Er:YAG激光预处理对釉质白斑的陶瓷剪切粘接强度影响研究

doi:10.13701/j.cnki.kqyxyj.2026.04.009

摘要/Abstract

摘要： 目的:比较釉质表面不同预处理和粘接界面不同蚀刻方式对釉质白斑表面形态与剪切粘接强度的影响。方法:在108颗完整离体前磨牙中随机选取60颗,在牙冠颊面中央切取4.0 mm×4.0 mm×2.0 mm釉质块,经人工脱矿后将其随机均分为D组(仅进行脱矿)和R组(树脂渗透预处理)。根据釉面蚀刻方式不同将各组样本再均分为3个亚组:P组(37%磷酸处理)、L组(Er:YAG激光照射)和LP组(Er:YAG激光照射+37%磷酸处理)。采用扫描电镜和原子力显微镜分析各亚组釉质表面超微结构变化并对釉质表面粗糙度值进行检测。剩余48颗前磨牙截根包埋后(仅颊侧釉质面暴露),根据上述分组信息进行相应处理并在其颊侧中央粘接圆柱形玻璃陶瓷柱,通过剪切力学测试计算各亚组试件剪切粘接强度,扫描电镜观察并记录试件断裂模式。结果:不同蚀刻方式对釉质表面粗糙度值和陶瓷剪切粘接强度有显著影响(P<0.05),而树脂渗透预处理的影响则无统计学差异(P>0.05)。Er:YAG激光联合37%磷酸蚀刻组的粗糙度值和剪切粘接强度均最高,激光处理组次之,37%磷酸处理组最低。树脂渗透预处理虽不能改善脱矿釉质的陶瓷剪切粘接强度,但显著改变了试件的断裂模式(P<0.05);脱矿组以粘接界面断裂为主,而树脂渗透组则以混合断裂为主。结论:Er:YAG激光单独或联合37%磷酸蚀刻处理,可明显改善釉质白斑表面形态,显著提高釉质白斑的陶瓷剪切粘接强度。

关键词: 釉质白斑, 树脂渗透, Er:YAG激光, 剪切粘接强度, 玻璃陶瓷

Abstract: Objective: To compare the effects of different enamel surface pretreatments and bonding interface etching methods on the surface morphology and shear bond strength (SBS) of enamel white spot lesions (WSLs). Methods: Sixty teeth were randomly selected from 108 intact extracted premolars. A 4.0 mm×4.0 mm×2.0 mm enamel block was cut from the central buccal surface of each crown. After artificial demineralization, the enamel blocks were randomly divided into group D (demineralization only) and group R (resin penetration pretreatment). Based on different enamel etching methods, the samples in each group were further divided into three equal subgroups: P (37% phosphoric acid treatment), L (Er:YAG laser irradiation), and LP (Er:YAG laser irradiation + 37% phosphoric acid treatment). The surface morphology and roughness of the enamel were examined using scanning electron microscopy (SEM) and atomic force microscopy (AFM), respectively. After cutting off the roots and embedding the remaining 48 premolars (with only the buccal enamel surface exposed), corresponding treatments were applied based on the above grouping information. Cylindrical glass-ceramic columns were then bonded to the center of the buccal surfaces. The SBS was evaluated through shear bond strength test, and the fracture modes were recorded using SEM. Results: The etching methods significantly affected the enamel surface roughness and shear bond strength of the WSLs (P<0.05), while resin penetration pretreatment showed no statistically difference (P>0.05). The groups treated with the Er:YAG laser combined with 37% phosphoric acid etching exhibited the highest roughness and SBS, followed by the laser-only groups, with the 37% phosphoric acid groups showing the lowest values. Resin penetration pretreatment did not improve the SBS of the WSLs, but significantly affected the fracture patterns among groups (P<0.05). The adhesive failure mainly occurred in group D, whereas the mixed failure occurred in group R. Conclusion: Er:YAG laser pretreatment alone or combined with 37% phosphoric acid etching significantly improves the surface morphology of WSLs and increases the SBS between WSLs and glass ceramics.

Key words: white spot lesions, resin penetration, Er:YAG laser, shear bond strength, glass ceramics

杨媛媛, 田景玉, 丁瑜, 孟庆飞, 孟箭. Er:YAG激光预处理对釉质白斑的陶瓷剪切粘接强度影响研究[J]. 口腔医学研究, 2026, 42(4): 318-324.

YANG Yuanyuan, TIAN Jingyu, DING Yu, MENG Qingfei, MENG Jian. Effect of Er: YAG Laser Pretreatment on Shear Bond Strength between Enamel White Spot Lesions and Glass Ceramics: An in Vitro Study[J]. Journal of Oral Science Research, 2026, 42(4): 318-324.

参考文献

[1] Klaisiri A, Vongsang J, Leelaudom T, et al. Methylene blue penetration of resin infiltration and resin sealant in artificial white-spot lesions [J]. Eur J Dent, 2023, 17(3): 828-833.
[2] Yagci A, Korkmaz YN, Buyuk SK, et al. White spot lesion formation after treatment with full-coverage rapid maxillary expanders [J]. Am J Orthod Dentofacial Orthop, 2016, 149(3): 331-338.
[3] Shu J, Huang Y, Ma X, et al. Aesthetic impact of resin infiltration and its mechanical effect on ceramic bonding for white spot lesions [J]. BMC Oral Health, 2024, 24(1): 365.
[4] Todorova VI, Filipov IA, Khaliq AF, et al. Aesthetic improvement of white spot fluorosis lesions with resin infiltration [J]. Folia Med (Plovdiv), 2020, 62(1): 208-213.
[5] Saxena P, Grewal MS, Agarwal P, et al. Clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains [J]. J Pharm Bioallied Sci, 2021, 13(Suppl 1): S301-S305.
[6] Youssef AS, Covell DA Jr, Makowka S, et al. Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study [J]. J Am Dent Assoc, 2022, 153(1): 39-49.
[7] Demirekin ZB, Turkaslan S. Laminate veneer ceramics in aesthetic rehabilitation of teeth with fluorosis: a 10-year follow-up study [J]. BMC Oral Health, 2022, 22(1): 42.
[8] Staninec M, Gardner AK, Le CQ, et al. Adhesion of composite to enamel and dentin surfaces irradiated by IR laser pulses of 0.5-35 micros duration [J]. J Biomed Mater Res B Appl Biomater, 2006, 79(1): 193-201.
[9] Mohammad Y, Yassin O, Hardan L, et al. An evaluation of Er:YAG laser in an intact enamel treatment on bonding to the resin cement compared to four traditional techniques [J]. J Contemp Dent Pract, 2019, 20(9): 1014-1018.
[10] Dundar B, Guzel KG. An analysis of the shear strength of the bond between enamel and porcelain laminate veneers with different etching systems: acid and Er,Cr:YSGG laser separately and combined [J]. Lasers Med Sci, 2011, 26(6): 777-782.
[11] 倪恪,王琰,贺晶宇,等.次氯酸钠和 EDTA 预处理对釉质白斑树脂渗透效果影响的实验研究[J].口腔医学研究,2023,39(12): 1056.
[12] Ismatullaev A, Taşın S, Usumez A. Evaluation of bond strength of resin cement to Er: YAG laser-etched enamel and dentin after cementation of ceramic discs [J]. Lasers Med Sci, 2021, 36(2): 447-454.
[13] 王琰,倪恪,贺晶宇,等.口腔酸碱环境下渗透树脂联合再矿化对釉质白斑治疗稳定性影响的实验研究[J].口腔医学研究,2023,39(9): 821.
[14] 吕静雅,蔡兴伟,杨永进,等.Er: YAG 激光对牙釉质与 IPS e. max Press 铸瓷间抗剪切强度的影响[J].应用激光,2016,36(6):764-768.
[15] Latta MA, Tsujimoto A, Takamizawa T, et al. Enamel and dentin bond durability of self-adhesive restorative materials [J]. J Adhes Dent, 2020, 22(1):99-105.
[16] He J, Chen L, Tian J, et al. Effect of NaOCl or EDTA pretreatments on the shear bond strength of the resin-infiltrated white spot lesions to the resin composite: an in vitro study [J]. BMC Oral Health, 2025, 25(1): 1494.
[17] Chay PL, Manton DJ, Palamara JE. The effect of resin infiltration and oxidative pre-treatment on microshear bond strength of resin composite to hypomineralised enamel [J]. Int J Paediatr Dent, 2014, 24(4): 252-267.
[18] Ibrahim DFA, Hasmun NN, Liew YM, et al. Repeated etching cycles of resin infiltration up to nine cycles on demineralized enamel: surface roughness and esthetic outcomes-in vitro study [J]. Children (Basel), 2023, 10(7): 1148.
[19] Borges AB, Abu Hasna A, Matuda AGN, et al. Adhesive systems effect over bond strength of resin-infiltrated and de/remineralized enamel [J]. F1000Res, 2019, 8: 1743.
[20] Hosseini MH, Namvar F, Chalipa J, et al. Comparison of shear bond strength of orthodontic brackets bonded to enamel prepared by Er:YAG laser and conventional acid-etching [J]. J Dent (Tehran), 2012, 9(1): 20-26.
[21] Arami S, Shahabi S, Tabatabaie M, et al. Assessing microleakage of composite restorations in class V cavities prepared by Er: YAG laser irradiation or diamond bur [J]. J Conserv Dent, 2014, 17(3): 216-219.
[22] Xia R, Lei J, Luo M, et al. Effects of Er: YAG laser and acid etching on bond strength of clear aligner attachments to fluorotic enamel [J]. PLoS One, 2025, 20(8): e0328937.
[23] Çokakoğlu S, Nalçacı R, Üşümez S, et al. Effects of different combinations of Er:YAG laser-adhesives on enamel demineralization and bracket bond strength [J]. Photomed Laser Surg, 2016, 34(4): 164-170.
[24] 于金宇,车舜,郭威. Er: YAG 激光处理牙釉质后对粘接性能影响的研究[J].口腔医学杂志,2023,43(9): 786-790.
[25] Sağır S, Usumez A, Ademci E, et al. Effect of enamel laser irradiation at different pulse settings on shear bond strength of orthodontic brackets [J]. Angle Orthod, 2013, 83(6): 973-980.
[26] Yilanci H, Usumez S, Usumez A. Can we improve the laser etching with the digitally controlled laser handpiece-xrunner? [J]. Photomed Laser Surg, 2017, 35(6): 324-331.
[27] Salman SQ, Hussein BMA. Topographical analysis of human enamel after phosphoric acid etching and Er,Cr:YSGG laser irradiation [J]. J Lasers Med Sci, 2023, 14: e68.
[28] Ni K, Chen L, He J, et al. Effect of sodium hypochlorite and EDTA pretreatment on the resin infiltration efficacy and acid resistance of enamel white spot lesions: an in vitro study [J]. BMC Oral Health, 2024, 24(1): 1437.