光光蚀而非传统机械方法精确地在牙齿和骨组织中进行激光切割。本研究的目的是评估铒钇铝石榴石激光与传统钻头相比是否不逊色。
将32颗牛切牙磨至1.5毫米厚。在16颗牙齿中，使用安装在固定钻机上、直径逐渐增大的牙科车针（B），逐步在每颗牙齿上钻出一个3.5毫米的孔。在另外16颗牙齿中，使用波长为2.94微米的铒钇铝石榴石激光（CARLO®的一部分）钻出一个孔。每组中的7颗牙齿，插入视柱体并用聚甲基丙烯酸甲酯（PMMA）骨水泥固定。每组其余7颗牙齿，插入视柱体但不使用固定材料（压配合）。粘结和干燥后，将所有标本储存在水中，直到使用单轴牵引机记录力的测量值。使用Instron 3344测试系统测量将视柱体从牙齿孔中移出所需的力。对每种方法钻出的孔，在两颗牙齿上进行扫描电子显微镜（SEM）观察，在四颗牙齿上进行光学显微镜（LM）观察。
在以下参数上发现了显著差异（P < 0.001）：B PMMA与B压配合；B PMMA与L压配合；L PMMA与B压配合；L PMMA - L压配合。这表明PMMA骨水泥固定优于压配合。B PMMA与L PMMA（P = 0.93）以及B压配合与L压配合（P = 0.83）之间未发现显著差异。SEM图片显示使用激光时表面更光滑。
激光切割的孔与车针钻出的孔强度相同，尽管SEM图片显示激光切割的孔表面更光滑。因此，激光骨钻有可能使孔的尺寸与视柱体的宽度精确适配，这是激光相对于传统车针的一个潜在优势。《激光外科与医学》51:531 - 537，2019年。© 2019威利期刊公司
