要 旨 波長 Er:YAG レーザー光は 2.94 μm の水に極めてよく吸収され軟組織と硬組織の蒸散も可能であることから,歯周 治療領域では主に炎症性肉芽組織と歯石のデブライドメントに用いられてきた.近年 Er:YAG レーザーの表面のみに 限局した血餅形成能を応用した骨再生の新術式である Er:YAG laser-assisted bone regenerative therapy(Er-LBRT)を開発 し,既存の術式と比較して同等以上の効果を得ている.また,インプラント周囲炎治療にも応用され良好な結果を示 している.本稿では Er-LBRT の臨床症例を紹介し,文献を参考に解説する. キーワード:歯周組織再生治療,インプラント周囲炎治療,骨再生,血餅形成,Er:YAG レーザー AbstractThe 2.94 μm wavelength Er:YAG laser is strongly absorbed by water and is able to effectively ablate both soft and hard tissues. In periodontal treatment, Er:YAG lasers are used to debride inflammatory granulation tissue and calculus. Recently, we developed a novel bone regenerative procedure, Er:YAG laser-assisted bone regenerative therapy (Er-LBRT), which induces blood clot coagulation in the superficial areas of grafted bone. We have applied this technique in periodontal regenerative therapy. Er-LBRT achieved successful clinical outcomes that are more than equivalent to those seen with conventional periodontal regenerative therapy. Furthermore, Er-LBRT was applied to regenerative therapy in peri-implantitis treatment. In this article, the Er-LBRT procedure is introduced and its effectiveness is discussed based on clinical evidence.
Since the 1960's, basic and clinical research has been conducted regarding the biostimulative effects of photobiomodulation (PBM) by means of low-reactive level laser therapy (LLLT). A number of studies have used low-level diode lasers in nearinfrared to infrared wavelengths because of their high degree of tissue penetration. In the dental field, it has been shown that LLLT enhances proliferation, migration, and differentiation of gingival fibroblasts, osteoblasts, periodontal ligament cells, as well as mesenchymal stem cells in vitro. Furthermore, LLLT promoted wound healing and bone formation in vivo. Currently, less invasive and safer procedures are desired for dental treatment, especially for regenerative therapy. It is expected that PBM by means of LLLT will contribute to attaining that goal. Consequently, we have reviewed basic and clinical studies using the diode laser for LLLT, and we discuss the potential of LLLT in promoting periodontal tissue healing and regeneration.
The Er:YAG laser has been widely applied in dental treatments such as caries therapy, periodontal therapy, endodontic therapy, and dental implant therapy and demonstrated the excellent clinical effects since the laser is applicable to both soft and hard tissues. In the field of implant therapy, the Er:YAG laser can be applied to the following stages: gingivectomy, osseous surgery for implant bed preparation and LLLT for promotion of wound healing in the first phase of implant therapy, and gingival and bone tissue preparation for uncoverage of submerged implants in the second phase, and treatment of peri-implant lesions in the maintenance stage. Thus, currently the Er:YAG laser has become a promising laser in implant therapy and the further development of applications is expected. In the present paper, the clinical applications of the Er:YAG laser are introduced with the results of recent basic studies.
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