JP2007508065A - 新規なバイオフィルム標的化技術としての2次光放出の使用 - Google Patents
新規なバイオフィルム標的化技術としての2次光放出の使用 Download PDFInfo
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Abstract
Description
本発明は、生きているバイオフィルムを、ヒトの身体においてそれを根絶するための標的化および続く細菌熱溶解に関し、それは近赤外レーザー送達ファイバーの遠位端から、2次量子光放出または2次量子熱放出を利用する。
今日までにヒト口腔内において、300を超える細菌の異なる種(Moore W.E.、The Bacteria of Periodontal Diseases、Periodontol.2000)が、記載されている。殆どの細菌は、歯垢および歯肉下歯周ポケットまたはインプラント周辺ポケットで見出される。これらの歯肉下細菌は、歯周ポケットにおいて独特の生態学的ニッチを創造する正常な宿主防御システムと戦いそして阻害するように進化してきた。
歯周/インプラント周辺器具は、罹病歯周組織および罹病インプラント周辺組織のプラーク除去および歯石除去、ルートプレーニングならびにデブライドメントならびに除去という特定の目的のために、長年にわたり発明されおよび設計されてきた。特に歯周スケーリング、ルートプレーニングおよび掻爬器具は、歯垢、歯石、罹病セメント質および罹病ポケット軟組織を除去するための選択の機械的アプローチである。
歯肉下歯垢が生きているバイオフィルムとして存在するという認識は、研究中の深層メカニズム(Periodontology 2000(上記);およびChen、J.Calif.Dent.Assoc.(2001))をいくらか解明してきた。
Cimasoni、Monogr.Oral Sci.12:III〜VII、1〜152(1983)
本発明は、患者の健康な歯の構造および組織を害することなく生きたバイオフィルムを凝固し、細菌を熱的に殺す従来からの歯科用固体ダイオードレーザーおよびNd:YAGレーザーを用いる利用可能な当面の機会の治療窓を拡げる新規なアプローチおよび組成物(キットも含む)を提供する。
本発明は、近赤外ダイオードレーザーまたはNd:YAGレーザーの光ファイバーのチップが、歯周/インプラント周辺組織と接触すると直ちに炭化ホットチップになる場合、近赤外レーザー送達光ファイバーの遠位端で重要な事実に基づいた量子的相互作用が起こるという発見を活用する。これらの量子的および熱力学的現実性は、近赤外レーザーおよび本発明で使用する光ファイバーからの2次量子放出を使用して生きた標的化バイオフィルムの熱分解を達成するために利用される。
(1)パワー密度=(W/cm2)=レーザー出力パワー
ビーム面積(Diameter)(cm2)
従って、口腔内組織に、歯科用近赤外レーザー(透明なチップが上記組織に接触する前に)により送達される全光子エネルギーは、ジュールで測定され、以下のように計算される。
1度、上記チップがバイオフィルムまたは組織に接触し、白熱黒体放射体になれば、ほぼ70+%のレーザーの出力パワーが局部的な熱に変換され、もはや重要な単色光を放出しない(即ち、炭化チップはそれを吸収するため)し、そして全ての方向において連続的に分布している(連続スペクトル)波長の光を今や産生する。従って、「パワー密度」等式に利用可能な「スポットサイズ」は存在しない。この理由により、全エネルギー等式(2)が使用される。
本発明を例示するのに使用されるレーザーは、パワー出力が800mW〜1200mWの間で連続発振の駆動様式で、600μmのシリカレーザー送達ファイバーを用いた830nmのダイオードレーザーであった。生きたヒト患者(インビボ)は全て歯周疾患もしくはインプラント周辺疾患および/または能動的な感染の、ある進行状態を示した。以下に代表的な2人の患者のデータを紹介する。注目すべきは、過去24ヶ月の間に50の患者に、上記手順が実施された。この期間に、発色団メチレンブルーおよびトルイジンブルーの両方が使用され、特に歯周ポケットおよび歯周感染ならびにインプラント周辺ポケットおよびインプラント周辺感染に置いて所定のパラメータで本発明を使用したときに奏効した結果が、得られた。
(難治性の10mm歯周ポケットの処置)
通常の歯のクリーニングとスケーリングの後、上顎犬歯(歯6番)の顔面上の難治性10mmの歯周ポケットを有する健常な24歳を紹介する。侵襲性を最小にした手順で、その患者をキシロカインで麻酔し、歯周ポケットに、ポケットの容量に容易にはまる小さな剛毛のあるブラシを経由して0.1%MB溶液を注入した。上記MB溶液を約2分間空気中に放置して、次いで水の表面洗浄を適用した。
(感染インプラント周辺組織の処置)
感染チタンインプラントおよび感染物を***するフィステルを有する不安定型糖尿病を紹介する。X線写真で8mmの骨損失およびインプラントの真中半分のあたりに全般的な放射線透過性を細部にわたって示した。3種の異なる抗生物質療法は感染患者の治癒に失敗した。その領域を従来の台形型の弁で外科的に開け、感染およびバイオフィルムの影響を受けた領域を0.1%MB溶液(Vista Dental Products、Racine、WIにより販売されている)に約2分間浸漬した。その領域を、次いで大量の水で洗浄し上記標的化バイオフィルムを後において過剰の染色を洗い落とした。830nm歯科用ダイオードレーザーに接続した600nmのシリカファイバーを1200mWで活性化し、そのファイバーをバイオフィルムおよび血液生成物に接触させ、直ちに炭化した。そのファイバーを、炭化チップから発する2次量子放出で、その領域またはインプラント(1/2mm以内)の近傍で、1度に2秒間以上一方向に留まることが決してないように60〜90秒間、動かし回した。その領域を、その後プラスチック製インプラントスケーラーでスケーリングし、大量の水で洗浄し、縫合して閉じた。上記患者に500mgのアモキシリン(Ranbaxy Phamaceuticals、Jacksonville、FLで販売されている)を5日間療法として与えた。
Claims (21)
- 歯周疾患を有する患者の歯周組織またはインプラント周辺組織において歯周疾患を処置するためのキットであって、以下:
A.近位端と遠位端の間に伸びる光ファイバーであって、該近位端は、その上に入射される近赤外スペクトル範囲における光エネルギーを受取るのに適合し、該光ファイバーは受取った光エネルギーを該遠位端に伝達するのに適合し、該遠位端はその上に入射される伝達光エネルギーに応答し、少なくとも1部の組織と接触する際に、所定のスペクトル範囲の光エネルギーを放出するのに適合する光ファイバーであって、該所定のスペクトル範囲は近赤外スペクトル範囲とは異なる光ファイバー;
B.発色団色素を貯蔵するのに適合した容器であって、該色素は、該所定のスペクトル範囲での吸収スペクトルにより特性づけられ、該容器は、該組織の領域へ発色団色素の選択的適用を果たすのに適合したアプリケーターアセンブリを含む、容器
を含む、キット。 - 前記所定のスペクトル範囲が、約600nm〜約700nmである、請求項1に記載の方法。
- 前記光エネルギーが、約830nmの波長である、請求項2に記載のキット。
- 請求項1に記載のキットであって、近赤外スペクトルにおける光エネルギーを発生する光エネルギー源および光ファイバーの近位端に光エネルギーを結合する連係結合アセンブリをさらに含む、キット。
- 前記所定のスペクトル範囲が、約600nm〜約700nmである、請求項4に記載のキット。
- 前記発生する光エネルギーがコヒーレントである、請求項5に記載のキット。
- 前記光エネルギー源が約500〜1200mWで駆動するダイオードレーザーであって、約830nmの波長で光エネルギーを発生する、請求項6に記載のキット。
- 請求項1に記載のキットであって、前記発色団色素がメチレンブルー、トルイジンブルー、コンゴレッドおよびマラカイトグリーンからなる群より選択され、該色素は該容器に配置される、キット。
- 前記光ファイバーの前記遠位端が溶融シリカである、請求項1に記載のキット。
- 請求項1に記載のキットであって、前記遠位端から前記近位端へ伸びている前記光ファイバーの側面の表面が、その上に入射する光照射を生じ、光ファイバーの中を該遠位端から伝播し、該側面の表面を通して屈折し、通過するのに適合した、キット。
- 歯周疾患を有する患者の歯周組織またはインプラント周辺組織における歯周疾患の処置のための方法であって、以下:
発色団色素組成物を前記組織に適用する工程であって、該色素組成物は約600nm〜約700nm範囲の少なくとも1つの波長を含む光エネルギーを吸収する少なくとも1つの色素を含む、工程;および
光ファイバーから発する約800nm〜約1064nmの範囲の少なくとも1つの波長を含むレーザーエネルギーで、歯周組織またはインプラント周辺組織を照射する工程
を包含する、方法。 - 前記エネルギーがコヒーレントである、請求項11に記載の方法。
- 前記レーザーエネルギーが近赤外スペクトルに入り、かつコヒーレントである、請求項11に記載の方法。
- 前記レーザーエネルギーが500〜1200mWで駆動するダイオードレーザーにより発生する、請求項11に記載の方法。
- 前記レーザーエネルギーが830nmの波長を含む、請求項11に記載の方法。
- 前記色素組成物がメチレンブルー、トルイジンブルー、コンゴレッドおよびマラカイトグリーンからなる群より選択される、請求項11に記載の方法。
- 前記光ファイバーが少なくとも組織の一部と接触する、請求項11に記載の方法。
- 前記歯周組織または前記インプラント周辺組織を照射する工程が、移動パターンで治療的に有効な時間である、請求項11に記載の方法。
- 固体の凝塊が前記組織をレーザーエネルギーで照射する際に歯周組織またはインプラント周辺組織の近傍に形成される、請求項11に記載の方法。
- 前記組織から前記固体の凝塊を、従来の歯周スケーラーまたは超音波スケーラーにより機械的に除去する工程をさらに包含する、請求項18に記載の方法。
- 歯周疾患を有する患者に治療的に有効な量の抗生物質を投与する工程をさらに包含する、請求項17に記載の方法。
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AU2004279443A1 (en) | 2005-04-21 |
EP1718236A2 (en) | 2006-11-08 |
WO2005034790A2 (en) | 2005-04-21 |
EP1718236A4 (en) | 2009-06-17 |
US7621745B2 (en) | 2009-11-24 |
US20080058908A1 (en) | 2008-03-06 |
CA2542246A1 (en) | 2005-04-21 |
WO2005034790A3 (en) | 2006-06-22 |
CN1984619A (zh) | 2007-06-20 |
US20110070552A1 (en) | 2011-03-24 |
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