中国实用口腔科杂志

中国实用口腔科杂志 ›› 2025, Vol. 18 ›› Issue (4): 433-439.DOI: 10.19538/j.kq.2025.04.007

• 论著 • 上一篇    下一篇

髓腔体积对Er∶YAG激光激活荡洗流体动力影响的体外研究

吉胡克的1，何新宇1，于    悦2，马利沙1，向芳芳1，胡    昕1，王靓雅1，潘    翀2，赵继志1   

  1. 1. 中国医学科学院北京协和医学院，北京协和医院口腔科，北京 100730；2. 北京航空航天大学航空科学与工程学院，流体力学教育部重点实验室，北京 100191
  • 出版日期:2025-07-30 发布日期:2025-07-30
  • 通讯作者: 赵继志
  • 基金资助:
    北京协和医院中央高水平医院临床科研专项（2022-PUMCH-B-037）；中国医学科学院临床与转化医学研究专项（2024-I2M-C&T-B-031）

  • Online:2025-07-30 Published:2025-07-30

摘要： 目的    应用Er∶YAG激光激活荡洗不同髓腔体积根管模型，研究髓腔体积对激光荡洗相关流体动力［蒸汽气泡体积、形态及根尖瞬时峰值压强（TAPP）］的影响，以期指导临床工作。方法    研究于2024年1—7月在中国医学科学院北京协和医院口腔科实验室进行。设计4种髓腔体积根管模型各3个，记为V1、V2、V3、V4组，其髓室顶直径依次为4、6、8、10 mm，髓室底直径依次为2、4、6、8 mm。设置Er∶YAG激光器参数为超短脉宽模式、频率为20 Hz。应用高速摄像系统记录每组模型在不同单脉冲能量（10、20、30、40、50 mJ）条件下的气泡形态，并计算最大气泡体积（Vmax）和最大气泡纵横径比（R）。通过高频脉动压力传感器采集根尖区的电压数据，计算每组模型在不同单脉冲能量条件下的TAPP。结果    4组产生蒸汽气泡均表现为典型的膨胀-塌缩周期，Vmax时刻气泡呈椭圆形；V1、V2组在20 ~ 50 mJ单脉冲能量条件下发生液面破裂，V3、V4组仅在50 mJ单脉冲能量条件下发生液面破裂。髓腔体积和单脉冲能量对Vmax、R和TAPP均有显著影响（均P < 0.001）。组内两两比较结果显示，V2、V3、V4组在40 mJ和50 mJ单脉冲能量条件下的Vmax、TAPP均大于在10 mJ和20 mJ单脉冲能量条件下的，差异均有统计学意义（均P < 0.05）；V1组在不同单脉冲能量条件下的TAPP比较，差异均无统计学意义（P > 0.05）；4组在不同单脉冲能量条件下的R比较，差异均无统计学意义（均P > 0.05）。组间两两比较结果显示，在同一单脉冲能量条件下，4组Vmax比较，差异均无统计学意义（均P > 0.05）。在40 mJ和50 mJ单脉冲能量条件下，V1组R显著大于其他3组；在40 mJ单脉冲能量条件下，V4组的R最小，差异均有统计学意义（均P < 0.05）。除20 mJ单脉冲能量条件外，在相同单脉冲能量条件下V1、V2、V3、V4组的TAPP依次增大，差异均有统计学意义（均P < 0.05）。V1、V2、V3、V4组单脉冲能量与TAPP的线性回归拟合分析结果显示，在30 ~ 50 mJ单脉冲能量条件下均为一次函数线性增长模式，回归系数（β1）依次为27.967、208.564、351.980、1 061.570，95%CI依次为25.013 ~ 30.920、157.532 ~ 259.596、289.555 ~ 414.404、773.532 ~ 1 349.607（均P < 0.05）。结论    髓腔体积对Er∶YAG激光激活荡洗的相关流体动力（蒸汽气泡体积、形态及TAPP）具有重要影响。当髓腔体积较小（V1、V2组）时，建议单脉冲能量< 20 mJ，以降低液面破裂及软组织损伤风险；当髓腔体积较大（V3、V4组）时，可根据需要选择30 ~ < 50 mJ的单脉冲能量，髓腔体积越大，其内流体动力受单脉冲能量的影响越显著。

关键词: 激光医学, 根管治疗, Er∶YAG激光, 流体力学, 髓腔体积

Abstract: Objective    To investigate the influence of pulp chamber volume on the fluid dynamics ［ vapor bubble volume，morphology and transient apical peak pressure（TAPP）］ associated with Er∶YAG laser-activated irrigation（LAI）across different pulp chamber root canal models，in order to provide guidance for clinical practice. Methods    This study was conducted from January to July 2024 at the Department of Stomatology，Peking Union Medical College Hospital. Four types of root canal models（3 models of each type）with different pulp chamber volumes were fabricated（V1，V2，V3，V4），with roof diameters of 4，6，8，and 10 mm，and base diameters of 2，4，6，and 8 mm，respectively. The Er∶YAG laser was operated in Super Short Pulse mode at a frequency of 20 Hz. High-speed imaging was used to record vapor bubble morphology at various single-pulse energy levels（10，20，30，40，and 50 mJ），and the maximum bubble volume（Vmax）and maximum aspect ratio（R）were calculated. A high-frequency pulsatile pressure sensor was employed to collect voltage data at the apex to calculate TAPP at various single-pulse energy levels. Results    The bubbles of all models exhibited a typical expansion-collapse cycle，with elliptical bubble morphology at Vmax. Liquid surface rupture occurred in V1 and V2 under 20-50 mJ single-pulse energy conditions，while in V3 and V4，it was observed only at 50 mJ. Both pulp chamber volume and single-pulse energy significantly influenced Vmax，R，and TAPP（all P < 0.001）. Intragroup comparisons showed that in V2，V3，and V4，both Vmax and TAPP were significantly greater at 40 mJ and 50 mJ compared to 10 mJ and 20 mJ（all P < 0.05），while no significant differences in TAPP were observed across energy levels in V1（P > 0.05）. No significant differences in R were found across different energy levels within each group（all P > 0.05）. Intergroup comparisons revealed no significant differences in Vmax among the four groups at the same single-pulse energy level（P > 0.05）. However，at 40 mJ and 50 mJ，R values in V1 were significantly higher than those in the other 3 groups，and at 40 mJ，V4 exhibited the smallest R value（all P < 0.05）. Except at 20 mJ，TAPP increased sequentially from V1 to V4 under the same energy condition（all P < 0.05）. Linear regression analysis demonstrated that TAPP exhibited a linear growth pattern with increasing energy between 30 mJ and 50 mJ in all groups，with regression coefficients（β1）of 27.967，208.564，351.980，and 1 061.570，respectively（95%CI：25.013-30.920，157.532-259.596，289.555-414.404，and 773.532-1 349.607，respectively；all P < 0.05）. Conclusion    Pulp chamber volume significantly influences fluid dynamics，including vapor bubble volume，morphology and TAPP，during Er∶YAG LAI. For smaller pulp chambers（V1 and V2），it is recommended to use single-pulse energies below 20 mJ to reduce the risk of liquid surface rupture and potential soft tissue injury. For larger chambers（V3 and V4），single-pulse energies ranging from 30 mJ to < 50 mJ may be selected based on clinical needs. The larger the pulp chamber volume, the more significant the influence of single-pulse energy on fluid dynamics.

Key words: laser medicine, root canal therapy, Er∶YAG laser, fluid dynamics, pulp chamber volume