Dental care system and device
Background of invention
Technical field
The present invention relates to oral cavity tissue treatment field, use to have the laser irradiation of special effective wavelength and have head, this head has and is used to send this laser irradiation and is used to spray liquid/gas mixture to the device of area for treatment with the improvement therapeutic effect.
Information disclosure is described
Various laser therapies are used for oral cavity and maxillary surface surgical field.These treatments provide many advantages, particularly its high coagulability, high cut quality and for surgeon and patient's post-operative benefits.
According to used wavelength, energy level and irradiation pattern, laser irradiation is significantly different to the effect of tissue.The objective of the invention is to minimize or bloodless no wound mode reaches fast, the cosmetic surgery effect of no carbonization, have limited coagulation region to be mainly to bleed.
In therapeutic process, because hydrone absorbs energy in the tissue, laser is heated tissue, thereby destroys living cells and cause resection organization or otch condenses.In the therapeutic process, be necessary to avoid the overheated or damage of surrounding tissue, and the control radiation response.Irradiation penetrates into to be organized deeply more, and then the gained thermal effect is uncontrollable more.Residual heat can influence dental nerve and cause patient's pain, and can cause carbonized and necrosis.Therefore, wish that the heat that is delivered to lower floor and surrounding tissue minimizes.Therefore, wish that accurately control is transferred to by the light energy of treated tissue.Essential fully control energy makes effectively not circumference tissue of treatment local organization and rudimental energy.
In WO 99/39652, how to have described with the laser therapy periodontal pocket and by injection water and Air mixing coolant on surrounding tissue and do not heat described tissue.Device therefor comprises head, and this head has the water pipe and the optical fiber tube of merging, and injection stream produces at the outfan of head thus.Yet the disclosure is not instructed and how to be avoided being heated than dark the undesirable of organized layer.In addition, this invention provides in a pipe and has carried out optical fiber and the water that laser is sent.This structure is disadvantageous, because absorb laser energy and make that therefore the energy that is delivered to tissue is uncertain at the water of fiber optic tip, in addition, the fiber optic tip heating also can cause undesirable calcination.In addition, fiber position and laser aiming thus are uncertain.Equally, WO 99/39652 has set forth use " wavelength that is absorbed by appropriateness " in water.This invents the wavelength that the claimed scope of application is 1-1.2 micron or 1.06-1.07 micron, and it is absorbed by appropriateness in water.By inference, use in water and will be reduced the treatment effectiveness, therefore need avoid this wavelength by the wavelength of high absorption.
United States Patent (USP) 5,374,266 have described laser equipment, and it comprises the head with particular fiber and optical fiber tube, is used for the irradiation of loculus and homogeneous.This equipment is characterised in that along the cold injection stream of optical fiber probe charging to clean area for treatment and to shine the postcooling optical fiber probe or cool off probe in irradiation process.Around probe, send into water then, to avoid of the infringement of any dampness to probe-type optical fiber.Therefore, making water in this invention is to be used to cool off probe, rather than is used for the coolant treatment position in therapeutic process.
Usually, prior art is considered and is used cold liquid or injection stream to combine with irradiation treatment to avoid the hot injury of surrounding tissue.Yet, can use with Control device of liquid cooling effectively according to stating the wavelength that has only a certain scope, these wavelength be those in water not by the wavelength of high absorption.In fact, as described in WO 99/39652, prior art is considered to use as 1 micron-sized wavelength, and they absorb low relatively in water, to such an extent as to do not hinder treatment.In addition, although United States Patent (USP) 6,129,721 has been described the irradiation head, it is characterized in that optical fiber and the delivery apparatus that is used for jet fluid and gas, it seems similar to the present invention at first, and the wavelength that uses in this patent is the 1-5.5 micron.
People's such as Levy United States Patent (USP) 5,290,274 has been described the irradiation with two kinds of different wave lengths and in irradiation process the fluidic step of therapentic part direct cold has been used.First wavelength is the 0.7-1 micron, and second wavelength is about 3 microns.The claimed Nd:YAG of Levy irradiation is effectively with common use the in fluid refrigerant source, is radiated in the water and is not absorbed substantially because wavelength is a frequency multiplication that 1.06 microns fundamental frequency irradiation and wavelength are 0.532 micron.Yet according to Levy, when Er:YAG laser used with cooling injection liquid, the effectiveness of Er:YAG laser reduced, because it is created in the water by the irradiation of the wavelength of high absorption.
Can find out that from above-mentioned prior art prior art has been instructed in water by the wavelength of high absorption, as 980nm laser, it will be invalid using with cooling injection liquid.
The invention solves the above-mentioned defective of prior art, provide and avoided that the surrounding tissue that caused by different device is undesirable is heated and by laser and cooling injection stream common use the method and apparatus that split-hair cut quality be provided of wavelength for about 980nm.Preferably, use energy deposition and the heating of pulse laser, avoided therefore that lower-hierarchy is undesirable to be heated so that localization to be provided.Other injection stream washes away fragment of tissue and provides by the additional cooling of treated tissue.
Purpose of the invention and overview
The purpose of this invention is to provide the system and method that is used for improved treatment of oral tissue, used laser and non-circumference tissue and carbonization does not take place.
Another object of the present invention is by using favourable illumination wavelength and by spraying liquid/gas mixture to tissue, avoids undesirable tissue to be heated and significantly improves therapeutic outcome.
It is the laser of 980nm that another object of the present invention is to use wavelength.
Another object of the present invention has provided head, and this head has laser fiber pipe and liquid/gas pipe.
Another object of the present invention has provided head, and this head has changeable sterile fiber tip.
Generally speaking, the invention provides the system and method that is used for improved treatment of oral tissue, used the 980nm laser irradiation and had the head of device, described device be used for sending simultaneously laser irradiation and liquid/gas spray to area for treatment to improve therapeutic effect.Reduced that surrounding tissue is undesirable is heated and carbonization.Liquid/gas spray can be mixed in head or mix in specific installation.Previous having avoided used cooling injection stream and the illumination wavelength that absorbs at the water camber jointly, because think that cool stream absorbs energy and makes the energy of sending to tissue become uncontrollable and benefit is minimized.Preferably, pulse laser provides the energy deposition of localization and heating lower-hierarchy is undesirable to be heated to avoid.Injection stream washes away fragment of tissue and cools off by treated tissue.
Above-mentioned and other purpose, feature and advantage of the present invention, from following explanation and accompanying drawing in conjunction with and become apparent, the reference number in the wherein different accompanying drawings is represented similar elements.
Description of drawings
Fig. 1: head with a playpipe and replaceable fiber optic tip.
Fig. 2: optical fiber with pipe.
DESCRIPTION OF THE PREFERRED
In laser therapy procedures, the energy of sending to tissue is by several parameter-definitions, as energy density, irradiation time-histories and wavelength.Wavelength is that the laser of 2 or 3 μ m, 1064nm, 980nm or 810nm all is used for dental applications.Discovery 980nm laser therapy uses the treatment of other wavelength favourable, provides unique balance because the 980nm wavelength appears between required water absorbability and the limited length of penetration.The water absorption curve shows local absorption maximum at 980nm wavelength place, and this shows that the 980nm irradiation is fully absorbed by water.In addition, fully absorb in hemoglobin and HbO2 Oxyhemoglobin because 980nm shines also, therefore shine cutting tissue and the condensation effect that produces excellence with 980nm laser, this passes through optics but not thermodynamics is realized, and is different with other at present used wavelength.Shorter wavelength has lower water absorbability and therefore penetration degree is too dark.Longer wavelength (as the wavelength of producing by Er:YAG) absorbs insufficient in blood constitutent such as hemoglobin and HbO2 Oxyhemoglobin, and difficulty is sent, and is difficult for handling with optical fiber and handel commonly used because can not obtain suitable transmission.In addition, low as the water absorbability and the blood constitutent absorbability of the longer wavelength [1064nm] that produces by Nd:YAG laser, and be not accepted because length of penetration is high.
In addition, another advantage of 980nm wavelength is that length of penetration is low than the length of penetration of common wavelengths such as visible wavelength or 1064nm, therefore can avoid being heated than organized layer is undesirable and uncontrollable deeply.Using the 980nm laser irradiation very accurately to control condenses.In all clinical practices, all observe postoperative advantages, as do not have swelling, hemorrhage, pain or incrustation tissue to form, and wound healing is good.
Also can use this wavelength to expose buried implantation body with treatment bone regeneration around implant inflammation (periimplantitis), and do not damage implant surface, this damage is visible (Romanos in longer wavelength or other method, Everts, Nentwig, " Effects of Diode and Nd:YAGLaser Irradiation on Titanium Discs:A Scanning Electron MicroscopeExamination ", J Periodontol 2000,71,810-815 (2000)).When using pulse mode, can use very high energies to strengthen the effectiveness of treatment with clear and definite therapentic part to less.Pulse mode is for avoiding the undesirable advantageous particularly that is heated of health tissues, and is short because the irradiation period enters the required period of dark organized layer than the beginning transferred heat.Yet, determined to use this wavelength necessarily can not surpass a certain energy level.
Surprisingly, and opposite with the instruction of prior art, use liquid/gas spray in addition and significantly improved the effect of using the 980nm irradiation treatment.Existing injection stream and other wavelength are used for the treatment of jointly, and there is no and the common description of using of 980nm wavelength, because this 980nm wavelength is with respect to the absorbability height of other wavelength in water.Initial expectation is used aqueous jet to cause energy loss and is reduced the treatment effectiveness.Yet, have been found that the fact is not as expecting.Injection stream is used to prevent to organize undesirable being heated as cooling mechanism, and keeps resection organization moistening to prevent exsiccation and carbonization.In addition, the additional benefits of liquid/gas spray is to remove the fragment of tissue that treatment produces, and these fragments will very likely absorb irradiation and cause carbonization on tissue and the fiber optic tip.Therefore, injection stream and fiber optic tip intersect on the therapentic part plane, to strengthen therapeutic effect.
The common use of the advantageous wavelength of 980nm and liquid/gas spray provides excellent surgery and aesthetic results in various oral application.These results' specific examples be included in observed in all clinical practices swelling does not take place, bleed, pain or incrustation tissue form, and wound healing is good.In the potential clinical practice of the present invention, the excision in periodontitis, bone regeneration around implant inflammation, implantation body's recovery, dental pulp disease, hypertrophy, vestibule shaping (vestibular plastic) and the oral surgery is arranged.The present invention since the coagulation region finite sum do not form aesthetic effect that incrustation tissue or tissue sink as these of the surgical intervention of corona place gingiva line be even more important in treating.Use is different from treatment of the present invention, being organized in operation back and sinking, thereby making the metal of corona/implantation body or other supporting construction as seen, thereby having destroyed the aesthetic effect of treatment.
The invention provides the system and method that is used for improved treatment of oral tissue.This system comprises that irradiation source is as the laser instrument of emission 980nm advantageous wavelength be used to shine and the delivery device of liquid/gas spray.Term " liquid/gas spray " can refer to incorporate into the blended injection stream of some liquid gas, perhaps is meant the injection stream that is made of one or more liquid fully.Handpiece directs irradiation and injection flow to therapentic part.The shape of head can several different methods forms, and makes the professional doctor can be comfily in different therapentic part work.In preferred embodiments, delivery device comprises head, and this head has been introduced optical fiber tube and has been used for the device of conductive liquid and gas.Optical fiber tube contains one or more optical fiber, is used to send 980nm and shines therapentic part.Perhaps, other wavelength can be sent via independent optical fiber and pass through optical fiber tube.For example, can add other optical fiber is that user provides higher visibility to send visible illumination, or adds other optical fiber to send the irradiation of the wavelength that is applicable to biostimulation or wound healing.
In preferred embodiment shown in Figure 1, head 101 is characterised in that disposable fiber optic tip 102, and it can be changed to use new with regard to every patient and through disinfectant optical fiber.Removable fiber optic tip 102 is designed to the connected mode of optical fiber 103 in head, effectively transmits irradiation, preferably directly contacts by optical fiber surface.The pipe of fiber optic tip is short, to avoid damaging during insertion optical fiber.The preferred fiber tip is kept in the protective cap 104, is aseptic condition to keep this tip remove medicated cap before treatment before.
Liquid/gas spray guides by head in a pipe 105 as injection stream, and originates from spraying equipment 106.Spraying equipment 106 can contain fixed gas and liquid mixture, and perhaps, as shown in Figure 1, spraying equipment 106 can obtain the mixture of not commensurability liquids and gases by liquid pay-off 107 and 108 chargings of gas feed arrangement.By this way, controlled respectively injection stream or the complete injection stream of forming by liquid of generation that comprises the liquid of controlled ratio to gas with generation of amount of liquid and flow rate of liquid and gas pressure.In another embodiment, head has pipe for gases and liquids separately respectively, and it merges in head and discharges as liquid/its mixture by nozzle 109.Perhaps in another embodiment, head has at least two nozzles 109, to guarantee evenly to be ejected into tissue.In preferred embodiments, use three nozzles to send cooling mechanism.
In a further preferred embodiment, as shown in Figure 2, liquid/gas guiding tube 201 in the optical fiber or locate with fiber-coaxial, liquid/gas guiding tube 201 is arranged in fiber optic hub and is radiated at outer shroud 202 and is directed (Fig. 2 a), or liquid/gas guiding tube 201 is positioned at the covering 203 (Fig. 2 b) around fiber cores 202.Liquid vapour mixture is preferably the mixture of sky G﹠W or normal saline or disinfectant solution.Also can use other noble gas such as nitrogen to produce injection stream.
In another embodiment, head can be through sterilization, and particularly fiber optic tip is removable, makes new can being inserted into through the disinfectant fiber optic tip be used for new each time treatment in the head.
Can successfully use system and method provided by the invention to be used for the various application of oral surgery, as the excision in periodontitis, bone regeneration around implant inflammation, implantation body's recovery, dental pulp disease, hypertrophy, vestibule shaping and the oral surgery.
The preferred embodiments of the invention have been described with reference to the drawings; be appreciated that; the invention is not restricted to specific embodiment; those skilled in the art can carry out various changes or modification to the solution of the present invention in the scope that does not break away from spirit of the present invention or essence, it falls in the protection domain of claim of the present invention.