CN101076294B - Oral treatment system and device - Google Patents
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- CN101076294B CN101076294BCN038263572ACN03826357ACN101076294BCN 101076294 BCN101076294 BCN 101076294BCN 038263572 ACN038263572 ACN 038263572ACN 03826357 ACN03826357 ACN 03826357ACN 101076294 BCN101076294 BCN 101076294B
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- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
- A61B2018/206—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the laser light passing along a liquid-filled conduit
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Abstract
Description
Translated fromChinese发明背景Background of the invention
技术领域technical field
本发明涉及口腔组织治疗领域，使用具有特别有效波长的激光照射并具有机头，该机头具有用于递送该激光照射和用于喷射液/气混合物到治疗区域以改进治疗效果的装置。The present invention relates to the field of oral tissue treatment using laser irradiation with a particularly effective wavelength and having a handpiece with means for delivering the laser irradiation and for spraying a liquid/gas mixture to the treatment area to improve the treatment effect.
信息公开描述Information disclosure description
各种激光治疗用于口腔和上颌面外科领域中。这些治疗提供许多优点，特别是其高凝结性、高切割质量、和对于外科医生和患者的术后益处。Various laser treatments are used in the field of oral and maxillofacial surgery. These treatments offer many advantages, notably their high coagulation, high cut quality, and postoperative benefits for the surgeon and patient.
根据所用波长、能量水平和照射图案，激光照射对组织的效果显著不同。本发明的目的是以主要为流血最小化或不流血的无创伤方式达到快速、无碳化的美容外科效果，具有有限凝结区域。The effect of laser irradiation on tissue varies significantly depending on the wavelength, energy level, and pattern of irradiation used. The aim of the present invention is to achieve rapid, non-carbonized cosmetic surgical results in an atraumatic manner, primarily with minimal or no bleeding, with limited coagulation areas.
在治疗过程中，由于组织中水分子吸收能量，激光使组织受热，从而破坏活细胞并引起切除组织或切口凝结。治疗过程中，有必要避免周围组织过热或损伤，并控制照射效果。照射渗透进组织越深，则所得热效果越不可控。残留热可影响牙神经引起患者疼痛，并可导致组织碳化和坏死。因此，希望传递到下层和周围组织的热量最小化。因此，希望精确控制转移到被治疗组织的光能量。必需充分控制能量使得有效治疗局部组织而残留能量不加热周围组织。During the treatment, the laser heats the tissue due to the energy absorbed by the water molecules in the tissue, which destroys living cells and causes the ablated tissue or incision to coagulate. During treatment, it is necessary to avoid overheating or damage to surrounding tissues and to control the irradiation effect. The deeper the radiation penetrates into the tissue, the more uncontrollable the resulting thermal effects. Residual heat can affect the dental nerve causing pain to the patient and can lead to tissue carbonization and necrosis. Therefore, it is desirable to minimize heat transfer to the underlying and surrounding tissues. Therefore, it is desirable to precisely control the light energy transferred to the tissue being treated. The energy must be sufficiently controlled so that local tissue is effectively treated without residual energy heating surrounding tissue.
在WO 99/39652中，描述了怎样用激光治疗牙周袋并通过喷射水和空气的混合冷却剂到周围组织上而不加热所述组织。所用设备包括机头，该机头具有合并的水管和光纤管，由此喷射流在机头的输出端产生。然而，该公开未教导如何避免较深组织层的不希望的受热。另外，该发明在一个管子中提供了进行激光递送的光纤和水。这一构造是不利的，因为在光纤尖端的水吸收激光能量并因此使得递送到组织的能量不确定，另外，光纤尖端变热并可引起不希望的灼烧。另外，光纤位置和由此的激光瞄准不确定。同样，WO 99/39652阐述了使用“在水中被适度吸收的波长”。该发明要求保护使用范围为1-1.2微米或1.06-1.07微米的波长，其在水中被适度吸收。据推测，使用在水中被高度吸收的波长将降低治疗有效性，因此需避免该波长。In WO 99/39652 it is described how to treat periodontal pockets with laser and by spraying a coolant mixture of water and air onto the surrounding tissue without heating said tissue. The equipment used consists of a handpiece with combined water and fiber optic tubes whereby a jet is generated at the output of the handpiece. However, this publication does not teach how to avoid undesired heating of deeper tissue layers. In addition, the invention provides fiber optics and water for laser delivery in one tube. This configuration is disadvantageous because the water at the fiber tip absorbs the laser energy and thus makes the energy delivered to the tissue indeterminate, in addition, the fiber tip heats up and can cause undesired burning. Additionally, the fiber position and thus the laser aiming is uncertain. Likewise, WO 99/39652 describes the use of "wavelengths that are moderately absorbed in water". The invention claims to use wavelengths in the range 1-1.2 microns or 1.06-1.07 microns, which are moderately absorbed in water. Presumably, the use of wavelengths that are highly absorbed in water will reduce the effectiveness of the treatment and should therefore be avoided.
美国专利5,374,266描述了激光设备，其包括具有特定光纤和光纤管的机头，用于小腔和均一照射。该设备的特征在于沿着光纤探针进料冷喷射流以清洗治疗区域并在照射后冷却光纤探针或者在照射过程中冷却探针。然后从探针周围送入水，以避免任何湿气对探针式光纤的损害。因此，在该发明中使用水是用于冷却探针，而不是在治疗过程中用于冷却治疗部位。US Patent 5,374,266 describes a laser device comprising a handpiece with specific optical fibers and fiber tubes for small cavities and uniform irradiation. The device features a cold jet fed along the fiber optic probe to wash the treatment area and cool the fiber optic probe after irradiation or to cool the probe during irradiation. Water is then fed around the probe to avoid any moisture damage to the probe fiber. Therefore, the use of water in this invention is for cooling the probe, not for cooling the treatment site during the treatment.
通常，现有技术考虑到使用冷的液体或喷射流与照射治疗相结合以避免周围组织的热损伤。然而，据述只有某一范围的波长可有效地与液体冷却装置一起使用，这些波长为那些在水中不被高度吸收的波长。实际上，如WO 99/39652所述，现有技术考虑使用如1微米级的波长，它们在水中吸收相对低，以至于不妨碍治疗。另外，尽管美国专利6,129,721描述了照射机头，其特征在于光纤和用于喷射流体和气体的递送装置，其最初看似与本发明相似，但是该专利中使用的波长为1-5.5微米。Typically, the prior art contemplates the use of cold liquids or jets in combination with radiation therapy to avoid thermal damage to surrounding tissue. However, only a certain range of wavelengths are said to be effective for use with liquid cooling devices, and these wavelengths are those that are not highly absorbed in water. Indeed, as described in WO 99/39652, the prior art contemplates the use of wavelengths of the order of eg 1 micron, which have relatively low absorption in water, so as not to hinder treatment. Additionally, although US Patent 6,129,721 describes an illumination handpiece featuring optical fibers and delivery means for ejecting fluids and gases, which at first appears to be similar to the present invention, the wavelengths used in this patent are 1-5.5 microns.
Levy等人的美国专利5,290,274描述了具有两种不同波长的照射与照射过程中对治疗部位引导冷流体的步骤一起使用。第一波长为0.7-1微米，第二波长为约3微米。Levy要求保护Nd:YAG照射与流体冷却物源共同使用是有效的，因为波长为1.06微米的基频照射和波长为0.532微米的倍频照射在水中基本不被吸收。然而，根据Levy所述，当Er:YAG激光与冷却喷射液一起使用时，Er:YAG激光的有效性降低，因为其产生在水中被高度吸收的波长的照射。US Patent 5,290,274 to Levy et al. describes the use of irradiation with two different wavelengths together with the step of directing a cold fluid to the treatment site during the irradiation. The first wavelength is 0.7-1 micron and the second wavelength is about 3 microns. Levy claimed that Nd:YAG irradiation used in conjunction with a fluid cooling source is effective because fundamental frequency irradiation at a wavelength of 1.06 microns and double frequency irradiation at a wavelength of 0.532 microns are substantially not absorbed in water. However, according to Levy, Er:YAG lasers are less effective when used with cooling jets because they produce radiation at wavelengths that are highly absorbed in water.
从上述现有技术可看出，现有技术教导了在水中被高度吸收的波长，如980nm激光，与冷却喷射液一起使用将是无效的。As can be seen from the above prior art, the prior art teaches that wavelengths that are highly absorbed in water, such as 980nm lasers, will not be effective for use with cooling jets.
本发明解决了现有技术的上述缺陷，提供了避免由不同装置引起的周围组织不希望的受热并通过波长为约980nm的激光和冷却喷射流共同使用提供极精确的切割质量的方法和装置。优选地，使用脉冲激光以提供局部化的能量淀积和加热，因此避免了下层组织不希望的受热。另外的喷射流冲去组织碎片并提供了被治疗组织的附加冷却。The present invention solves the above-mentioned drawbacks of the prior art, and provides a method and a device for avoiding undesired heating of surrounding tissue caused by different devices and providing extremely precise cutting quality through the combined use of a laser with a wavelength of about 980 nm and a cooling jet. Preferably, a pulsed laser is used to provide localized energy deposition and heating, thus avoiding undesired heating of the underlying tissue. Additional jets flush away tissue debris and provide additional cooling of the treated tissue.
发明目的和概述Invention purpose and overview
本发明的目的是提供用于口腔组织改进治疗的系统和方法，使用了激光而不加热周围组织和不发生碳化。It is an object of the present invention to provide systems and methods for improved treatment of oral tissue using laser light without heating the surrounding tissue and without carbonization.
本发明的另一个目的是通过使用有利的照射波长和通过喷射液/气混合物到组织上，避免不希望的组织受热并显著改进治疗结果。Another object of the present invention is to avoid undesired tissue heating and significantly improve the treatment outcome by using favorable irradiation wavelengths and by spraying a liquid/gas mixture onto the tissue.
本发明的另一个目的是使用波长为980nm的激光。Another object of the present invention is to use a laser with a wavelength of 980nm.
本发明的另一个目的是提供了机头，该机头具有激光光纤管和液/气管。Another object of the present invention is to provide a handpiece having a laser fiber tube and a liquid/air tube.
本发明的另一个目的是提供了机头，该机头具有可更换的无菌光纤尖端。Another object of the present invention is to provide a handpiece with replaceable sterile fiber optic tips.
总而言之，本发明提供了用于口腔组织改进治疗的系统和方法，使用了980nm激光照射和具有装置的机头，所述装置用于同时递送激光照射和液/气喷射流到治疗区域以改进治疗效果。降低了周围组织不希望的受热和碳化。液/气喷射流可在机头内混合、或者在单独设备中混合。先前已避免将冷却喷射流与在水中高度吸收的照射波长共同使用，因为认为冷却流吸收能量使得向组织递送的能量变得不可控制并使益处最小化。优选地，脉冲激光提供了局部化的能量淀积和加热以避免下层组织不希望的受热。喷射流冲去组织碎片并冷却被治疗组织。In summary, the present invention provides systems and methods for improved treatment of oral tissue using 980nm laser irradiation and a handpiece with a device for simultaneously delivering laser irradiation and liquid/air jets to the treatment area for improved treatment Effect. Undesirable heating and carbonization of surrounding tissue is reduced. The liquid/gas jets can be mixed in the handpiece, or in a separate device. The use of cooling jets with illumination wavelengths that are highly absorbed in water has previously been avoided because it was believed that the energy absorbed by the cooling jet made the energy delivery to tissue uncontrollable and minimized the benefit. Preferably, the pulsed laser provides localized energy deposition and heating to avoid undesired heating of the underlying tissue. The jets flush away tissue debris and cool the treated tissue.
本发明的上述的和其它目的、特征和优点，从以下说明及附图结合而变得显而易见，其中不同附图中的参考数字表示相同元件。The above and other objects, features and advantages of the present invention will become apparent from the following description when taken in conjunction with the accompanying drawings, wherein reference numerals in different drawings represent the same elements.
附图说明Description of drawings
图1：具有一个喷射管和可更换光纤尖端的机头。Figure 1: Handpiece with one injection tube and replaceable fiber optic tips.
图2：具有管子的光纤。Figure 2: Optical fiber with tube.
优选实施方案详述DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
在激光治疗过程中，向组织递送的能量由若干个参数定义，如能量密度、照射时程和波长。波长为2或3μm、1064nm、980nm或810nm的激光都用于牙科应用。发现980nm激光治疗较使用其它波长的治疗有利，因为980nm波长看似在所需水吸收性和有限渗透深度之间提供了独一无二的平衡。水吸收曲线在980nm波长处表现出局部最大吸收，这表明980nm照射被水充分吸收。另外，因为980nm照射还在血红蛋白和氧合血红蛋白中充分吸收，因此用980nm激光进行照射产生优异的组织切除和凝结效果，这通过光学而非热力学实现，与目前所用的其它波长不同。较短波长具有较低的水吸收性并因此渗透程度太深。较长波长(如通过Er:YAG生产的波长)在血液组分如血红蛋白和氧合血红蛋白中吸收不充分，并较难递送，因为不能获得适当的传送用光纤并且常用的镜臂不易处理。另外，如通过Nd:YAG激光产生的较长波长[1064nm]的水吸收性和血液组分吸收性低，并且由于渗透深度高而不被接受。During laser therapy, the energy delivered to tissue is defined by several parameters, such as fluence, duration of exposure, and wavelength. Lasers with a wavelength of 2 or 3 μm, 1064 nm, 980 nm or 810 nm are used in dental applications. 980nm laser therapy was found to be advantageous over treatments using other wavelengths because the 980nm wavelength appeared to provide a unique balance between the desired water absorption and limited penetration depth. The water absorption curve exhibits a local maximum absorption at a wavelength of 980 nm, which indicates that the 980 nm irradiation is fully absorbed by water. In addition, because 980nm irradiation is also well absorbed in hemoglobin and oxyhemoglobin, irradiation with 980nm lasers produces excellent tissue ablation and coagulation, which is achieved optically rather than thermodynamically, unlike other wavelengths currently used. Shorter wavelengths have lower water absorption and therefore penetrate too deeply. Longer wavelengths, such as those produced by Er:YAG, are not well absorbed in blood components such as hemoglobin and oxyhemoglobin, and are more difficult to deliver because of the unavailability of suitable optical fibers for delivery and the awkward handling of commonly used mirror arms. Additionally, longer wavelength [1064 nm] absorption of water and blood components such as that produced by Nd:YAG lasers is low and not acceptable due to high penetration depth.
另外，980nm波长的另一个优点是渗透深度较常用波长如可见波长或1064nm的渗透深度低，因此可避免较深组织层不希望的和不可控的受热。使用980nm激光照射可非常精确地控制凝结。在所有临床应用中都观察到术后优点，如没有肿胀、出血、疼痛、或结痂组织形成，且伤口愈合良好。In addition, another advantage of the 980nm wavelength is that the penetration depth is lower than that of commonly used wavelengths such as visible wavelengths or 1064nm, thus avoiding unwanted and uncontrollable heating of deeper tissue layers. Coagulation is very precisely controlled using 980nm laser irradiation. Postoperative advantages were observed in all clinical applications, such as no swelling, bleeding, pain, or scab formation, and good wound healing.
也可使用该波长暴露浸没的种植体以治疗种植体周围炎(periimplantitis)，而不损伤种植体表面，该损伤在较长波长或其它方法中可见(Romanos，Everts，Nentwig，″Effects of Diode and Nd:YAGLaser Irradiation on Titanium Discs：A Scanning Electron MicroscopeExamination″，J Periodontol 2000，71，810-815(2000))。当使用脉冲模式时，可以对较小的和明确的治疗部位施用极高能量以增强治疗的有效性。脉冲模式对于避免健康组织不希望的受热特别有利，因为照射时段比开始传递热进入较深组织层所需时段短。然而，已经确定使用这一波长一定不能超过某一能量级。This wavelength can also be used to expose submerged implants for the treatment of periimplantitis without damaging the implant surface, which is seen with longer wavelengths or other methods (Romanos, Everts, Nentwig, "Effects of Diode and Nd: YAG Laser Irradiation on Titanium Discs: A Scanning Electron Microscope Examination", J Periodontol 2000, 71, 810-815 (2000)). When using the pulsed mode, very high energy can be applied to small and defined treatment sites to enhance the effectiveness of the treatment. The pulsed mode is particularly advantageous for avoiding undesired heating of healthy tissue because the irradiation period is shorter than that required to initiate heat transfer into deeper tissue layers. However, it has been determined that the use of this wavelength must not exceed a certain energy level.
令人惊讶地，并且与现有技术的教导相反，另外施用液/气喷射流显著改进了用980nm照射治疗的效果。已有喷射流与其它波长共同用于治疗，而并无与980nm波长共同使用的描述，因为该980nm波长相对于其它波长在水中的吸收性高。最初预料使用水喷射流引起能量损耗和降低治疗有效性。然而，已经发现事实并非如预料的那样。喷射流用作冷却机制，用于防止组织不希望的受热，并保持切除组织湿润以防止变干和碳化。另外，液/气喷射流的附加益处是除去治疗产生的组织碎片，这些碎片将极有可能吸收照射并引起组织上以及光纤尖端上的碳化。因此，喷射流与光纤尖端在治疗部位平面上相交，以增强治疗效果。Surprisingly, and contrary to the teachings of the prior art, the additional application of a liquid/air jet significantly improved the effect of treatment with 980 nm irradiation. Jet streams have been used for therapy with other wavelengths, but there is no description of the use with 980nm wavelength because of the high absorption in water compared to other wavelengths. The use of water jets was initially expected to cause energy loss and reduce therapeutic effectiveness. However, it has been found that this is not the case. The jet is used as a cooling mechanism to prevent unwanted heating of the tissue and to keep the excised tissue moist to prevent drying and carbonization. Additionally, an added benefit of the liquid/air jet is the removal of treatment-generated tissue debris that would most likely absorb the radiation and cause carbonization on the tissue as well as on the fiber tip. Therefore, the jet stream intersects the fiber optic tip in the plane of the treatment site to enhance the treatment effect.
980nm的有利波长和液/气喷射流的共同使用在各种口腔应用中提供了优异的外科和美学结果。这些结果的特定例子包括在所有临床应用中观察到的不发生肿胀、流血、疼痛、或结痂组织形成，并且伤口愈合良好。在本发明潜在的临床应用中，有牙周炎、种植体周围炎、种植体恢复、牙髓病、增生、前庭整形(vestibular plastic)、和口腔外科中的切除。本发明由于凝结区域有限和不形成结痂组织或组织下陷的美学效果在如牙冠处牙龈线的外科治疗的这些治疗中尤其重要。使用不同于本发明的治疗，组织在手术后下陷，从而使牙冠/种植体的金属或其它支撑结构可见，从而破坏了治疗的美学效果。The co-use of the favorable wavelength of 980nm and the liquid/air jet provides excellent surgical and aesthetic results in various oral applications. Specific examples of these results include the absence of swelling, bleeding, pain, or scab formation and good wound healing observed in all clinical applications. Among potential clinical applications of the present invention are periodontitis, peri-implantitis, implant restoration, endodontics, hyperplasia, vestibular plastic, and resection in oral surgery. The present invention is especially important in such treatments as surgical treatment of the gum line at the crown due to the aesthetic effect of the limited coagulation area and the absence of scab tissue formation or tissue subsidence. With treatments other than the present invention, the tissue sags post-operatively, making the metal or other support structure of the crown/implant visible, thereby ruining the esthetics of the treatment.
本发明提供了用于口腔组织改进治疗的系统和方法。该系统包括照射源如发射980nm有利波长的激光器、和用于照射和液/气喷射流的递送设备。术语“液/气喷射流”可以指并入了某些液气混合的喷射流，或者是指完全由一种或多种液体构成的喷射流。机头引导照射和喷射流到治疗部位。机头的形状可以多种方法形成，使职业医生可以舒服地在不同的治疗部位工作。在优选实施方案中，递送设备包括机头，该机头引入了光纤管和用于传导液体和气体的装置。光纤管含有一个或多个光纤，用于递送980nm照射到治疗部位。或者，另外的波长可经由单独的光纤递送通过光纤管。例如，可加入另外的光纤以递送可见照射为使用者提供更高的能见度，或加入另外的光纤以递送适用于生物刺激或伤口愈合的波长的照射。The present invention provides systems and methods for improved treatment of oral tissues. The system includes an irradiation source such as a laser emitting at a favorable wavelength of 980 nm, and a delivery device for irradiation and a liquid/gas jet. The term "liquid/gas jet" may refer to a jet incorporating some mixture of liquid and gas, or to a jet consisting entirely of one or more liquids. The handpiece guides the radiation and jets to the treatment site. The shape of the handpiece can be formed in a variety of ways, so that the professional doctor can work comfortably on different treatment parts. In a preferred embodiment, the delivery device includes a handpiece incorporating fiber optic tubing and means for conducting liquids and gases. The fiber optic tube contains one or more optical fibers for delivering 980nm radiation to the treatment site. Alternatively, additional wavelengths can be delivered through the fiber optic tube via separate optical fibers. For example, additional optical fibers may be added to deliver visible radiation to provide greater visibility to the user, or to deliver radiation at wavelengths suitable for biostimulation or wound healing.
在图1所示的优选实施方案中，机头101的特征在于一次性光纤尖端102，其可进行更换以就每位患者而言使用新的和经过消毒的光纤。可更换的光纤尖端102与光纤103在机头内的连接方式设计为，有效传送照射，优选通过光纤表面直接接触。光纤尖端的管短，以避免在插入过程中损伤光纤。优选光纤尖端保存在保护帽104内，以维持该尖端在治疗前除去帽之前为无菌状态。In the preferred embodiment shown in Figure 1, the
液/气喷射流作为喷射流在一个管105内引导通过机头，并起源于喷射设备106。喷射设备106可含有固定的气体和液体混合物，或者，如图1所示，喷射设备106可通过液体送料装置107和气体进料装置108进料得到不同量的液体和气体的混合物。以这种方式，液体量和液体流速以及气体压力分别可控以产生包括可控比的液体对气体的喷射流或产生完全由液体组成的喷射流。在另一个实施方案中，机头分别具有单独用于气体和液体的管，其在机头内合并并通过喷嘴109作为液/其混合物释放。或者在又一个实施方案中，机头具有至少两个喷嘴109，以确保均匀喷射到组织上。在优选实施方案中，使用三个喷嘴以递送冷却机制。The liquid/gas jet is guided through the handpiece as a jet in a
在另一个优选实施方案中，如图2所示，光纤内的液/气引导管201要么与光纤同轴定位，液/气引导管201位于光纤中心而照射在外环202中被引导(图2a)，要么液/气引导管201位于围绕光纤芯202的包层203内(图2b)。液气混合物优选为空气和水或生理盐水或消毒液的混合物。还可使用其它惰性气体如氮气来产生喷射流。In another preferred embodiment, as shown in Figure 2, the liquid/gas guide tube 201 within the fiber is either positioned coaxially with the fiber, the liquid/gas guide tube 201 is located in the center of the fiber and the radiation is guided in the outer ring 202 (Fig. 2a), or the liquid/air guide tube 201 is located within the cladding 203 surrounding the fiber core 202 (Fig. 2b). The liquid-gas mixture is preferably a mixture of air and water or physiological saline or disinfectant. Other inert gases such as nitrogen may also be used to generate the jet.
在另一个实施方案中，机头可经过消毒，特别是光纤尖端是可更换的，使得新的经过消毒的光纤尖端可插入到机头内用于每一次新的治疗。In another embodiment, the handpiece can be sterilized, and in particular the fiber optic tip is replaceable such that a new sterilized fiber optic tip can be inserted into the handpiece for each new treatment.
可成功地使用本发明提供的系统和方法用于口腔外科的各种应用，如牙周炎、种植体周围炎、种植体恢复、牙髓病、增生、前庭整形、和口腔外科中的切除。The systems and methods provided by the present invention can be successfully used in various applications in oral surgery, such as periodontitis, peri-implantitis, implant restoration, endodontics, hyperplasia, vestibular plastic, and resection in oral surgery.
已经参考附图描述了本发明的优选实施方案，可以理解，本发明不限于具体的实施方案，本领域的技术人员可在不脱离本发明精神或实质的范围内对本发明的方案进行各种改变或修饰，其落入本发明权利要求的保护范围内。Preferred embodiments of the present invention have been described with reference to the accompanying drawings, it can be understood that the present invention is not limited to specific embodiments, and those skilled in the art can carry out various changes to the solutions of the present invention within the scope not departing from the spirit or essence of the present invention Or modification, it falls within the scope of protection of the claims of the present invention.
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