탄산가스 레이저 조사가 노출 치수에 미치는 영향에 관한 연구

AN HISTOPATHOLOGICAL STUDY ON THE EFFECT OF $CO_2$ LASER IRRADIATION ON THE EXPOSED DENTAL PULP

This study investigated the effects of laser irradiation on the exposed pulp and the possibility of direct pulp capping with the $CO_2$ laser. Results were obtained from the observation of the residual pulpal healing process. Class V cavities on 48 anterior teeth from 8 adult dogs were prepared and pulp chambers were intentionally opened with dental explorer. The control group consisted of 16 teeth. $Dycal^{(R)}$(Caulk Co., U.S.A.) was applied to exposed site once bleeding was stopped. Cavities were sealed with $I.R.M^{(R)}$. In the experimental group 1 (16 teeth), laser(LASERSAT $CO_2^{(R)}$, Satelec Co.) was irradiated on the exposed pulp. The laser procedure followed the manufacturers recommendations for the treatment of human pulp(1.5 Watts, 0.2 seconds, unfocused), and cavities were sealed with $I.R.M^{(R)}$. In the experimental group 2 (16 teeth), laser was irradiated on the exposed pulp in a more powerful dosage(5.0 Watts, 0.2 seconds, unfocused), and cavities were sealed with $I.R.M^{(R)}$. Two dogs were sacrificed immediately after experiment and the others were sacrificed at intervals of one, three, and eight weeks respectively. All teeth were routinely processed and the pulpal tissues and odontoblastic layers were observed by the light microscope. The results were as follows; 1. In the control group, the initial mild inflammation had improved to normal by week eight. An active formation of reparative dentin was observed at week three, and at week eight, a firm dentin bridge was present beneath the $Dycal^{(R)}$ with no inflammatory responses in the remaining pulp. 2. In the experimental group 1, immediately following irradiation, the superficial shape of the exposed pulp was crater-like. And it was lined with the coagulated layer, $60{\sim}70{\mu}m$ in width. Moderate inflammatory pulpal conditions existing at week one were improved to mild at week eight. And from the week three specimens, a reparative dentin formation was observed in the adjacent odontoblastic layer of the exposed site. A dentin bridge at the exposed site, however, did not form during the experimental period. 3. In the experimental group 2, the width of the coagulation layer lining the crater was $70{\sim}130{\mu}m$. Beneath the coagulated layer, severe inflammatory pulpal responses were observed at week one, and conditions did not improve during the experimental period.