ISSN eissn Review Article Laser therapy in peri-implantitis treatment: literature r

Size: px

Start display at page:

Download "ISSN eissn Review Article Laser therapy in peri-implantitis treatment: literature r"

해진 설
5 years ago
Views:

1 ISSN eissn Review Article Kyung-Joong Lee 1, Jong-Ho Lee 2, Kee-Yeon Kum 3, Young-Jun Lim 1 * 1 Department of Prosthodontics 2 Department of Oral and Maxillofacial Surgery, 3 Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea Peri-implantitis is the most common reason for a late failure and can occur even after years of successful osseointegration. The role of microbial plaque accumulation in the development of peri-implantitis has been well documented. On the other hand, the ideal method of implant surface decontamination to re-establish the health of peri-implant tissue remains to be determined. Removal of bacterial deposits is essential in the treatment of peri-implant infections, and various therapeutic approaches have been described in the literature, including mechanical debridement, disinfection with chemotherapeutic agents, and laser therapy. Recently, there has been a plenitude of scientific data regarding the use of laser irradiation to achieve titanium surface decontamination. Thus, research is focusing on lasers potential use in the treatment of peri-implantitis. The aim of this literature review is to analyze and evaluate the efficacy of laser therapy for the treatment of peri-implantitis. (J Dent Rehabil Appl Sci 2015;31(4):340-8) Key words: dental implant; peri-implantitis; laser therapy; debridement 서론 기계식절삭장치는과거 100여년간치과영역에서널리이용되어왔다. 점진적연구개발을통해장치는더작아지고절삭효율은증가해왔다. 그러나핸드피스또는초음파스케일러에서발생하는진동과소음, 이로부터환자가느끼게되는공포는아직도해결되지못한과제로남아있다. 1 레이저는이러한기계식접촉장치를대체하는수단으로주목을받아왔다. 레이저는기계식절삭장치와는달리조직에마멸, 지혈및정화 (detoxification) 효과가복합적으로작용한다. 또한정확한절개및주변조직에대한최소한의손상발생으로인해술후통증이적고회복이빠른장점이있는 것으로알려졌다. 소음과진동이미비하여환자의심리적편안함을증진시키는효과도있다. 1 레이저가치과임상에활용되었던초기에는연조직을자르거나지혈을시키는등주로연조직술식에사용되었으나치주질환의처치, 치수처치, 근첨부질환의치료와치아우식증의치료에레이저의사용은불가능하였다. 직경이적은광섬유의개발로레이저의구강내전달이가능하게되어현재는 pulsed Nd:YAG, Argon, Holmium, diode, Er:YAG, Er:YSGG 및 CO 2 레이저가치과임상에광범위하게사용되고있다. 각종레이저의임상응용을살펴보면 Er :YAG, Er:YSGG 레이저는치아우식증등의경조직처치에주로사용하며, 부가적으로연조직처치에사용되고있으 *Correspondence to: Young-Jun Lim Professor, Department of Prosthodontics, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea Tel: , Fax: , limdds@snu.ac.kr Received: June 16, 2015/Last Revision: September 10, 2015/Accepted: December 5, 2015 Copyright 2015 The Korean Academy of Stomatognathic Function and Occlusion. cc It is identical to Creative Commons Non-Commercial License. 340

2 나지혈효과가떨어지는단점을가지고있다. 연조직술식을위해확실한조직의제거가요구되는경우에는 diode, CO 2 레이저가사용되나광범위한열손상이일어날가능성이있으므로주의하여사용해야한다. 최근에는임플란트영역의레이저사용에대한연구가활발하게이루어지고있다. 임플란트영역에서사용가능한이상적인레이저는주위조직에열손상을최소로하고혈관을응고시켜정확한시술을가능케하며임플란트주위염치료시육아조직을정확히제거할수있어야한다. 비록치과임플란트가치아를상실한경우취할수있는성공적인치료옵션이지만실패또한발생한다. 2 임플란트주위염은임플란트의후기실패의원인으로가장높은비율을차지한다. 3,4 임플란트주위염은미생물감염에의한염증성질환으로임플란트를지지하는골의소실을동반하며임플란트주위의미생물의침착으로인한염증반응이주요병인으로알려져있다. 5,6 임플란트표면에형성된세균막에대한숙주반응은초기에연조직에대한염증반응으로나타나고진행되며적절히처치되지않을경우임플란트주위골의진행적인파괴를가져온다. 여러연구들을통해미생물침착이임플란트주위염에미치는영향이보고된바있으며세균막의제거는임플란트주위염의치료시필수조건이된다. 그에반해오염된임플란트표면을정화하여임플란트주위조직의건강을회복하는이상적인방법에대해서는아직명확한기준이확립되지않았다. 7 임플란트주위의미생물침착을제거하는방법으로티타늄보다단단하지않은플라스틱큐렛등을사용하는물리적제거 (mechanical debridement) 와함께보조적인화학적방법으로항생제의국소또는전신투여가시행되고, chlorhexidine과같은국소살균제에의한세정등이사용되어왔다. 8,9 또한오염된임플란트표면정화에 air-abrasive device가사용되고있다. 최근에, 여러연구들을통해티타늄임플란트에레이저를사용하여표면을살균, 정화시키는방법에대한실험이많이보고되고있으며, 임플란트주위염치료에있어서레이저조사의잠재적인효과가주목을받고있다 생체외연구에서 Er:YAG, CO 2, diode 레이저조사시티타늄표면의세균이높은비율로제거된결과가보고되었다. 10 또한 CO 2, diode 레이저는조사시티타늄표면의변화를야기하지않는다는결과도보고되었다. 11,12 또한적절한조건으로조사시 Er:YAG 레이저또한티타늄표면의변화를야기하지않으면서표면미 생물의제거에효과적이라는연구도발표되었다. 11,12 그럼에도불구하고, 임상에서임플란트주위염치료에레이저를사용하는것에대해아직신중한입장을보이고있다. 레이저장치에대한초기비용부담이발생하는것은차치하더라도임플란트주위염의치료에있어서레이저의사용이비교적최근에야도입된방법이라이론적근거가부족하다고판단하기때문이라고보인다. 또한다양한레이저중어떤레이저가임플란트주위염치료에효과적이며, 레이저사용시조사조건에대한기준이임상가들에게낯설기때문이라고생각된다. 본논문에서는임플란트주위염의치료에있어서레이저가갖는효과에대한최근연구결과를살펴보고자한다. 본론 임플란트주위염을치료하는이상적인프로토콜에대한합의는아직없지만플라스틱큐렛등을이용해서오염된조직을제거하는것이추천되어왔다. 13 그러나이러한기계적제거방법만으로는임플란트표면으로부터세균과오염된산물을완전히제거하기어렵다. 14 기계적제거외에화학적제제나항생제투여등을병행하는보조적치료요법이추천되기도하지만그효과가미비하거나항생제내성등의부작용에대한우려가있어왔다. 15 따라서레이저를이용해오염물을제거하고임플란트표면을정화하는요법이주목을받고있다. 임플란트주위염에이환된임플란트의표면을레이저조사를통해치료하기위해서는오염된임플란트표면을효과적으로정화함과동시에임플란트표면의변화를일으키지않아야한다. Kreisler 등은 Nd:YAG, Ho:YAG, Er:YAG, CO 2 레이저를티타늄임플란트표면에조사하였을때표면변화양상비교를통해 Nd:YAG와 Ho:YAG는레이저출력에상관없이표면변화를유발하여임플란트주위염치료에적합하지않다고하였다. 16 Romanos 등또한 Nd:YAG, diode 레이저조사시임플란트표면의변화를관찰한결과 Nd:YAG 레이저는출력에상관없이임플란트표면변화를야기하여적합하지않다고하였다. 17 따라서치과영역에주로사용되는레이저중 Er:YAG, CO 2, diode 레이저사용시임플란트주위염치료효과및임플란트표면, 임플란트주위조직에미치는영향에관한연구를살펴보고자한다. J Dent Rehabil Appl Sci 2015;31(4):

3 Lee KJ, Lee JH, Kum KY, Lim YJ 1. 임플란트주위염치료에 Er:YAG 레이저적용치과영역에서주로사용되는 Er:YAG 레이저의파장은 2.94 um로수분에대한흡수도가매우높다. 일반적으로수분에대한흡수도가높을수록주변조직의불필요한손상이적다. 임플란트주위염의치료가효과적으로이뤄지기위해서는오염된임플란트표면의정화뿐만아니라임플란트주위에형성되어있는육아조직의제거가동반되어야한다. 치과영역에서사용되는레이저들중 Er:YAG 는임플란트주위조직의열손상을유발하지않으면서육아조직제거와임플란트표면정화를함께이룰수있는특징을가진다. 일부연구에서적절한에너지세팅으로 Er:YAG 레이저를조사하였을때티타늄표면에변화가없었다. 18,19 Matsuyama 등은임플란트표면에조사조건을달리하여 Er:YAG 레이저를조사한후표면변화, 온도상승여부에대해실험한결과 50 mj/pulse 이하에서임플란트표면의형태학적변화는관찰되지않았고온도상승도최소로관찰되었다. 18 그러나 Er:YAG 레이저를 100 mj/ pulse 이상의높은에너지로조사하였을때는티타늄표면에현저한변화가관찰되었으므로주의가필요하다. 18 Schwarz 등은 100 mj/pulse, 10 Hz로 Er:YAG 레이저를조사하였을때임플란트표면의조골세포의부착율은영향을받지않는다는결과를얻었다. 19 또한 Er:YAG 레이저는임플란트표면에부착된치태및치석의제거에효과적이라는연구도있었으며, 18,20 일반적인물리적정화방법에비해높은살균력을보였다는연구결과도있었다. 20 Friedmann 등에의하면 P. gingivalis에오염된임플란트표면에서물리적제거법을시도한후임플란트표면에조골세포의부착이나타나지않은반면에 Er:YAG 레이저를처리한경우조골세포의부착이증가하였다고하였다. 21 Kreisler 등은생체내실험에서 Er:YAG 레이저를사용하였을때임플란트-골계면에온도상승은관찰되지않았다고하였다. 22 최근에이르러생체내에서임플란트주위염의비수술적접근에 Er:YAG 레이저를이용한연구가있었다 Schwarz 등은임플란트주위염의비수술적치료시실험군으로 Er:YAG 레이저를조사한경우와대조군으로플라스틱큐렛을사용하여물리적제거를한후 0.2% chlorhexidine을적용한방법을비교하여연구한결과를보고하였다. 23,24 결과를보면치료후 6개월시점까지 는두그룹에서치주낭깊이와결합조직부착소실에유의미한감소가나타났으나이러한감소가 12개월까지는유지되지못하였다고하였고, 실험군과대조군사이에차이는관찰되지않는다고하였다. 탐침시출혈의감소는두그룹에서유의미하게나타났으며, 두그룹중 Er:YAG 레이저를조사한경우가더효과적이라고하였다. Schwarz 등은또다른연구를통해임플란트주위염을비수술적접근법으로치료한후 24개월에조직병리검사를시행한결과여전히결합조직간질에만성염증세포가침윤되어있다는결과를얻었고따라서비수술적접근으로임플란트주위염을완전히치료할수없다고하였다. 25 Renvert 등은임플란트주위염의비수술적치료시실험군으로 Er:YAG 레이저를조사한경우와대조군으로 air-abrasive device를사용한방법을비교하여연구한결과를보고하였는데, 치료 6개월시점에서두그룹에서탐침시출혈의유의미한감소는관찰되었으나치주낭깊이의유의미한감소는관찰되지않았다고하였다. 26 임플란트주위염의수술적접근에 Er:YAG 레이저를이용한연구도있었다 Schwarz 등은동물실험을통해판막수술중임플란트표면에 Er:YAG 레이저를적용하였을때대부분의임상지표에서효과가있음을확인하였고기존의물리적방법에비해재골유착 (re-osseointegration) 을촉진한다고하였다. 27 또한오염된임플란트에실험군으로 Er:YAG 레이저를조사한경우와대조군으로플라스틱큐렛을사용하여물리적제거를한후멸균식염수를적용한방법을비교하여연구한결과를보고하였다. 치료후 12개월까지는두방법모두치주낭깊이의유의미한감소가관찰되었으나 24개월후에는대조군에서만치주낭깊이의유의미한감소가유지되었다. 결합조직부착소실와탐침시출혈은두그룹에서치료후 12 개월시점까지유의미한감소가관찰되었고그이후에는감소정도가유의미하지않았다. 28 Takasaki 등은개에서임플란트주위염치료에 Er:YAG 레이저를조사한연구를통해육아조직제거와임플란트표면정화에 Er:YAG 레이저가물리적정화법에비해좀더효과적이고안전하다고하였다. 29 또한치료 24주후에조직시편관찰결과 Er:YAG 레이저를적용한경우물리적방법에비해새로형성된골이더임플란트표면상방까지위치해있음을통해 Er:YAG 레이저조사시새골형성이저해되지않으며레이저조사된임플란트표면의생 342 J Dent Rehabil Appl Sci 2015;31(4):340-8

4 체적합성은증가한다고하였다. 2. 임플란트주위염치료에 CO 2 레이저적용치과영역에서주로사용되는 CO 2 레이저는 10.6 um 의파장을가지며, 진동파혹은연속파모드로사용가능하다. CO 2 레이저를임플란트표면에조사하였을때, 표면의형태학적변화가관찰되지않았다는연구가있었다. 11,12 또한 CO 2 레이저사용시티타늄표면의조골세포의부착에영향을미치지않는것으로나타나서임플란트표면의정화에사용되고있다. 30,31 CO 2 레이저는안전하며오염된임플란트표면에조사시골재생을촉진시킨다는결과도보고되었다. 32 CO 2 레이저를임플란트에적용할때, 임플란트-골계면의온도상승정도를확인하기위한여러연구가있었다. Ganz은레이저출력과시간을달리하여임플란트에조사하였을때온도변화에대해조사한결과연속파모드로 2, 4 W의레이저를 4초까지조사하였을때온도상승이 7 를넘지않는정도로작다고하였다. 33 그러나높은출력으로 CO 2 레이저를적용하였을때티타늄임플란트표면의온도가유의미하게상승할위험성이있다는연구결과가있어주의가필요하다. 34,35,36 Kreisler 등은임플란트표면에레이저조사조건을달리하여임플란트-골계면의온도상승을관찰한결과연속파모드로 1.0 W로 56초, 1.5 W로 35초, 2.5 W로 15초조사시임계온도인 47 C를넘어섰다고하였고, 34 Mouhyi 등은진동파모드로 output power, pulse width, pulse repetition rate, irradiation period를달리하여임플란트표면에조사한후온도변화를관찰하였는데 8 W/10 ms/20 hz 로 5초동안조사하였을때온도상승이 3 C 미만으로나타나온도상승에대한위험을줄일수있다고하였다. 35 Oyster 등은임플란트표면에출력과조사시간을달리하여임플란트-골계면의상부와하부에서온도변화를살펴보는실험을하였는데조사조건에따라임플란트-골계면의상부에서는 C, 하부에서는 C의온도상승이관찰됨을통해레이저의조사조건에따라온도상승정도가달라지므로주의해야한다고하였다. 37 사람을대상으로레이저를이용한표면정화와골이식을통해임플란트주위염을치료한연구들이있다. Deppe 등은오염된임플란트표면에 CO 2 레이저를조 사한그룹과일반적인방법으로치료한그룹으로나누어표면정화및골이식후결과를비교하였다. 38 치료 4 개월후에레이저치료후골이식한그룹에서임플란트- 골결합및임상지표들의향상이관찰되었으나결과가장기간유지되진않았다. 따라서저자는임플란트주위염치료에있어서단기간동안에는레이저를사용한그룹에서더좋은결과를보이나시간이지난후두그룹간에차이는관찰되지않는다고하였다. 또한치료후 4 개의임플란트에서만성염증으로인해임플란트의실패로이어졌다고보고하였다. Romanos와 Nentwig는임플란트주위염치료에있어서레이저조사와골이식을동반한치료시치주낭깊이, 탐침시출혈, 결합조직부착소실이감소된것을통해임플란트주위염치료시레이저치료와골이식을동반한치료는효과적이라고하였다 임플란트주위염치료에 diode 레이저적용가장일반적으로사용되는 diode 레이저는 galliumaluminum-arsenide (GaAlAs) 레이저 (810 nm) 와 indiumgallium-arsenide-phosphide (InGaAsP) 레이저 (980 nm) 이며 diode 레이저는연속파혹은진동파모드로사용가능하다. 40 Diode 레이저는물에흡수가적게되므로조직으로의침투율이높아조사되는부분과그주변에온도상승을유발할위험이있다. Kreisler 등에의하면 GaAlAs 레이저를조건을달리하여임플란트표면에조사한결과 1.0 W로 30.5초, 1.5 W로 18.0초, 2.0 W로 12.5초, 2.5 W로 9초, 조사시임계온도인 47 C를넘어섰다고하였고, 이결과를통해임플란트주위염치료시 GaAlAs 레이저의조사시간과출력을제한하여야임플란트주위골의온도상승에따른손상을막을수있다고하였다. 41 Diode 레이저조사시임플란트표면손상가능성에대해서 Kreisler 등은 GaAIAs 레이저를사용하여 7 W (50 Hz; 26.6 J cm 2 ) 의출력으로까지조사하였을때임플란트표면손상이관찰되지않았으며, 16 Castro 등의연구에서도유사한결과를보였다. 42 일부연구에서는 diode 레이저를이용한치료가 chlorhexidine을동반한물리적정화법에비해임플란트주위염에덜효과적이라고나타났다. 43 또한 Schar 등은 660 nm, 100 mw의 diode 레이저와 phenothiazine chloride dye를조합하여임플란트주위염을비수술적방 J Dent Rehabil Appl Sci 2015;31(4):

5 Lee KJ, Lee JH, Kum KY, Lim YJ 법으로치료하였다. 44 Minocycline을임플란트주위열구에적용한대조군과비교하였을때, 임상지표에서두그룹간의유의미한차이는없었으며, 두방법모두임플란트주위염의완전한치료가이루어지지않았다고하였다. 결론 레이저를이용한임플란트표면오염정화방식은큐렛, 초음파스케일러와같은기계적정화방식을대체할유력한후보임이분명하다. 상용화된레이저장치가임플란트주위염치료를위해사용되고있음에도불구하고, 아직그임상적효능에대해서는의견이분분하다. 최근에발표된문헌고찰연구를통해레이저의치료효과에대해살펴본결과, 신뢰할만한무작위비교연구의수가극히미비함을알수있었다. 이전의여러연구에의해서밝혀졌듯이임플란트주위염의치료에있어서는비수술적방법은제한된효과를보이며임상적으로적절한치료결과를얻기위해서는수술적접근이필요할것으로보인다. 수술적접근을통한레이저의사용은비수술적접근시와비교해봤을때치주낭깊이, 결합조직부착소실등의임상지표의감소가적어도 2배정도차이가났다그러나몇몇연구에서 레이저치료후치료효과가장기간유지되지않는다고하였으며, 28,38 Er:YAG 레이저의효과에대한메타분석결과 Er:YAG 레이저적용후치주낭깊이와결합조직부착소실감소가통계적으로유의미하지않은것으로나타났다 (Fig. 1, 2). 45 또한임플란트주위염치료에물리적정화방법에비해레이저적용법이더효과적인지에대해서는의견이분분한상황이다. 레이저를이용한임플란트주위염의치료시이와같은한계를극복하기위해서는향후더많은연구가필요할것으로보인다. 일반적으로임플란트주위염치료에레이저를적용한대부분의연구에서레이저적용모드, 레이저출력, 임플란트표면에대한레이저적용시간, 광섬유의직경, 진동의주기등에대해확실하게명시하지않고있다. 같은파장의레이저라도적용하는조건에따라임플란트표면의손상이나온도상승등의부작용을일으킬가능성이있기때문에이러한정보들이중요하다. 따라서임플란트주위염의치료에있어서일반적인방법과대비하여레이저치료의효과를알아보는연구도중요하지만레이저적용시부작용을줄이면서효과를극대화시킬수있는적절한조건을제시하는연구또한앞으로더욱필요하다고생각된다. Test Control Mean Difference Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI Non-surgical CAL Schwarz % 0.10 (-0.78 to 0.98) Schwarz % 0.16 (-0.43 to 0.76) Subtotal (95% CI) % 0.14 (-0.35 to 0.64) Heterogeneity: χ 2 = 0.01, df = 1 (P = 0.90): I 2 = 0% Test for overall effect: Z = 0.58 (P = 0.56) Surgical CAL Schwarz % (-1.63 to 0.23) Subtotal (95% CI) % (-1.63 to 0.23) Heterogeneity: Not applicable Test for overall effect: Z = 1.47 (P = 0.14) Total (95% CI) % (-0.47 to 0.40) Heterogeneity: χ 2 = 2.49, df = 2 (P = 0.29): I 2 = 20% Test for overall effect: Z = 0.18 (P = 0.86) Test for subgroup difference: χ 2 = 2.47, df = 1 (P = 0.12): I 2 = 59.6% Favors (control) Favors (teat) Fig. 1. Forest plot for selected studies reporting CAL changes after 6 months of treatment. Weighted mean differences were estimated by a fixed-effects model. Mean difference > 0 indicates better treatment effect in the laser group than the control group. CAL, clinical attachment level; SD, standard deviation; CI, confidence Interval; df, degrees of freedom. 344 J Dent Rehabil Appl Sci 2015;31(4):340-8

6 Test Control Mean Difference Mean Difference Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI Non-surgical PD Renvert % (-0.39 to 0.19) Schwarz % 0.10 (-0.85 to 1.05) Schwarz % 0.33 (-0.25 to 0.91) Subtotal (95% CI) % (-0.26 to 0.25) Heterogeneity: χ 2 = 1.72, df = 2 (P = 0.42): I 2 = 0% Test for overall effect: Z = 0.03 (P = 0.97) Surgical PD Schwarz % (-1.67 to 0.27) Subtotal (95% CI) % (-1.67 to 0.27) Heterogeneity: Not applicable Test for overall effect: Z = 1.42 (P = 0.16) Total (95% CI) % (-0.29 to 0.20) Heterogeneity: χ 2 = 3.58, df = 3 (P = 0.31): I 2 = 16% Test for overall effect: Z = 0.39 (P = 0.70) Test for subgroup difference: χ 2 = 1.86, df = 1 (P = 0.17): I 2 = 46.2% Favors (control) Favors (teat) Fig. 2. Forest plot for selected studies reporting PD changes after 6 months of treatment. Weighted mean differences were estimated by a fixed-effects model. Mean difference > 0 indicates better treatment effect in the laser group than the control group. PD, probing depth; SD, standard deviation; CI, confidence Interval; df, degrees of freedom. Acknowledgments 본연구는산업통상자원부의재원으로신성장동력 장비경쟁력강화사업의지원에의하여이루어진것임 ( ). ORCID Kyung-Joong Lee Jong-Ho Lee Kee-Yeon Kum Young-Jun Lim References 1. Ishikawa I, Aoki A, Takasaki AA, Mizutani K, Sasaki KM, Izumi Y. Application of lasers in periodontics: true innovation or myth? Periodontol ;50: Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10: Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29 Suppl 3: Atieh MA, Alsabeeha NH, Faggion CM Jr., Duncan WJ. The frequency of peri-implant diseases: a systematic review and meta-analysis. J Periodontol 2013;84: Lindhe J, Meyle J; Group D of European Workshop on Periodontology. Peri-implant diseases: consensus report of the sixth European workshop on Periodontology. J Clin Periodontol 2008;35 Suppl 8: Froum SJ, Rosen PS. A proposed classification for peri-implantitis. Int J Periodontics Restorative Dent 2012;32: Esposito M, Grusovin MG, Kakisis I, Coulthard P, Worthington HV. Interventions for replacing missing teeth: treatment of perimplantitis. Cochrane Database Syst Rev 2008;16:CD Kotsovilis S, Karoussis IK, Trianti M, Fourmousis I. Therapy of peri-implantitis: a systematic review. J J Dent Rehabil Appl Sci 2015;31(4):

7 Lee KJ, Lee JH, Kum KY, Lim YJ Clin Periodontol 2008;35: Ntrouka VI, Slot DE, Louropoulou A, Van der Weijden F. The effect of chemotherapeutic agents on contaminated titanium surfaces: a systematic review. Clin Oral Implants Res 2011;22: Tosun E, Tasar F, Strauss R, Kıvanc DG, Ungor C. Comparative evaluation of antimicrobial effects of Er:YAG, diode, and CO 2 lasers on titanium discs: an experimental study. J Oral Maxillofac Surg 2012;70: Stubinger S, Etter C, Miskiewicz M, Homann F, Saldamli B, Wieland M, Sader R. Surface alterations of polished and sandblasted and acidetched titanium implants after Er:YAG, carbon dioxide, and diode laser irradiation. Int J Oral Maxillofac Implants 2010;25: Park JH, Heo SJ, Koak JY, Kim SK, Han CH, Lee JH. Effects of laser irradiation on machined and anodized titanium disks. Int J Oral Maxillofac Implants 2012;27: Roos-Jansåker AM, Renvert S, Egelberg J. Treatment of peri-implant infections: a literature review. J Clin Periodontol 2003:30: Schwarz F, Sculean A, Romanos G, Herten M, Horn N, Scherbaum W, Becker J. Influence of different treatment approaches on the removal of early plaque biofilms and the viability of SAOS2 osteoblasts grown on titanium implants. Clin Oral Investig 2005:9: Schou S, Holmstrup P, Jørgensen T, Skovgaard LT, Stoltze K, Hjørting-Hansen E, Wenzel A. Implant surface preparation in the surgical treatment of experimental peri-implantitis with autogenous bone graft and eptfe membrane in cynomolgus monkeys. Clin Oral Implants Res 2003;14: Kreisler M, Götz H, Duschner H. Effect of Nd:YAG, Ho:YAG, Er:YAG, CO 2, and GaAIAs laser irradiation on surface properties of endosseous dental implants. Int J Oral Maxillofac Implants 2002;17: Romanos GE, Everts H, Nentwig GH. Effects of diode and Nd:YAG laser irradiation on titanium discs: a scanning electron microscope examination. J Periodontol 2000;71: Matsuyama T, Aoki A, Oda S, Yoneyama T, Ishikawa I. Effects of the Er:YAG laser irradiation on titanium implant materials and contaminated implant abutment surfaces. J Clin Laser Med Surg 2003;21: Schwarz F, Rothamel D, Sculean A, Georg T, Scherbaum W, Becker J. Effects of an Er:YAG laser and the vector ultrasonic system on the biocompatibility of titanium implants in cultures of human osteoblast-like cells. Clin Oral Implants Res 2003; 14: Schwarz F, Sculean A, Romanos G, Herten M, Horn N, Scherbaum W, Becker J. Influence of different treatment approaches on the removal of early plaque biofilms and the viability of SAOS2 osteoblasts grown on titanium implants. Clin Oral Investig 2005;9: Friedmann A, Antic L, Bernimoulin JP, Purucker P. In vitro attachment of osteoblasts on contaminated rough titanium surfaces treated by Er:YAG laser. J Biomed Mater Res A 2006;79: Kreisler M, Al Haj H, d Hoedt B. Temperature changes at the implant-bone interface during simulated surface decontamination with an Er:YAG laser. Int J Prosthodont 2002;15: Schwarz F, Bieling K, Bonsmann M, Latz T, Becker J. Nonsurgical treatment of moderate and advanced peri-implantitis lesions: a controlled clinical study. Clin Oral Investig 2006;10: Schwarz F, Sculean A, Rothamel D, Schwenzer K, Georg T, Becker J. Clinical evaluation of an Er:YAG laser for nonsurgical treatment of periimplantitis: a pilot study. Clin Oral Implants Res 2005;16: Schwarz F, Bieling K, Nuesry E, Sculean A, Becker J. Clinical and histological healing pattern of periimplantitis lesions following non-surgical treatment with an Er:YAG laser. Lasers Surg Med 2006;38: Renvert S, Lindahl C, Roos Jansåker AM, Persson GR. Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device: a randomized clinical trial. J Clin Periodontol 2011;38: Schwarz F, Jepsen S, Herten M, Sager M, Rothamel D, Becker J. Influence of different treatment approaches on non-submerged and submerged heal- 346 J Dent Rehabil Appl Sci 2015;31(4):340-8

8 ing of ligature induced peri-implantitis lesions: an experimental study in dogs. J Clin Periodontol 2006;33: Schwarz F, John G, Mainusch S, Sahm N, Becker J. Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report. J Clin Periodontol 2012;39: Takasaki AA, Aoki A, Mizutani K, Kikuchi S, Oda S, Ishikawa I. Er:YAG laser therapy for peri-implant infection: a histological study. Lasers Med Sci 2007; 22: Crespi R, Romanos GE, Cassinelli C, Gherlone E. Effects of Er:YAG laser and ultrasonic treatment on fibroblast attachment to root surfaces: an in vitro study. J Periodontol 2006;77: Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of carbon dioxide laser against bacteria-contaminated titanium implant and subsequent cellular adhesion to irradiated area. Lasers Surg Med 1998; 23: Stubinger S, Henke J, Donath K, Deppe H. Bone regeneration after peri-implant care with the CO 2 laser: a fluorescence microscopy study. Int J Oral Maxillofac Implants 2005;20: Ganz CH. Evaluation of the safety of the carbon dioxide laser used in conjunction with root form implants: a pilot study. J Prosthet Dent 1997;71: Kreisler M, Al Haj H, Götz H, Duschner H, d Hoedt B. Effect of simulated CO 2 and GaAlAs laser surface decontamination on temperature changes in Ti-plasma sprayed dental implants. Lasers Surg Med 2002;30: Mouhyi J, Sennerby L, Nammour S, Guillaume P, Van Reck J. Temperature increases during surface decontamination of titanium implants using CO 2 laser. Clin Oral Implants Res 1999;10: Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of carbon dioxide laser against bacteria-contaminated titanium implant and subsequent cellular adhesion to irradiated area. Lasers Surg Med 1998; 23: Oyster DK, Parker WB, Gher ME. CO 2 lasers and temperature changes of titanium implants. J Periodontol 1995;66: Deppe H, Horch HH, Neff A. Conventional versus CO 2 laser-assisted treatment of peri-implant defects with the concomitant use of pure-phase beta-tricalcium phosphate: a 5-year clinical report. Int J Oral Maxillofac Implants 2007;22: Romanos GE, Nentwig GH. Regenerative therapy of deep periimplant infrabony defects after CO 2 laser implant surface decontamination. Int J Periodontics Restorative Dent 2008;28: Schwarz F, Aoki A, Sculean A, Becker J. The impact of laser application on periodontal and peri-implant wound healing. Periodontol ;51: Kreisler M, Al Haj H, D Hoedt B. Temperature changes induced by 809-nm GaAlAs laser at the implant-bone interface during simulated surface decontamination. Clin Oral Implants Res 2003;14: Castro GL, Gallas M, Nũñez IR, Borrajo JL, Alvarez JC, Varela LG. Scanning electron microscopic analysis of diode laser-treated titanium implant surfaces. Photomed Laser Surg 2007;25: Kreisler M, Kohnen W, Marinello C, Schoof J, Langnau E, Jansen B, d Hoedt B. Antimicrobial efficacy of semiconductor laser irradiation on implant surfaces. Int J Oral Maxillofac Implants 2003; 18: Schar D, Ramseier CA, Eick S, Arweiler NB, Sculean A, Salvi GE. Anti-infective therapy of periimplantitis with adjunctive local drug delivery or photodynamic therapy: six-month outcomes of a prospective randomized clinical trial. Clin Oral Implants Res 2013;24: Kotsakis GA, Konstantinidis I, Karoussis IK, Ma X, Chu H. Systematic review and meta-analysis of the effect of various laser wavelengths in the treatment of peri-implantitis. J Periodontol 2014;85: J Dent Rehabil Appl Sci 2015;31(4):

9 Review Article 임플란트주위염처치에서레이저의이용 : 문헌고찰 이경중 1, 이종호 2, 금기연 3, 임영준 1 * 서울대학교치의학대학원및구강과학연구소 1 치과보철학교실, 2 구강악안면외과학교실, 3 치과보존학교실 임플란트주위염 (peri-implantitis) 은기능중인골유착임플란트주위의조직에서생기는사이트별감염성질환이며임플란트후기실패 (late failure) 의원인으로가장높은비율을차지한다. 여러연구들을통해미생물침착이임플란트주위염에미치는영향이보고된바있으며세균막의제거는임플란트주위염의치료시필수조건이된다. 최근에여러연구들을통해티타늄임플란트에레이저를사용하여표면을살균, 정화시키는방법에대한실험이많이보고되고있다. 본논문에서는임플란트주위염처치에있어레이저가갖는효능에대한최근연구결과들을문헌고찰을통해되짚어보고자한다. ( 구강회복응용과학지 2015;31(4):340-8) 주요어 : 치과임플란트 ; 임플란트주위염 ; 레이저치료 ; 세정 * 교신저자 : 임영준 (03080) 서울특별시종로구대학로 101 서울대학교치의학대학원치과보철학교실 Tel: Fax: limdds@snu.ac.kr 접수일 : 2015 년 6 월 16 일 수정일 : 2015 년 9 월 10 일 채택일 : 2015 년 12 월 5 일 348

ÀÌ½ÄÇÐÈ¸24±Ç2È£-2Â÷±³Á¤

ÀÌ½ÄÇÐÈ¸24±Ç2È£-2Â÷±³Á¤ 14 CO2, Er:YAG, Er,Cr:YSGG 레이저를임프란트표면에조사시표면성상의변화및열변화에관한연구 수원리빙웰치과의원 1), 리빙웰치과병원 2),3) 강만석 1), 김현철 2), 이장렬 3) Ⅰ. 서론임프란트실패의중요한원인인임프란트주위염은크게교합력, 치태세균이나치석의축적등과같은국소적요인과전신질환이나신체방어력의약화등과같은전신적요인에의해단독적또는복합적으로발생된다.