隨著植牙治療的普及，由微生物所引起的植體周圍炎的發生率也隨之上升。治療方式也從單純的殺菌，進一步希望能夠達到再骨整合作用。傳統的治療方式都有其優缺點存在，因此本研究希望以目前常用的幾種雷射，來評估在鈦金屬試片或植體上的殺菌效果。
結果顯示在所使用的雷射當中，Er:YAG雷射和二極體雷射都可以明顯讓造骨母細胞比未處理前更貼附上植體表面。但是就從數量上來看，Er:YAG雷射處理過的植體表面會有較多的細胞貼附。
另外在平面的鈦金屬試片上，不管是Er:YAG雷射、光動力處理或是兩者合併使用，都明顯的比未處理前清除掉絕大多數的細菌。不過其中以合併兩種雷射處理能夠得到最好的殺菌效果，但是Er:YAG雷射處理後的表面是還有較多細菌殘留的。
不過當細菌附著的物體換成植體時，雖然這三種處理方式都明顯可以達到殺菌的效果，但是Er:YAG雷射的殺菌效果明顯的是最差的了，屬於光化學性殺菌的光動力治療，殺菌效果是第二好的，若是兩者合併使用時，殺菌效果不管在試片上或植體上都是最好的。

As microbial plaques have been proven to be the primary etiological agent of inflammatory peri-implantitis, the major purpose of peri-implantitis therapy has been to eliminate all bacterial deposits on the implant surface. About tranditional treatment regimens, there were some disadvantages existing when using to treat peri-implantitis. The aim of this study was to evaluate the bactericidal effects of different dental laser systems on treating titanium discs or implants surfaces.
In preliminary experiment, there were more MG63 cells attached on implants treated with Er:YAG laser and diode laser than untreated ones. But the result of the group treated with Er:YAG laser was better than the one treated with diode laser.
On titanium discs surface, whether treated by Er:YAG laser, photodynamic therapy or combined Er:YAG laser and photodynamic therapy, could significantly eliminate most of the bacteria. The least counts of residual bacterial was the group which treated with combined Er:YAG laser and photodynamic therapy, and the most counts of residual bacterial was the group which treated with Er:YAG laser.
On titanium implant surface, the results were same with which on titanium disc surface. There were statistically significant differences between the three treatment groups. We concluded that combined Er:YAG laser and photodynamic therapy may be a better treatment regimen for peri-implantitis.

目錄

致謝…………………………………………………………………… I
中文摘要 …………………………………………………………… II
Abstract ………………………………………………………… III
圖目錄 …………………………………………………………… VIII
第一章、文獻回顧 ………………………………………………… 1
1-1 植體周圍炎 ………………………………………………… 1
1-1-1 微生物引起植體周圍炎的證據 …………………1
1-1-2 症狀和盛行率 ………………………………………3
1-1-3 診斷 …………………………………………………5
1-1-4 治療方式 ……………………………………………7
1-2 雷射對於治療植體周圍炎的文獻回顧 ………………… 9
1-2-1 對於鈦金屬表面型態的影響 ………………………9
1-2-2 評估雷射的殺菌效果 ………………………………12
1-2-3 殺菌後的鈦金屬試片對細胞貼附的影響 …………13
1-2-4 動物實驗 ……………………………………………15
1-3 光動力療法對於治療植體周圍炎的文獻回顧 ………… 17
1-3-1 何謂光動力療法 ……………………………………17
1-3-2 光動力療法的作用機制 ……………………………18
1-3-3 所作用的目標微生物 ………………………………21
1-3-4 光敏感劑的種類與細胞毒性 ………………………24
1-3-5 對於殺菌效果的相關研究結果 ……………………26
1-3-5-1 針對單一菌種 ……………………………27
1-3-5-2 針對biofilm ……………………………28
1-3-5-3 針對內毒素 ………………………………28
1-3-6 在動物模型上的殺菌效果評估 ……………………29
1-3-6-1 菌量的減少 ………………………………29
1-3-6-2 發炎症狀的減緩 …………………………29
1-3-6-3 骨喪失的減少 ……………………………29
1-3-7 對於鈦金屬試片或植體表面的殺菌效 ……………30
1-3-7-1 鈦金屬試片表面 …………………………30
1-3-7-2 動物實驗 …………………………………31
1-3-7-3 臨床實驗 …………………………………32
1-4 實驗研究計畫之動機及目的 …………………………… 32
第二章、實驗研究材料與細胞 ………………………………………34
2-1 實驗樣本的製備 ………………………………………… 34
2-1-1 鈦金屬試片 …………………………………………34
2-1-2 鈦金屬植體 …………………………………………34
2-2 實驗用細菌與細胞 ……………………………………… 34
2-2-1 E. coli ……………………………………………34
2-2-2 MG63 cell ……………………………………… 35
2-3 光敏感劑的配製 ………………………………………… 35
2-4 實驗用雷射 ………………………………………………35
2-4-1 Diode laser ………………………………………35
2-4-2 Photodynamic therapy ………………………… 36
2-4-3 Er: YAG laser ……………………………………36
2-5 定量用染劑 ……………………………………………… 37
第三章、研究方法及步驟 …………………………………………38
3-1 在鈦金屬植體上評估處理後細胞貼附效果 …………… 38
3-1-1 實驗方式 ……………………………………………38
3-1-2 分析方法 ……………………………………………39
3-2 在鈦金屬試片上評估殺菌效果 ………………………… 40
3-2-1 實驗方式 ……………………………………………40
3-2-2 分析方法 ……………………………………………42
3-3 在鈦金屬植體上評估殺菌效果 ………………………… 43
3-3-1實驗方式 …………………………………………… 43
3-3-2分析方法 …………………………………………… 44
第四章、實驗結果 ……………………………………………………45
4-1 在鈦金屬植體上評估處理後細胞貼附效果 …………… 45
4-2 在鈦金屬試片上評估殺菌效果 ………………………… 45
4-3 在鈦金屬植體上評估殺菌效果 ………………………… 48
第五章、討論 …………………………………………………………51
第六章、結論 …………………………………………………………56
第七章、參考文獻 ……………………………………………………58

圖目錄
圖一：10 X 10 mm的鈦金屬試片 34
圖二：鈦金屬植體 34
圖三：濃度10 mg/ml的methylene blue 35
圖四：diode laser 35
圖五：2D的spot robe 36
圖六：3D的pocket probe 36
圖七：Er:YAG laser 37
圖八：植體放入1.5 ml離心管中，且菌液蓋過整支植體 38
圖九：距離1 mm，以繞圈方式照射植體60秒 39
圖十：Er:YAG雷射照射植體60秒 39
圖十一：共十二片試片放入同一培養皿中 40
圖十二：光敏感劑滴在三片試片上，黑暗中放置120秒 41
圖十三：雷射照射120秒 41
圖十四：Er:YAG雷射照射60秒 42
圖十五：光敏感劑滴在植體上 43
圖十六：以雷射照射120秒 43
圖十七：受汙染的植體經不同雷射處理後細胞的貼附量統計圖 45
圖十八：沒有經過雷射處理的試片表面 46
圖十九：經過三種不同的雷射系統處理後的試片表面 46
圖二十：處理後的鈦金屬試片表面上所殘留菌量統計圖 47
圖二十一：處理後的鈦金屬試片表面貼附細胞量統計圖 48
圖二十二：處理後的鈦金屬植體表面上所殘留菌量統計圖 49
圖二十三：處理後的植體表面貼附細胞量統計圖 50

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