TAP CH( NGHIEN CO'U Y H p C •
SO SANH HIEU QUA BVT 6 N G NGA TREN T H 6 THLTC NGHIEM CUA LASER DIODE 810NM Cf 3 LI^U CHI^U TIA: 5 GIAY, 10 GIAY, 15 GIAY TAI 1 DI^M
Pham Thj T u y l t Nga, Le Van S e n , Trjnh Thj ThSi Ha Vi^n dao tQo RSng Ham Mat - Truong D?i hgc Y Ha Npi Di4u tri nhay cam nga bing laser la mot phuang ph6p dieu trj an toAn va cho ket qua ch^c chin. Tuy nhien, hi$u qui di§u tri ph(i IhuQC vAo lo^i laser va cac thong s6 su dung. Do dd, chung tdi tiSn hanh nghiSn cikt nay vai muc tieu: so s6nh hi$u qua bit 6ng nga va tac dong gay n&t mi^ng 6ng nga cua laser diode SlOnm 6 3 lieu chieu tia 5 giay, 10 giiy, 15 giiy tren Ihuc nghidm. Siu con tho dugc chia thanh 3 nhom nhan cac liiu chieu laser khic nhau: 5 giay (5J/mm^). 10 giay (lOJ/mm^). 15 giay (15J/mnf). Sau 3 lan chiiu laser (7 ngay 1 lan) cac rang duc^c nho. xu iy be mat va sot tren SEM Ket qua cho thay ty le 6ng nga dUpc bit hoan toan a 3 nhdm tuong ung 49,4% ,86,3% va 86.9% Ty 1$ ong nga bi ran nCet tuong img li: 14%, 16.1% va 38.2%. Su dung laser diode BlOnm, 0,5W voi liiu chieu 10 giay lien tuc (lOJ/mm^) dem lai hi^u qua bit dng ngi cao mi han chi anh huong den ciu true dng nga.
Tip khoa: LD - Laser diode, nhay cam nga, bjt dng nga
I. OAT
VANBt
Nhay cam nga tuy chya phai la mOl bdnh nhyng lai la nguygn nhSn khflng nho gSy ra sy khb chiu thydng xuygn v l rang mieng va khien nhilu ngydi phai di kh^m chuyen khoa Theo mpt so nghign cdu, ty !g m i c nhay cam nga c l the Ign tdi 57% [1]. Vi vay viec d i l u tn hoi chdng nhay cam nga da va dang la mdi quan tam cua nhieu nha sT Co nhieu phyong phap d i l u tn nhay cam nga da d y g c nghign cdu va dng dyng nhy s y dung cac varnish, gel boi, trong d6 d i l u tn bang laser la mot phyong phap dieu tri c l nhieu yu diem nhy khong dau, nhanh chong va cho k i t qua c h i c c h i n [2] Tuy nhien hieu qua d i l u tri ciia laser CO sy khac nhau phy thuoc vao loai laser, dp Idn ty trong, phyong each phat quang, each
Dia chi li&n he. Pham Thi Tuyil Nga - Vi$n D6o tao RSng Ham M$t, Tru&ng Dai hqc Y Hi NQI
Email [email protected] vn Ngaynh$n 21/01/2015 Ngay duryc chip thuan 18/5/2015
tiep xiic dau quang hoc vdi md dich va thdi gian c h i l u tia [3] M6t so nghien cdu sd dyng laser diode dieu tn nhay cam nga thay higu qua d i n 85% [4] hay trong mdt nghign ciiu khac ty lg nay la 6 0 % [5], hoac nghign cdu si>
dyng laser 0 0 2 co the dem d i n thanh c6ng 100% [6].
0 6 n h i l u loai laser d y g c s d dung d l dieu tn nhay cam nga nhy laser CO2, laser Nd.
YAG, laser diode... Trong do cac laser nSng lygng cao {gom laser C O j , laser Nd:YAG) vdi kha nang smh nhiet cao la d i l u can lyu y vdi eae bac sT rSng ham m^t. Oac laser nang lyong thap (dgi dign la laser diode) noi bat vdi y u diem gpn nhe, an toan, chi phi t h i p . Tai Vigt Nam, laser diode b y d c song 810nm kha pho b i l n va c6 chi phi phCi hgp do db cd t h l d y g c s y dyng rdng rSi Vay vdi loai laser nay cac thdng so d y g c s d dung nhy t h l nao de dgt hieu qua d i l u tr; cao ma hgn c h l nhdng tac ddng khong mong muon d i n c l u tnic b l
• TAP CHi NGHIEN C U ^ Y HQC mat rang Vi vay nghign cdu nay d y g c t i l n
hanh vdi muc tigu;
1. So sanh higu qua bit I n g nga cua laser diode 810 nm d 3 l i l u c h i l u tia (tai 1 diem), 5 giay. 10 giay, I S g i a y .
2. So sanh tac d i n g gay ndt migng ong nga cua 3 each chilu tia tren.
II. D 6 | TU'O'NG VA PHU'ONG PHAP
I.Ddi tipgng£)6i t y o n g nghien c d u la sau eon tho trydng thanh, cung Ida vdi 24 c h i l e rang c d a nguyen ven, d y o c chia ngau nhien thanh 3 nhdm nhan 3 l i l u c h i l u laser: 5 gigy (nhom 1), 10 giay (nhom 2), 15 giay (nhdm 3).
2. PhiFcng phap
Nghign c d u t h y c nghigm trgn tho theo p h y o n g phap cua Nandakumar A [7].
M l i c h i l e rang cda cua tho d y g c m d 1 "cda sd men" vung co rang kich t h y d c 2 x 2 mm, sau 0,5 mm b i n g mui khoan (phun n y d c lien tuc). Cac rang d y o c etching b i n g aeid phosphoric 37% trong 10 giay, sau do rda sach. C d 2 rang trgn cung 1 cung lam cua 1 eon tho d y g c b i t thanh cap. 1 rSng chdng va 1 rang nhan anh sang laser vdi cac thdi gian c h i l u khae nhau. Hai con tho nhom 1 nhan l i l u c h i l u 5 giay lign tuc tai mpt diem - nghi 5 giay, tong lieu 5J/mm^. Hai con tho nhdm 2 nhan l i l u e h i l u 10 giay lien tuc tai mdt diem - ngh? 10 giay , tong l i l u 10J/mm^. Hai con tho nhdm 3 nhan lieu c h i l u 15 giay lien tuc tai 1 ^ e m - nghl 15 giay, tong hlu 15J/mm^
Tong l i l u chieu laser d y g c tfnh d y a theo cdng thde:
T6ng l i l u (J/mm^) = cong suat dau ra (w) x Thdi gian c h i l u (s) x So i l n chieu tren 1 mm^.
May laser s d dyng trong nghign edu la laser diode 810nm, s d dung c6ng s u i t may
0,5W, c h l do s i n g lign tuc, k h i n g tigp xue, khoang each t d d i u tip d i n be mat rang la 1 mm. c a c rang d y g c c h i l u 3 i l n vdi cung each thde, 7 ngay/lln. S d dung mpt la c h i n (matnx) de anh sang laser khong tac dpng d i n rang chdng bgn canh. Sau 1 t u i n t d khi c h i l u lia I l n 3, tien hanh nho rang ca n h i m chdng va nhom laser. Rang d y g c co dinh b i n g dung dich glutaraldehyd 2,5% a 4°C it n h i t trong 24 gid. Sau do m l u rang d y g c x d ly* va t i l n hanh soi tren kinh h i l n vi dign t d quet (SEM:
Scanning electron microscopic) de danh gia hieu qua bit ong nga va quan sat nhdng thay doi a b l mat nga rang khi c h i l u cac l i l u laser khac nhau. Anh chyp cua mdi nhom rang d y o c lyu vao tdng file rigng va d y g c ma hoa d l viec dpc k i t qua la hoan toan khach quan.
Tigu chi danh gia hieu qua bit I n g nga (theo danh gia cua West N.X [8] nam 1998 cd sda doi):
- Ong nga bit hoan toan la nhdng I n g nga d y g c bit toan bp b l mat hoac chl cdn lai 1 khe hep.
- Ong nga bit 1 p h l n : la nhdng ong nga khong d y o c bit hoan toan nhyng d y o c bjt s 1/4 d y d n g kinh
- Ong nga khong d y g c bit la nhdng I n g nga d y g c bit < 1/4 d y d n g kinh.
3. Dao di>c n g h i e n cu>u
Nghidn edu d y o c t i l n hanh theo d l c y o n g Nghign c d u smh da d y g c Hpi dong thfing qua de c y o n g cua Vien Bao tao Rang Ham Mat, trydng Dai hpc Y Ha Npi phg duyet
Tho s y dung trong nghign cdu d y g c nufii trong d i l u kign tot n h i t vdi mpt can b l chuygn trach. M l i b y d c thyc hien nghign cdu , tho d y g c gay me vdi l i l u lygng thuoc phu hgp de dam bao khdng dau va cung khOng gay anh hydng d i n sde khoe chung cua tho Sau mdi
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN CCPU Y HQC -
b y d c nghign c d u tho d y o c theo d6i chat ehe bdi ngydi nghign c d u va can bO chuygn trach de phat hign va giai quyet kip thdi cac van d l v l sdc khoe.
. K^T QUA
1. Hieu qua bjt dng nga ciia laser
Bang 1. Hieu qua bjt dng nga cua laser diode 810 nm v&\ ligu chigu tia 5 giay lien tuc - nghi 5 giay (tai 1 di^m bg mat)
Chu'ng Can thiep
Hieu qua
P Chisd Bjt hoan Bjt mot Khong hieu
toan phdn bjt c|ua
Bjt hoSn to^n Bit 1 phSn Kh6ng bit Tong
15 29 331 376
4,0%
7,7%
88,3%
100 190 152 43 385
49,4%
39,6%
11,1%
100 0,007 0,000
0,007
0,000 0.000 0,000
45,4%
31,8%
77,2%
Vdi hlu chilu 5 giay hgn tuc tai 1 diem cd 49,4% I n g nga d y o c bit hoan toan, 39.5% dng nga dyoc bit 1 p h l n Ohiing toi quan sat t h i y migng I n g nga d y g c bit bdi cac sgi collagen dan kit nhau mot each thya thdt, tao thanh mot ldp mong phu Ign migng ong
Bang 2. Hieu qua bjt 6ng nga cua laser diode 810 nm vdi l i l u c h i l u tia 10 giay lien tuc - nghl 10 giay (tai 1 d i l m b l mat)
Chyng Can thiep
Hieu qua
Bit
toan Bjt mgt
phan Khdng
bit
Chisd hieu qua
Bjt tioan toSn Bit 1 ptiln Kti6ng bit Tong
12 46 439 497
2,4%
9,3%
88,3%
100%
480 53 23 656
86.3%
9,5%
4,2%
100%
0,000 0,000
0,000
0,000 0,000 0,000
83,9%
0,2%
84,1%
Vo'l li§u ctiiSu 10 giay lien tuc tai 1 fliem hieu qua bit ong nga hoan toan li 86,3%. Tren be mat mSu Chung toi quan sat thay cic bb soi collagen (Jan ket c h j t che vdi nhau {661 chS t^o thSnh nhOng nOt) 14m thanh 1 l&p collagen dSy. c h i c c h i n phu ISn ml$ng ong n g i .
• TAP CHi N G H I S N C L P U Y H p c
Bang 3. Hieu qua bjt dng nga cua laser diode 810 nm vdi l i l u c h i l u tia 15 giay lien tuc - nghi 15 giay (tai 1 d i l m b l mat)
Chu'ng Can thiep
Hieu qua
Bjt hoan toan
Bjt mgt Khong ^i'?"
ph^n bjt qua
Bit hoan toan Bit 1 phSn Khong bit Tong
12 45 437 494
2,4%
9 , 1 % 88,5%
100%
364 46 10 419
86,9%
10,7%
2,4%
100%
0,000 0,000
0,000
0,000 0,000 0,000
84,5%
1,6%
8 6 , 1 %
Co 86,9% ong nga du'ae bit hoan toan o lieu chi^u tia 15 giay vol chi s6 hieu qua dat 84,5%
Quan sat tren SEIVl chung toi thSy cac bb soi collagen co lai ro ret, dan xen vac nhau chSc chSn 6k phu len mieng 6ng nga. p h l n mieng 6ng du'ae phu collagen hoi lOm xudng so voi xung quanh.
^ : : a i ' > '
: i
•••:f-,:
Nhom chijng (do phong dai x 45000} Laser 5 giay (do phong dai x 30000)
Laser 10 giay ( d l phdng dai x 35000) Laser 15 giay (dp phong dai x 45000) Hinh 1. Hinh anh mieng dng nga
TCNCYH 93(1)-2015
TAP cMMyi|N;cO'u Y Hpc — -
- Tac dpng cda iaser ien be mat nga rSng:
Quan sat d eac m d c phdng dai v d a va nho (500 lan, 2000 i l n , 5000 lan, 10000 lan) chung tdi thay b l m$t nga rang d ca nhdm chdng va 3 n h i m c h i l u laser dieu mjn khdng quan sat thay cac dydng ndt gay. Tuy nhign, khi quan sat d cae m d c phdng dgi Idn ( t d 15000 lan t r d ien), Chung t6i thay m i t so migng ong nga co nhdng d y d n g ndt nhe Ohiing t6i t i l n hanh danh gia ty Ig % dng nga e l hign t y o n g rgn ndt d ca nhdm chdng va 3 nhdm e h i l u laser
Bang 4 . Ty l§ d n g nga r^n niet d n h d m e h i r n g va 3 n h d m c h i l u lasler
Nhdm Chiang Hieu qua
Nhom laser 5 giay
N h d m laser Nhom laser 10 giay 15 giay
So Iu'O'ng ong ngS blnh thu'O'ng So lucng ong ngS ran ne't
Tong Nhbm chi>ng Nh6m laser 5 giay Nhdm laser 10 giay Nhdm laser 15 giay
42 89.4 5 10,6 47 100
0,752 0,524 0,006
37 86,0 6 14,0 43 100
0.762
1,000 0,018
31 83,8 6 16,2 37 100
0,524 1,000
0,059
21 61,8 13 38,2 34 100
0,006 0,018 0,059
0 nhdm laser 5 giay va 10 giay c l ty lg ong nga b\ rgn ndt la t y d n g d y o n g nhau va khing khac biet so vdi nhom chdng.
Trong khi d6 d nhCm laser 15 giSy co ty lg ndt migng ngS la 38,2%i eao hon h i n so vdi nhom ehdng va 2 n h i m laser 5 giay, 10 gigy.
: • • > ! • " . '
Nh6m ehdng ( d | p h i n g dai x 4000)
'^<
• " ^ . ^ ' ; ^ % ^ - ' ? .^" %
. ii'7^',/-,_>',^;
Nhdm lasers gigy (dO p h i n g dai x 4000)
/Su
;,:..-A
'^if":
• TAP CHi NGHieN CU'U Y HQC
Laser 10 giSy (do phong da x 46000) Laser 15 giay (do phong da x 50000) Hinh 2. Hinh anh be mat nga rang
IV. BAN LUAN
Theo k i t qua nghign c d u nay, 3 nhom nghign c d u nhan 3 h l u c h i l u tia (5 giay, 10 giay, va 15 giay), nh6m 5 giay chl co 49,4%
I n g nga d y g c bjt hoan toan va eau triie colla- gen bit migng I n g kha thya. Trong khi do, d nhdm c h i l u 10 giay va 15 giay, higu qua bit ong nga hoan toan la r i t cao (gan 86%). Oau triic collagen phu migng I n g d ea 2 nhom d i u day va c h i c c h i n ; trong do d nhom c h i l u 15 giay cac bo sgi collagen co lai nhieu hon d nhom 10 giay, ddi chd tao thanh nhdng vung tan chay n h d Nhy vay, mdc do b i l n doi eiia eae bo soi collagen ty lg thuan vdi mdc nang lyong tac ddng Ign md rang. Tuy nhign, nghign cdu cOng chf ra r i n g higu qua bit dng nga d nhdm 10 giay va 15 giay la tyong dyong nhau.
K i t qua nay cho thay khi tae d i n g mot mdc nang lygng laser thich hgp co the cho higu qua bit I n g nga eao nhyng hieu qua nay lai khong tang ty 10 thuan vdi mdc nSng lyong khi mdc nang lygng tiep tyc tSng hon nda.
Nghien c d u nay cho t h i y , d nhdm 10 giay va 15 giay cd s y t y o n g ddng vdi k i t qua nghign c d u eua mOt s l tac gia v l higu qua bjt dng nga s d dung laser diode nhy nghien cdu
cua Umana M [8], s d dung laser diode 810 nm va 980 nm, cong s u i t 0,8W, thdi gian c h i l u 10 giay hay nghien cdu cua Satoshi M [9] vdi laser diode 810 nm, cong suat 1W. K i t qua 2 nghign c d u trgn cho t h i y hau h i t cac I n g nga d y o c bit hoan toan do do co t h l iam giam tinh t h i m cua nga rang ma khong ggy ndt gay b l mat rang. Trong nghien nay, khi quan sat b l mat nga rang d eae mdc phdng dgi vda va nho ehiing toi cung khong nhan thay eae dydng ndt gay d ca 3 n h i m c h i l u laser nhyng d mdc phdng dai Idn x u l t hien eac d y d n g ndt nhe migng ong nga Ty lg cac ong nga bi ndt d nh6m 5 giay va 10 giay khing khac biet nhau nhyng d nhom 15 giay ty lg nay eao hon h i n . Tuy vay, 12 c h i l e rang cua ca 3 nhom laser deu khong c l hien tygng hoai t y tuy, cac rang sau 3 t u i n (td i l n chieu d i u tign d i n 1 tuan sau i l n chieu e u l i ciing) d i u mpc dai ra t y o n g d y o n g rang chdng bgn cgnh. Dieu nay cho thay mSc du cd s y ran ndt mieng ong nga d mdc do nhe (nhdm laser 5 giay, 10 giay) hay mdc dp trung binh (nhdm laser 15 giay) viec d i l u tri b i n g laser diode la an toan doi vdi tuy rang trgn thye nghigm.
TCNCYH 93(1)-2015
TAP CHi NGHIEN C U U Y H p C •
V. KtT LUAN
T y k i t qua nghign c d u thyc nghigm.
chiing t6i nhan thay s d dyng hgu c h i l u tia 10 giay lign tuc (nghi 10 giay) ta; 1 d i l m d6i vdi laser diode 810 nm, c y d n g do 05W la thich hop de d i l u tn nhay cam nga, higu qua bit I n g nga cao va han c h l anh hydng ndt mieng I n g nga,
Lo'i cam cn
Toi xin chan thanh cam on bo mon M l phoi - Trydng Dai hpc Y Ha Noi va phong kinh hien vi - Vien Ve sinh dich t l Trung y o n g da giiip tdi hoan thanh nghign c d u nay. Tdi xm cam doan khdng co xung dot lgi ich t d k i t qua eiia nghien cdu nay.
TAI LIEU THAM KHAO
1. Martinet, Faus M.V (2008). Dentinal sensitivity: concept and methodology for its objective evalution Med Oral Patol Oral Cir Suca/, 13(3). 201 - 2 0 6
2. Marisilio A.L, Rodrgues J.R (2003).
Effect of the clinical in the treatment of dentine hypersensitivity J Clin Laser Med Surg. 21(5), 291 - 296.
3- Pinheiro A.L (1998). Interagao tecidual Laser na Odontologia Moderna. Sao Paulo:
Pancast, 45 - 62.
t . Setoguchi T, Mastunaga U, Chinju N (1990). The effects of soft laser irradiation and
stron tium chlinde application on dentin hyper- sensitivity induced by penodental treat- ment Japan J Conserv Dent. 33, 620 - 627.
5. Yamaguchi M, Ito M, Miwata T (1990).
Clinical study on the tuetment of hy persensi- tive dentin by Gaalas laser usiung the double blind test J Dent Soi, 28, 703 - 707.
6. Zhang C, Matsumoto K (1998). Effects of 0 0 2 laser in treatment of cervical dentinal hypersensivity. J Eridod. 24. 595 - 597
7. Nadakumar A, Lyer V.H (2004). In vitro analysis comparing efficacy of laser and desensitizing agents on dentin tubule occlusion; A scanning electron microscope study International Journal of Laser Dentistry.
4(1), 1 - 7
8. West N.X, Addy M, Hughes J (1998}
Dentine hypersensitivity, the effects of brushing desensitizing toothpastes, their solid and liquid phases and detergents on dentine and acrylic studies in vitro. J Oral Rehabil, 25, 885 - 895
9. Umana M, Heysselaer D, Tieleman M (2013). Dentinal tubules, sealing by mean of diode laser (810 nm and 980 nm) a prelimi- nary in vitro study . Photomed Laser Surg, 31 (7), 3 0 7 - 3 1 4 .
10. Satoshi M, Masahiro K (2008) Stimu- latory effects of OO2 laser, E r Y A G laser and Ga-At-As laser on exposed dentinal tubule onfices J Chn Biochem Nutr, 42(2), 138 -143.
Summary
COMPARISON OF EMPIRICAL SEALING EFFECTIVENESS ON DENTINAL TUBULES OF 810NM LASER DIODE AT THREE CONSTANT DOSES:
5 SECONDS, 10 SECONDS, 15 SECONDS AT 1 POINT
The. treatment of hypersensitive dentine by laser is a safe therapy w/ith good results.
However, the effectiveness of the treatment depends on the type of laser and parameters used.
Therefore, we conducted this study with the following objectives; to compare the dentinal tubule
• TAP CHl NGHIEN CUU Y HpC sealing effectiveness and tubular orifice cracking impacts of 810nm diode laser at 3 doses, 5 seconds. 10 seconds and 15 seconds in vitro. 6 rabbits are divided into 3 group receiving different dose of laser: 5 second (5J/mm^), 10 second (10J/mm^) and 15 second (15J/mm^). After three times of laser radiations (once for 7days), the teeth are extracted, the surface was treated and scanned with SEM. Research results the percentage of dentinal tubule sealing in 3 group is 49 4%, 86.3% and 86.9% respectively The percentage of cracked dentinal tubule is 14%; 16 2%
and 38.2% respectively. Conclusion: Using 810 nm laser; 0.5W and a 10 - constant - second dose (10J/mm^) produces a high dentinal tubule sealing effectiveness while restricting impacts on the dentinal tubule structure
Key words: LD - Laser diode, hypersensitivity, occlusion dental tubule
TCNCYH 93(1)-2015