超声是诊断和治疗应用的有效工具。作为成像工具,超声主要用于实时无创诊断成像。当超声波在材料中传播时,当遇到声阻抗的失配时,产生反射的射频(RF)信号。虽然传统上公认的诊断成像能力,超声的应用已经扩大到包括治疗干预措施,最值得注意的是低强度脉冲超声(LIPUS)的形式。低强度脉冲超声(LIPUS)是一种通过高频声压波经皮传输的机械能。LIPUS的强度(30mW/cm2)在用于诊断目的的超声强度范围内(1-50mW/cm2),被视为非热,非破坏性的,渗透活组织并在细胞水平引发一系列生化反应。LIPUS器件可产生200µs的1.5MHz声波正弦波,以1kHz的调制频率重复,并提供30mW/cm2的峰值压力。低强度脉冲超声(LIPUS)形成了除了电刺激(脉冲电磁场,PEMF)。这种方式已被用来加强药物输送,加速损伤恢复,改善肌肉活动能力,缓解关节僵硬和肌肉疼痛,增强骨折愈合。尽管LIPUS已被各种医学学科所接受,它融入标准牙科实践仍处于起步阶段,标志着一个未探索的前沿,具有潜在的变革意义。低强度脉冲超声(LIPUS)已成为各种牙科手术中一种有吸引力的辅助疗法,如正畸治疗和上颌窦增强。它的吸引力在于其简单性和非侵入性,将LIPUS定位为临床创新的有希望的途径。一个特别感兴趣的领域是正畸诱导的炎性牙根吸收(OIIRR),正畸干预通常不可避免的结果,导致根结构的永久损失。值得注意的是,OIIRR是第二种最常见的根吸收形式(RR),仅超过与牙髓感染相关的根吸收。鉴于OIIRR的高患病率和潜在的长期后果,这篇文献综述旨在评估LIPUS作为一种治疗方法的疗效,重点是评估其将OIIRR的严重程度降低到临床意义水平的能力。为了进行系统的审查,在多个数据库中执行全面的自动文献检索,包括MEDLINE,Embase,PsycINFO,WebofKnowledge,Scopus,CINAHL,LILACS,SciELO,科克伦,PubMed,试验登记处,3ie,谷歌学者。采用了正向和反向引文跟踪,涵盖从数据库开始到2009年1月至2023年4月发表的研究。该综述集中于随机对照试验(RCT),该试验专门评估了低强度脉冲超声治疗对正畸引起的炎性牙根吸收(OIIRR)的影响。不受发布日期的限制。采用了严格的选择标准,仅纳入具有高水平统计学意义的研究.最终,14项研究符合纳入标准,接受进一步分析.纳入的随机对照试验(RCTs)的总体质量采用建议评估分级进行严格评估。发展,和评估(等级)方法。此分析揭示了某些方法上的局限性,这在从现有证据中得出明确结论方面提出了挑战。尽管有这些限制,这篇综述提供了宝贵的见解,可以为未来的研究提供信息和指导。具体来说,它描述了针对目标人群的建议,必要的干预措施,适当的结果措施,合适的研究设计,和必要的基础设施,以促进进一步的调查。这些见解的综合旨在加强低强度脉冲超声治疗在牙科领域的发展和应用,从而有助于改善患者的预后。
Ultrasound is an effective tool for both diagnostic and therapeutic applications. As an imaging tool, ultrasound has mostly been used for real-time noninvasive diagnostic imaging. As ultrasound propagates through a material, a reflected radio-frequency (RF) signal is generated when encountering a mismatch in acoustic impedance. While traditionally recognized for its diagnostic imaging capabilities, the application of ultrasound has broadened to encompass therapeutic interventions, most notably in the form of Low-Intensity Pulsed Ultrasound (LIPUS). Low-Intensity Pulsed Ultrasound (LIPUS) is a form of mechanical energy transmitted transcutaneously by high-frequency acoustic pressure waves. The intensity of LIPUS (30 mW/cm2) is within the range of ultrasound intensities used for diagnostic purposes (1-50 mW/cm2) and is regarded as non-thermal, non-destructive, permeating living tissues and triggering a cascade of biochemical responses at the cellular level. The LIPUS device produces a 200 µs burst of 1.5 MHz acoustic sine waves, that repeats at a modulation frequency of 1 kHz and provides a peak pressure of 30 mW/cm2. Low-intensity pulsed ultrasound (LIPUS) forms one of the currently available non-invasive healing-enhancing devices besides electro-stimulation (pulsed electro-magnetic field, PEMF). This modality has been leveraged to enhance drug delivery, expedite injury recovery, improve muscle mobility, alleviate joint stiffness and muscle pain, and enhance bone fracture healing. Although LIPUS has been embraced within various medical disciplines, its integration into standard dental practices is still in its nascent stages, signifying an unexplored frontier with potentially transformative implications. Low-intensity pulsed ultrasound (LIPUS) has emerged as an attractive adjuvant therapy in various dental procedures, such as orthodontic treatment and maxillary sinus augmentation. Its appeal lies in its simplicity and non-invasive nature, positioning LIPUS as a promising avenue for clinical innovation. One particular area of interest is orthodontically induced inflammatory root resorption (OIIRR), an oftenunavoidable outcome of the orthodontic intervention, resulting in the permanent loss of root structure. Notably, OIIRR is the second most common form of root resorption (RR), surpassed only by root resorption related to pulpal infection. Given the high prevalence and potential long-term consequences of OIIRR, this literature
review seeks to evaluate the efficacy of LIPUS as a therapeutic approach, with an emphasis on assessing its capacity to reduce the severity of OIIRR to a level of clinical significance. To conduct this systematic
review, a comprehensive automated literature search was executed across multiple databases, including MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, SciELO, Cochrane, PubMed, trials registries, 3ie, and Google Scholar. Both forward and backward citation tracking was employed, encompassing studies published from database inception through January 2009 to April 2023. The
review focused on randomized controlled trials (RCTs) that specifically evaluated the effects of low-intensity pulsed ultrasound therapy on orthodontically induced inflammatory root resorption (OIIRR), without restrictions of publication date. A stringent selection criterion was applied, and only studies demonstrating high levels of statistical significance were included. Ultimately, fourteen studies met the inclusion criteria and were subjected to further analysis. The overall quality of the included randomized controlled trials (RCTs) was rigorously assessed utilizing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. This analysis revealed certain methodological limitations that posed challenges in drawing definitive conclusions from the available evidence. Despite these constraints, the
review offers invaluable insights that can inform and guide future research. Specifically, it delineates recommendations for targeted populations, necessary interventions, appropriate outcome measures, suitable study designs, and essential infrastructure to facilitate further investigations. The synthesis of these insights aims to enhance the development and application of low-intensity pulsed ultrasound therapy within the field of dentistry, thereby contributing to improved patient outcomes.