JPH05344982A - Medical laser device - Google Patents

Abstract

PURPOSE:To permit the laser beam radiation from the top edge of a handpiece and the injection of cleaning water, etc., and prevent a light introducing fiber from being given with the influence of moistre, by forming a light introducing built-in part airtight. CONSTITUTION:This laser medical device is equipped with a light introducing fiber 2 for introducing laser beam from a laser beam source, probe 21 for introducing the laser beam to a body to be radiated, two air feeding passages 3 and 4, and a water feeding passage 5, and the outgoing edge 201 of the light introducing fiber 2 is separated in airtight form from the incidence edge 211 of the probe 21 through a light introduction shielding plate 8 such as lens, and the part having the light introducing fiber built-in is made airtight. The outgoing edge 201 is cooled by a dry gas supplied from the air feeding passage 3, and the incidence edge 211 is cooled by a gas supplied from the air feeding passage 4. The water supplied from a water supply passage 16A flows in the gap between a probe protecting pipe 29 and the fiber probe 2 and is jetted from the top edge of the probe 2.

Description

Detailed Description of the Invention

[0001]

FIELD OF THE INVENTION The present invention relates to a laser medical device including a laser handpiece for dental treatment.

[0002]

2. Description of the Related Art Laser handpieces have been widely used for medical and dental purposes for the purpose of evaporating and incising living tissue, coagulation and hemostasis, or heating and pain relief.
Has medical effects. As a laser source used for conventional laser handpieces, carbon dioxide excitation laser,
Nd: YAG solid-state lasers have been used, but all of these lasers are intended to treat soft tissues such as visceral tissues, muscles, skin, etc. In the field of dental treatment, they are generated in soft tissues around teeth. For the treatment of periodontal disease, the above-mentioned laser treatment has been performed.

The handpieces for these purposes are roughly classified into contact type laser handpieces in which the end of the probe at the tip of the handpiece for irradiating the laser beam is brought into direct contact with the patient and the laser beam is emitted through the probe. There is a non-contact type laser handpiece that irradiates the affected part with laser from a laser emitting port at the tip of the handpiece while keeping a distance from the affected part.

At the time of laser irradiation, a cooling gas is sprayed or water is injected onto the affected area in order to prevent overheating of the affected area and to cool surrounding tissues that should not be heated. In the contact type laser handpiece, a laser probe that irradiates while passing through a laser while contacting the affected area, that is, a translucent glass or synthetic resin cylindrical or conical tip itself is heated. The chips may be cut or melted, or the adhered matter may cause irradiation failure. Therefore, water may be passed or poured into the chip for cooling and cleaning of the tip.

In recent years, a technique for performing dental treatment by laser irradiation has been studied, and a laser treatment apparatus for treating hard dental tissue such as dental caries removal, dentin removal or enamel excision has been tried.

[0006] A conventional treatment apparatus using a carbon dioxide laser has a very large absorption of the irradiation laser on the tooth tissue surface, is likely to cause carbonization, and has a large laser absorption of water. The laser energy is absorbed only in the water layer on the surface of the tissue, and the laser light does not reach the affected area of the tissue, which makes treatment difficult. Further, since the manipulator using the light guide tube is used, there is a problem that operability is poor.

The Nd: YAG solid-state laser has been found to have a transpiration effect on the hard tissue of the tooth due to the pulse wave, and a dental treatment apparatus using the Nd: YAG solid-state laser has been proposed (Japanese Patent Laid-Open No. 2-500833). This laser can be used to remove dentin, but laser light with a wavelength of 1.06 μm
Since the absorption rate to the tooth substance is small, the evaporation efficiency is very poor and the cutting speed is slow, and the laser light penetrates into the tooth substance to generate heat, which causes a heat failure in the tooth portion. Also,
It has little effect on thin enamel.

On the other hand, since the Er: YAG solid-state laser has a very high workability in tooth structure, it has attracted attention for tooth treatment, and a treatment device using this laser light has also been proposed (Japanese Patent Laid-Open No. Hei 2). -504478).

Er: YAG solid state laser has a wavelength of 2.94μ
m is an infrared ray and has the property that this laser excites OH groups and has an extremely high absorption rate in living tissue containing OH groups. In the field of dentistry, hard tissue such as teeth containing OH groups. The effect of transpiration is recognized, and utilizing this property, it is being used for cutting teeth, removing tartar, etc. by irradiating Er: YAG solid laser light.

The applicants have already proposed a contact type laser treatment apparatus which can also use Er: YAG solid state laser light,
We proposed a device with a replaceable fiber probe that enabled etching of initial caries, hemostasis and incision of soft tissues such as cavity formation of teeth, treatment of root canals, and removal of tartar (Japanese Patent Application No. 3-211837).

Optical fibers for guiding the laser light emitted from the Er: YAG laser to a laser treatment device such as a laser handpiece include glass fibers such as fluoride fiber, chalcogenide glass fiber and quartz glass fiber, sapphire fiber, and zinc. Crystal fibers such as selenium fibers can be used, but fluoride fibers are most preferable from the viewpoint of high transmission efficiency of laser light.

[0012]

In the conventional contact type laser handpiece for soft tissue, since the probe for laser emission, that is, the tip is heated, water is poured on the outer peripheral surface of the tip or provided in the tip. Water to the through hole
Although the tip itself is cooled together with the irradiated area, the tip is a columnar or conical shape with a rounded tip, which is not suitable for precise processing such as cavity formation of teeth, and its tip. When is damaged or melted, the laser light is scattered and cannot be focused, so that it cannot be used.

When the laser emission probe is a fiber probe having a translucent filament as described above, it is necessary to cool it in order to prevent heating of the tip portion. It is difficult to efficiently cool the outer peripheral surface of such a short conical tip as water drops off from the surface of the filament and drops.

On the other hand, in a device for treating a hard tooth by irradiating a tooth with an Er: YAG laser beam, first, a fluoride fiber having a high laser transmissivity exhibits hygroscopicity, and when it absorbs moisture, it deteriorates and is transmitted by a laser. There was a serious problem of heating and breaking of the fiber. This is because the outer circumference of the fiber is covered with a jacket to prevent moisture, but it is difficult to provide a suitable moisture-proof coating on the end face of the fiber that does not hinder the transmission of laser light.

Next, using Er: YAG laser light,
When treating a tooth that is a hard tissue, it is necessary to insert the probe into the gap portion / capillary portion of the tooth so that the probe can be efficiently perforated and cut. Therefore, the fiber probe used for treating a tooth must have a shape and structure that match the treatment site and treatment mode of the tooth.

Such a contact type laser handpiece is
It is convenient for depth adjustment during surgery, but the defect of the probe tip during use disturbs the laser light irradiation pattern,
The processing precision of the tooth material deteriorates.

Further, while the transpiration residue adheres to the tooth during laser irradiation of the tooth, it is present on the surface of the tooth part in order to remove the transpiration residue adhering to the tooth and promote the transpiration and scattering of the irradiated tooth part. Since water is effective, it is necessary to find an effective supply means for cleaning and cooling the tooth surface when adopting the fiber probe.

Further, the tooth enamel was once irradiated with an Er: YAG solid laser, and the tooth enamel remaining without being evaporated was coated with a layer depleted in OH groups contained in the hydroxychancel. Therefore, even if laser irradiation is performed again, there is a problem that cutting of this layer becomes difficult and the workability is deteriorated.

In order to solve the above problems, the present invention firstly makes it possible to irradiate a laser beam from the tip of a handpiece and to spray washing water and the like, and is easily affected by moisture. The present invention proposes a laser medical device in which the light guide fiber is shielded from water including the above-mentioned jetted water and the like and is not affected by water.

A second object of the present invention is that the laser handpiece is provided with a probe having a shape suitable for a treatment site and a treatment content by laser irradiation, and water can be effectively injected into the treatment site and the tip of the probe. To provide a laser medical device.

A third object of the present invention is to enable the removal of dental caries and dentin by laser irradiation, the excision of enamel, the formation of cavities, and the removal of tartar, which have been difficult in the past. , Er: YAG solid-state laser is used for laser treatment to remove heat damage to the affected part of the tooth and peripheral tissues, and to provide a laser treatment apparatus which does not reduce processing efficiency due to water injection or adhesion of non-evaporated matter.

[0022]

A laser medical device of the present invention.
Is a light guide for guiding the laser light emitted from the laser light source.
Fiber and laser light guided by the fiber
A probe leading to the projectile and at least two independent air supplies
A laser beam connecting the channel and at least one water channel
A laser treatment device equipped with a handpiece.
The handpiece shields the output end of the above-mentioned light guide fiber.
The light guide frame is hermetically isolated from the incident end of the probe through a shield plate.
The internal part of the fiber is made airtight and is supplied from the first air supply passage.
When the exit end of the light guide fiber is cooled by the dry gas
Both are connected by the gas supplied from the second air supply passage.
Cools the incident end of the valve and supplies the water supplied from the water supply channel.
The feature is that it spouts from around the tip of the bu
It is what

In the laser medical device of the present invention, the proximal end of the probe protection tube is detachably fitted to the front part of the body of the handpiece so as to be able to pass through the water supply passage, and the probe is inserted. It includes a water passage for supplying water to the tip of the probe with a gap between the inner surface of the probe protection tube and the outer surface of the probe.

Further, in the laser medical device of the present invention, the laser source is a laser generator for generating an Er: YAG solid state laser, and the light guide fiber is a fluoride light guide fiber. Comprises laser control means for adjusting the laser output of the laser generator.

[0025]

According to the present invention, inside the laser handpiece, the laser light is emitted from the emission end of the light guide fiber, transmitted through the light guide shield plate, incident from the incident end of the probe and irradiated from the probe tip. The exit end of the light-guiding fiber is hermetically separated from the entrance end of the probe through the light-guiding shield plate to hermetically seal the light-guiding fiber built-in portion. Since the exit end of the light guide fiber is cooled by the dry gas supplied from the first air supply passage without using the laser light, the exit end face of the light guide fiber is
It is always kept in a dry state, and at the same time, it is possible to cool the heat generation of the emission end face during laser transmission. Therefore, a fiber that is easily deteriorated by moisture absorption can be used as the light guide fiber, and since the hygroscopic light guide fiber is separated from the probe, the probe can be freely attached and detached for replacement.

Since the incident end face of the probe is cooled by the gas supplied from the second air supply passage, water droplets at the time of exchanging the probe are scattered and removed from the incident end face and the light guide shield plate surface to be dried, and the laser transmission The heat generated at the incident end face can be cooled.

In the laser medical device of the present invention, when the probe by the optical fiber of the filament is detachably attached to the tip of the laser handpiece, the fiber probe is detachably attached to the tip. Since the probe is inserted through the probe protection tube, the optical fiber is protected by the protection tube when the tip of the fiber probe is brought close to the target tooth or other treatment site, and the optical fiber is less likely to be broken. The fiber can be an ultrafine fiber suitable for inserting a deep space.

An appropriate gap is formed between the outer circumference of the fiber probe and the inner surface of the probe protection tube, and the tip end of the handpiece to which the base end of the probe protection tube is attached is introduced into the handpiece. Since it is connected to the above water supply passage, it can be used as a water passage through the gap, and therefore, the water flowing through the probe protection tube reliably cools the outer periphery and the tip of the fiber probe, and at the same time the laser irradiation site It can be effectively ejected or ejected, which is effective in preventing overheating of the irradiated site or evaporating hard tissue.

When using a flexible optical fiber as the fiber probe, if the probe protection tube is a straight tube or a curved tube of a desired shape, the fiber probe can be easily fixed to the desired shape. The laser irradiation direction from the probe to the handpiece body can be freely adjusted to a desired direction simply by replacing the probe protection tube.

The Er: YAG solid-state laser light emitted from the laser generator is transmitted to the handpiece by the fluoride light guide fiber and guided to the fiber probe attached to the tip of the handpiece to form this fiber probe. It is irradiated from the tip of the fiber to the tooth and dentin to be treated. Er: Y irradiated to the tooth dentin
The AG solid laser light is infrared light having a wavelength of 2.94 μm, and evaporates the hard tissue containing the OH group in the tooth structure, and ablates the irradiated surface.

Since the fiber probe has a thin tip diameter of 50 to 600 μm, the laser beam emitted from the irradiation end surface to the target portion has a beam diameter close to the tip diameter and the irradiation end surface. Can be inserted into the deep space of the tooth, and the manual operation of the handpiece facilitates the chamfering of the irradiated tooth and the accurate formation of a small-diameter cavity.

Since the water injection means injects water from the vicinity of the tip of the fiber probe, water can be injected to the irradiation site. Since the fiber probe has a fine fiber tip, the tip of the fiber probe is irradiated with an uneven shape. The tissue surface can be easily and accurately brought into contact with and contact with the tissue surface. Therefore, the water layer in the gap between the tip of the fiber probe and the irradiated tissue surface becomes thin, and the absorption rate of laser light into water becomes small. The absorption efficiency to the tissue is increased.

Among the dentin, especially when the enamel is irradiated, the calcium-enriched layer remaining on the traces of the OH-containing hydroxychancells on the surface of the enamel which has remained to reduce the evaporation of re-irradiation. However, in the present invention,
By the disturbing action of cavitation due to the intermittent water irradiation of the irradiation surface and the pulsed laser irradiation, the adhered residue can be removed and the high enamel evaporation efficiency can be maintained.

The water injection into the tooth portion cools the heat generated by the laser permeation in the tooth structure and surrounding tissues, so that it is possible to prevent the heat damage to the living tissue in the tooth portion.

The fiber probe has good directivity of the irradiation laser beam from its tip, and even if the tip is broken,
Since the surface is almost flat, the beam direction does not change, and therefore, the beam can be used as it is even after being broken, and thus the frequency of fiber probe replacement can be reduced.

[0036]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a vertical sectional view of a laser handpiece for dental treatment which is an embodiment of the present invention, and I in the horizontal sectional view of FIG.
The cross section by the -I line is shown. FIG. 2 is a vertical sectional view taken along the line II-II in FIG. FIG. 3 is a cross-sectional view taken along the line III-III in FIG.

In FIG. 1 to FIG. 3, reference numeral 1 is a handpiece body, inside of which a light guide fiber 2 for guiding a laser beam emitted from a laser light source, a first air supply pipe 3, a second air supply pipe 4 and water supply are provided. It has a built-in pipe 5. The light guide fiber 2 is, for example, an optical fiber whose core and clad are made of fluoride glass and which is covered with a protective jacket such as UV resin.

A light guide fiber holder 6 is mounted inside the tip side of the handpiece body 1 so as to abut the step 101 on the inner peripheral surface thereof, and a light guide shield plate holder 82 is attached to the tip side of the holder 6. Is attached, and further, a joint 11 is attached to the tip end side of the light guide shield plate holder 82, and the step portion 101 and the cover nut 12 are screwed together by tightening the cover nut 12 screwed with the screw portion 102 of the handpiece body.
The holders 6 and 8 and the joint 11 are fixed to the stepped portion 122.

The protective jacket of the light guide fiber 2 is removed from the optical fiber insertion hole 60 of the light guide fiber holder 6, and the light guide fiber terminal in which the sleeve (ferrule) 7 is adhered with an adhesive or the like is inserted, and the circle of the outer circumference of the sleeve 7 is inserted. The ring 71 fitted in the groove in the circumferential direction comes into contact with the end surface of the holder 6 so that the emitting end 2 of the light guide fiber 2
Position 01. Even when a twist occurs between the handpiece 1 and the fiber 2 during the operation of the handpiece, the rotation of the sleeve 7 and the holder 6 causes the fiber 2 to rotate.
It has a structure that can prevent breakage of the.

The light guide shield plate holder 82 has a recessed chamber 81 for receiving the emission end 201 of the light guide fiber 2 and a window portion adjacent to the recessed chamber 81. The window portion is provided with a condenser lens, an optical glass plate or the like. A light shield plate 8 is mounted, and an O-ring 10 hermetically supports it. Therefore, both sides of the light guide shield plate 8, that is, the exit cooling chamber 81 and the entrance cooling chamber 14 of the joint 11 are provided.
Is airtightly isolated. The interface between the joint 11 and the handpiece body 1 is also hermetically sealed by the O-ring 20, the light guide fiber built-in portion on the left side of the light guide shielding plate is hermetically sealed, and the light guide fiber 2 is also protected from moisture in the atmosphere. It has been cut off.

The joint 11 has a probe insertion hole 13 provided so as to communicate with the incident cooling chamber 14. The insertion hole 13 has a small-diameter portion 131, a large-diameter portion 132, and a step portion 133 at the boundary between these. A fiber probe terminal without a protective jacket is inserted into the small diameter portion 131, and a fiber probe 21 is inserted into the large diameter portion 132 with a terminal sleeve (ferrule) 22 attached to the outer periphery thereof. Then, the end portion of the terminal sleeve 22 comes into contact with the step portion 133, so that the fiber probe 2
The one incident end 211 is positioned so as to project into the incident cooling chamber 14 by an appropriate length.

The fiber probe 21 guides the laser light guided by the above-mentioned light guide fiber 2 to the object to be irradiated, and is formed by a short optical fiber. Since the fiber probe is short, it uses an optical fiber that has higher light resistance compared to the fluoride fiber that forms the light guide fiber, but has higher moisture resistance than the fluoride fiber and mechanical strength such as breakage resistance. be able to.

Further, the fiber probe 21 is exchanged relatively frequently because the laser light emitting end thereof is melted by the heat at the time of irradiation or the vaporized substance of the living tissue generated at the time of irradiation adheres to the emitting end. Therefore, it is desirable that the cost be low. For these reasons, as the optical fiber forming the fiber probe, it is preferable to use an optical fiber whose core and clad are made of silica glass and which are provided with a metal coat or a protective jacket of a heat resistant resin such as polyimide. However, since it is used by exchanging it relatively frequently as described above, the use of the fluoride fiber is not excluded.

The laser beam emitted from the emission end 201 of the light guide fiber 2 is as efficiently as possible.
The exit end 201 and the entrance end 211 are designed and arranged so as to be incident on the entrance end 211 of the first end.
A part of the laser light emitted from 01 becomes loss and heat is generated. Therefore, the emission end 201 is cooled by the dry gas supplied by the first air supply pipe, and the incidence end 211
Is cooled by the gas supplied by the second air supply pipe. In addition, the air supply end 2 of the fiber is supplied by this air supply.
01 and the incident end 211 are prevented from attaching dust.

The opening end of the first air supply pipe 3 is inserted into the through hole 61 of the light guide fiber holder 6 and the end is fixed with an adhesive or the like. The dry gas supplied from the first air supply pipe, usually dry air whose water dew point is reduced as much as possible by a dehydrator, passes through the gap between the light guide fiber holder 6 and the light guide shield plate holder 82 from the through hole 61. Output cooling chamber 8
1 to cool the exit end 201 of the light guide fiber 2. The dry gas that has flowed into the emission cooling chamber 81 passes through the gap or the like provided between the water supply pipe insertion hole 62 of the holder 6 and the water supply pipe, and between the handpiece body 1 and the light guide fiber 2 and the pipes 3, 4, and 5. Of the gas, flows backward in the space to the left in the figure, and is discharged from a gas discharge port (not shown) provided at a position sufficiently separated from the emission end 201. The gas outlet has a one-way valve to prevent outside air from entering the light guide cable built-in portion.

As described above, the dry gas supplied from the first air supply pipe 3 cools the emission end of the light guide fiber, then flows backward in the light guide fiber built-in portion and is released at a position sufficiently distant from the emission end 201. Therefore, the backflowing dry gas also has the effect of shielding the light guide fiber from moisture and cooling it. In addition, even if the light guide fiber made of fluoride fiber and having a relatively low breaking strength is broken and the broken portion is burned by the laser light, the broken powder or smoke is generated by the flow of the dry gas as described above. Since it is released to the outside at a place sufficiently away from 201, it is possible to prevent the light guide shield plate from being contaminated with dust or smoke, and to attach smoke or broken powder to the affected area or give a fear to the patient. Absent. In the present invention, it is desirable to select a place where the dry gas supplied from the first air supply pipe is discharged to the outside and a place sufficiently separated from the emission end from the above viewpoint.

The second air supply pipe 4 for supplying the gas for cooling the incident end 211 of the fiber probe penetrates the light guide fiber holder 6 and the light guide shield plate holder 82 and is inserted into the pipe insertion hole 15A of the joint 11. The opening end is fixed with an adhesive or the like. The gas (usually air) supplied from the pipe 4 flows from the pipe insertion hole 15A, which is an air supply passage, into the incident cooling chamber 14 through the air supply passage 15B, and cools the incident end 211. The gas flowing into the incident cooling chamber 14 reaches the gas discharge path 15D via the gas guide path 15C and is discharged to the outside from the gas discharge port 124 of the cover nut 12.

The joint 11 has a small-diameter portion on the tip side, and a screw 19 is provided on the tip side of the outer periphery thereof. The step portion 18 at the boundary between the large diameter portion and the small diameter portion contacts the step portion 122 at the tip end portion of the cover nut when the screw of the cover nut 12 is tightened, and fixes the joint 11 and the like to the handpiece body. This is as described above.

Reference numeral 24 is a cylindrical probe holder, and a screw 27 provided on the inner surface of the large-diameter portion 25 is screwed with the screw 19 of the joint 11. The taper portion 28 provided on the inner surface of the probe holder has a taper surface at one end that matches the taper surface 28, and the other end of which is the fastener 23 that is in contact with the outer diameter surface of the tip of the joint 11. Have been combined. When the screw 27 of the probe holder 24 is tightened and the holder 24 moves to the left in the figure, the taper portion 28 presses the taper surface of the fastener 23, whereby the fastener 23 is deformed inward. Clamp and hold the end sleeve 22 of the fiber probe. When the screw 27 of the probe holder 24 is loosened, the fastening of the terminal sleeve 22 by the fastening tool 23 is released. Therefore, by tightening and loosening the screw 27 of the probe holder 24, the fiber probe 21 with the terminal sleeve 22 attached can be freely attached and detached.

Small diameter portion 26 on the tip side of the probe holder 24
Has an outer surface formed in a polygon such as a hexagon, and the polygonal base end portion 291 of the probe protection tube 29 is covered therewith. The water supply pipe 5 penetrates the light guide fiber holder 6 and the light guide shielding plate holder 82, and the water supply pipe insertion hole 1 of the joint 11 is formed.
6A, and the open end of the pipe is fixed with an adhesive or the like. The tip of the insertion hole 16A communicates with a water conduit 16B that opens to the tip surface of the joint 11.

The water (saline solution,
The water may be a water spray) through the water conduit 16B, the internal space of the tightening ring 23, and the notch 221 in the longitudinal direction provided on the distal end side of the terminal sleeve, and the probe holder 2
Flowing in between the small diameter portion 26 of 4 and the fiber probe,
The transpiration residue that flows along the water passage of the gap 16C between the inner surface of the probe protection tube 29 and the outer surface of the fiber probe 21, is jetted from the tip of the protection tube 29, is sprayed on the teeth, etc., and is attached to the periphery of the teeth etc. is washed. Remove. At the same time, the tip of the fiber probe 21 is also cooled and washed. Since water flows along the fiber probe 21 as described above, it also has an effect of cooling the fiber probe 21.

In the above description, the light guide fiber 2 is described as being made of a fluoride fiber, but the light guide fiber 2 is not limited to the fluoride fiber in the present invention. The present invention is not limited to the use of a fluoride fiber, but is more generally applied to a laser treatment device such as a laser handpiece from a laser light source, not only when an optical fiber having low moisture resistance that is easily affected by moisture is used as the light guide fiber 2. This is also effective in the case where a relatively long light guiding fiber that guides light is protected from moisture to extend the life of the light guiding fiber. As such a light guide fiber 2, a chalcogenide glass fiber, a glass fiber such as a quartz glass fiber, or a crystal fiber such as a sapphire fiber or a zinc selenium fiber can be used.

The probe is also the fiber probe 21.
The laser treatment apparatus of the present invention is not limited to the dental treatment handpiece. Furthermore, various modifications can be made to the embodiment described above. Also,
As a modification of the one shown in FIG. 3, the entire inner diameter portion of the handpiece may be used as the ventilation passage. As the light guide fiber 2, it is possible to select an optical fiber having a high light guide efficiency without fear of water resistance and moisture resistance. The gas supplied from the second air supply passage 4 for cooling the incident end of the probe 21 need not be a dry gas. Further, in the above-described embodiment, the exit end 201 of the light guide fiber and the entrance end 2 of the fiber probe 2
11 shows the configuration in which the cooling chambers 81 and 14 are provided, respectively, but the present invention is not limited to this, and the front faces of the emission end 201 and the incidence end 211 are simply connected to the first air supply passage 3 and the second air supply passage 3, respectively.
It may be a gas flow passage communicating with the air supply passage 4, and in the same manner, the objects of mutual isolation, moisture prevention and cooling can be achieved.

Next, FIG. 4 shows examples of various shapes of the fiber probe 21 applied to the laser treatment apparatus used exclusively for dentistry of the present invention. The shape of the fiber probe 21 already shown in FIG. 1 is a general one formed by a wire having a uniform outer diameter up to the end.
The parts shown in (A) and (B) have a tapered portion 2 with a tapered front side.
A fiber probe 21 having a diameter of 15, which has a smaller tip diameter, for example, allows the irradiation end surface to reach the deep bottom of a small-diameter hole of a tooth and focuses laser light to cope with endodontic treatment or the like. Is. In a flexible fiber as shown in FIG. 4B, the tapered portion 215 is bent and used. FIG. 4C shows the tapered portion 215.
This is an example in which the tip side of the column is a finer cylinder 216.

4D and 4E, the enlarged diameter portion 21 is provided at the tip.
7 is an example of the fiber probe 21 having No. 7, which is to irradiate the affected area with the expanded irradiation end surface 210 and irradiate the laser light widely and uniformly, for treating initial caries, imparting acid resistance to the tooth surface, and It is effectively used for etching.

Irradiation end face 2 of the fiber probe 21
Reference numeral 10 is not limited to a flat surface, and may be formed into a convex surface or a concave surface to establish a divergence angle of laser light. Further, the irradiation end surface 210 does not necessarily have to be a polished smooth surface, and may be an appropriately rough surface or a broken surface. It may be a surface or a cleavage plane.

The fiber probe 21 may be formed of an optical fiber single core, but in order to increase the laser transmittance, it is preferable that a clad layer is formed on the outer circumference of the fiber, and FIG. ) And FIG. 9 (A), it is particularly preferable that the covering material 214 is formed on the outer layer in order to improve the bending strength. As the coating material 214, a heat resistant resin such as polyimide is preferably used.

FIG. 5 shows various shapes of the probe protection tube 29 and the relationship with the fiber probe 21.
FIG. 5A is an example of the probe protection tube 29 whose front side is bent. The fiber probe 21 inserted into the probe protection tube 29 is bent by being bound by the inner surface of the probe protection tube 29. By changing the curvature and the length of the probe protection tube 29, the fiber probe 21 can be adjusted to a desired direction angle.

FIG. 5 (B) shows an example of a probe protection tube 292 whose front side is tapered so as to fit the above-mentioned tapered fiber probe 21 (FIG. 4 (A)). FIG. 5C shows a probe protection tube 29 in which the end surface 295 is formed as a surface obliquely intersecting the tube axis. The irradiation laser strongly irradiates the open inclined surface 295 side and the inclined surface 295.
It is possible to reduce the irradiation amount in the direction of the protruding end 295a. Such a probe protection tube 29 is used for removing subgingival calculus in the periodontal part, and if the tip end 295a of the tip is directed to the tooth side, tooth cementum and dentin are less likely to be damaged. On the contrary, if the 295a is directed toward the gingiva side, it is possible to reduce the influence on the gingival part.

FIG. 5D shows a projecting piece 29 inclined at the tip.
4, the inner surface of the projecting piece, that is, the surface on which the laser light emitted from the fiber probe tip 210 is projected is a mirror surface 294, and the mirror surface 294 reflects the direction of the laser to change the direction. 29 is shown.
The probe protection tube is formed of a highly reflective stainless steel tube or other metal tube. The mirror surface 294 may be coated with a reflective coating such as gold plating.

FIG. 5 (E) shows a probe protection tube 29 having a narrow flat end and housing the irradiation end face of the fiber probe 21, and the inner surface of the flat portion 296 is, for example, gold-plated. Is applied to enhance reflectivity.
Such a probe protection tube 29 is effective in removing tartar from the periodontal portion without damaging the cementum of the tooth.

FIGS. 6 (A) and 6 (B) show an example in which the tip 293 of the curved probe protection tube 29 and the tip 210 of the fiber probe 21 inserted therethrough are aligned on substantially the same plane. , The irradiation end face 210 is the probe protection tube 29.
Since it does not protrude from the tip 293, the irradiation area can be limited and the risk of breakage is small. The fiber probe 21 shown in FIG. 5B is used similarly to that shown in FIG.

FIG. 9 shows another embodiment of the fiber probe 21. In FIG. 9A, as described above, the straight fiber (core portion) 41 having the light guiding property is provided on the cladding layer 44.
The outer peripheral surface of which is covered with the above-mentioned reinforcing covering material 2
14 is a coated fiber probe.

As the material of the fiber (core portion) 41, a silica glass fiber having good water resistance is adopted, and a material having a diameter of 50 to 600 μm is suitable for excising tooth structure. You can use a taper with a different diameter cross section for the fiber,
In this case, the diameter of the irradiation side end face 210 of the fiber is 5
It is set to 0 to 600 μm.

FIG. 9B shows the arrangement of the tip portion of the probe protection tube 29 that covers the outer surface of the fiber probe 21, but the irradiation end surface 40 is arranged so as to slightly project from the probe protection tube 29, and the gap 16C is provided. Water can be poured from the water passage in the direction of laser irradiation.

In FIG. 6C, double probe protection tubes 29, 29a are coaxially inserted in the outer surface of the fiber probe 21, and are used for water injection and air ejection from the gaps 16C, 16D, respectively. As a result, a mist state is formed in front of the laser irradiation, which is effective for cooling and irradiating the irradiation site and for removing and cleaning the evaporated material.

9 (D) and 9 (E), a probe protection tube is not used, and a small diameter water injection pipe 6 is attached to the fiber probe 21.
4 is an example in which 4 is attached alone or in parallel with the air supply pipe 74. The water supply pipe 64 is joined to the water supply passages 5, 16B at the front part of the laser handpiece body 1, and the air supply pipe 74 is similarly connected to the second air supply passages 4, 15C. , And water and air, respectively, are jetted ahead of the irradiation laser.

FIG. 7 is an external view of a dental laser treatment apparatus. This apparatus is an E housed in a laser generator 90.
r: YAG solid-state laser generator 9 and this laser generator 1
And a laser control device 91 for controlling the laser output and the like.

In the laser control means 91, the laser output is
Pulse width 150-300μs Pulse period 1-30pps
And the irradiation energy per pulse is set to a maximum of 1 J. If the pulse width exceeds the upper limit, the light guide fiber made of fluoride may be damaged, and if the pulse width is less than the lower limit, thermal stimulation is caused in the tissue. On the other hand, if the pulse period exceeds the upper limit value, the size of the laser generator becomes large and the cost becomes high, and if the pulse period is less than the lower limit value, the cutting speed becomes slow and the efficiency decreases. If the maximum irradiation energy of 1 J per pulse is exceeded, the light guide fiber may be damaged or durability may be deteriorated.

The laser generator 90 is connected to a fluoride-based transmission light guide fiber 2 which has a very small absorption loss for Er: YAG solid laser light. This light guide fiber 2 is the handpiece body 1 described in detail above. , And a fiber probe 21 is projectedly attached to the tip of the handpiece body 1.

As shown in FIG. 8, the laser treatment apparatus of the present invention is used for dental treatment of enamel A, dental caries B, dentin C, dental pulp D, and periodontal tartar F as shown in FIG. Although used, the laser irradiation conditions differ depending on the irradiation site.
Examples of laser irradiation conditions are shown below.

Soft dentin B and caries enamel A in the carious area
Of quartz fiber having a core diameter of 600 μm
Irradiation output 100 at fiber probe irradiation end face 210
Irradiation with a laser having a period of 5 pps at ˜200 mJ (per pulse) under water injection enabled efficient ablation. It was effective for removing the transpiration of the healthy dentin C by increasing the output to about 200 mJ because the cutting speed could be further increased.

As a pretreatment for resin filling after cavity formation,
By irradiating the enamel A with a laser having a low energy density of about 5 to 20 mJ / cm ² , the etching treatment can be performed, and the conventional acid etching treatment can be replaced.

For calculus F above and below the gingiva that causes periodontal disease, a fiber having a core diameter of 600 μm is brought into contact with calculus F to give an irradiation output of 20 to 30 mJ (per pulse) of 5 pps. Irradiate with a periodic pulse laser under water injection. Since the laser beam emitted from the fiber probe 21 has a good directivity, the calculus F could be completely removed without damaging the cement material directly under the calculus.

[0075]

As described above, according to the present invention, the output end of the light guide fiber is airtightly separated from the incident end of the probe through the light guide shield plate such as a lens to make the light guide fiber built-in part airtight and independent. Since the emission end of the light guide fiber is cooled by the dry gas supplied from the gas passage, the light guide fiber is maintained in a state of being shielded from moisture. Therefore, even if water is supplied or fountains around the teeth on the probe side, the light guide fiber is not affected in any way. Therefore, a hygroscopic optical fiber can also be used for the light guide fiber, and both utilization of the optical fiber having high transmission efficiency for the laser light to be irradiated and water injection from the vicinity of the probe tip to the affected area can be compatible. You can

Therefore, the light source of the laser light is 2.94 μm.
When an Er: YAG laser that emits a laser beam having a wavelength of m is used and a hygroscopic fluoride fiber is used as a light guide fiber, the laser light is guided with high light guide efficiency and the affected area by water injection is applied. It facilitates cooling and washing and removal of transpiration residue, and can effectively deal with breakage powder and smoke emission at the time of breakage and burning of the light guide fiber.

Since the probe used in the laser medical apparatus of the present invention is replaceably attached to the tip of the handpiece body, it is easy to select and use an optical fiber having a size and shape suitable for the treatment site and the treatment purpose. Thus, by using the ultrafine filament fiber probe, for example, effective treatment can be performed on the narrow gap portion / deep hole portion of the hard living tissue. Moreover, since the fiber probe can be disposable, it can be easily formed at low cost.

Even if the probe insertion hole of the handpiece is submerged when the fiber probe is replaced, the shielding plate does not affect the light guiding laser fiber due to moisture. The probe entrance end face is constantly cooled in a dry state, so that the fiber probe can be replaced easily and quickly even during treatment without deteriorating the function of the handpiece.

Since the fiber probe is inserted through the probe protection tube, it is protected from damage due to external force, and the probe protection tube is molded into a moderately curved shape so that the handpiece body can be protected from the fiber probe. The irradiation laser can be easily turned, and the laser can be effectively irradiated to the target treatment site in the optimum irradiation direction. Since the probe protection tube is removable, the laser irradiation direction can be freely adjusted even during treatment by exchanging the probe protection tube.

Since water is passed through the gap between the fiber probe and the probe protection tube, the cooling water is discharged from the tip of the probe protection tube almost coaxially with the fiber probe, and the tip of the fiber probe can be cooled, and at the same time laser irradiation is performed. It is possible to effectively prevent overheating of the tissue at the affected area.

In particular, when an Er: YAG laser is used as a laser beam for the laser handpiece of the present invention and it is used for perforating or cutting hard tissue, especially tooth tissue, or removing tartar, water is irradiated on the laser irradiation site. This is effective in promoting transpiration and increasing the efficiency of perforation and excision. Also,
It is also effective for treatment of root canals, removal of tartar, etching of initial caries, hemostasis of soft tissues, and incision. By injecting water, Er: YAG laser light, which is highly absorbed by water, is instantaneously absorbed by the water, and the water evaporates and scatters, so that the affected area becomes a new surface to enhance the evaporation effect and the cleaning effect.

The laser treatment apparatus of the present invention is a pulse-shaped E
When the r: YAG solid state laser is focused by a fiber probe, particularly when it is brought into contact with the tooth part and water is irradiated,
Efficient transpiration excision is also effective for enamel, and by adjusting the laser output and pulse conditions, a wide range of dentin parts required for conventional dental treatment such as cavity formation, removal of tartar and substitution of acid etching. Almost all treatments can be achieved.
By using the laser treatment apparatus of the present invention, there is no heat damage to the tissue around the tooth due to laser irradiation, and there is no pain, vibration, or noise during cutting associated with conventional mechanical cutting, and there is no physical or mental pain for the patient. It is opened, and the practitioner can perform efficient dental treatment.

[Brief description of drawings]

1 is a longitudinal section of a laser handpiece for dental treatment according to an embodiment of the present invention, showing a section taken along line I-I of FIG.

FIG. 2 is a vertical sectional view of the laser handpiece taken along line II-II of FIG.

3 is a cross-sectional view of the laser handpiece taken along line III-III in FIG.

FIG. 4 is a view (A to F) showing various shapes of a fiber probe that is replaceably mounted on the front side of the handpiece.

FIG. 5 is a view (A to E) showing various shapes of a probe protection tube that is packaged on a fiber probe.

FIG. 6 is a cross-sectional view of a bent probe protection tube.

FIG. 7 is an external view of a laser treatment apparatus.

FIG. 8 is a diagram showing a treatment target portion of a tooth portion by a laser treatment device.

FIG. 9 is a sectional view (A) of the fiber probe according to the embodiment of the fiber probe, sectional views (B) and (C) of the probe protection tube, and a side view (D) of the fiber probe additionally provided with a water injection tube. ) (E).

[Explanation of symbols]

 1 Handpiece body 2 Light guide fiber 3 First air supply pipe 4 Second air supply pipe 5 Water supply pipe 6 Light guide fiber holder 8 Light guide shield plate 10 O-ring 11 Joint 15A, 15B Air supply passage 16A Water supply passage 16C Water passage 21 Fiber Probe 29 Probe protection tube 201 Emission end 211 Incident end 90 Laser generator 9 Er: YAG solid state laser generator 91 Laser control device

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[Procedure amendment]

[Submission date] June 30, 1993

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] Figure 5

[Correction method] Change

[Correction content]

FIG. 5 is a view (A to F ) showing various shapes of a probe protection tube that is packaged on a fiber probe.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Yoshihide Okagami 680 Higashihamanancho, Fushimi-ku, Kyoto City Morita Manufacturing Co., Ltd. (72) Akira Yuba 680 Higashihamanancho, Fushimi-ku, Kyoto City Morita Manufacturing Co., Ltd. (72) Inventor Sadahiro Nakajima 2-7-5 Nakaochiai, Shinjuku-ku, Tokyo Within Hoya Co., Ltd. (72) Inventor Naoshi Endo 2-7-5 Nakaochiai, Shinjuku-ku, Tokyo Within Hoya Co., Ltd.

Claims (11)

[Claims] 1. A light guide fiber for guiding a laser beam emitted from a laser light source, a probe for guiding the laser beam guided by the fiber to an irradiation target, at least two independent air supply paths, and at least A laser medical device comprising a laser handpiece formed by connecting one water supply channel, wherein the laser handpiece has an emission end of the above-mentioned light guide fiber and an incidence end of a probe through a light guide shield plate. The light guide fiber built-in portion is made airtight by air-tightly separating, the emission end of the light guide fiber is cooled by the dry gas supplied from the first air supply passage, and the probe supplied by the gas supplied from the second air supply passage. A laser medical device characterized in that an incident end is cooled and water supplied from a water supply passage is ejected from around a tip portion of a probe. 2. The dry gas, which has cooled the exit end of the light guide fiber, flows backward in the light guide fiber built-in portion and is discharged to the outside of the handpiece at a place separated from the exit end of the light guide fiber. The laser medical device according to claim 1. 3. The laser medical device according to claim 1, wherein the light guide fiber is a fluoride fiber. 4. A probe protection tube in which a proximal end portion of a probe protection tube is detachably attached to the front part of the main body of the handpiece so as to be able to pass water through the water supply channel, and the probe is inserted therethrough. The water passage for supplying water to the tip of the probe with a gap between the inner surface of the probe and the outer surface of the probe.
The laser medical device described. 5. The laser medical device according to claim 1, wherein the probe is a fiber probe whose front side is reduced in diameter or whose front side is expanded and whose emission end face is orthogonal or oblique to the fiber axis. 6. The laser medical device according to claim 4, wherein the probe protection tube is a straight, tapering or curved metal tube or a synthetic resin tube. 7. The laser medical device according to claim 4, wherein the tip of the probe protection tube is formed by a cut surface obliquely intersecting the tube axis. 8. The laser medical device according to claim 4, wherein a projection piece having a mirror surface on the tube axis side is provided on the tip of the probe protection tube so as to be inclined toward the tube axis side. 9. The laser medical device according to claim 4, wherein the tip of the probe protection tube is flat. 10. The laser source is a laser generator for generating an Er: YAG solid state laser, the light guide fiber is a fluoride fiber, and the laser treatment apparatus adjusts a laser output of the laser generator. The laser medical apparatus for dental treatment according to claim 1 or 4, further comprising laser control means for performing the treatment. 11. The diameter of the tip of the probe is 50 to 60.
0 μm, and the laser irradiation output of the probe tip is pulse width 150 to 300 μm by the laser control means.
s, pulse period 1 to 30 pps, maximum 1 per pulse
The laser medical device for dental treatment according to claim 10, wherein the laser medical device is adjustable in the range of J.