DEVICE FOR STERILIZING TREATMENTS, EQUIPMENT COMPRISING THE DEVICE AND RELATED METHOD

Abstract

The device (3) comprises a first duct (14) having a proximal end, associated with a hand-piece (5), and an open distal end (14A). The first duct (14) is in fluid communication with an inlet port (18) for a liquid containing scattering particles. The device (3) furthermore comprises a light guide (7) so arranged and configured as to convey a laser radiation coming from a laser source (11) near the open distal end (14A) of the first duct (14).

Claims

1. A medical equipment for tissue laser treatments, the medical equipment comprising: a device comprising a first duct having a proximal end, associated with a hand-piece, and an open distal end, the first duct communicating with an inlet port for a liquid containing scattering particles and configured to dispense liquid containing scattering particles in an area to be treated, the device further comprising a light guide arranged and configured to convey a laser radiation near or at the open distal end of the first duct; a laser source connectable to the light guide; a supply circuit that contains a liquid where the scattering particles are suspended, the scattering particles being configured to scatter a laser radiation emitted by the laser source and emitted by the light guide, said supply circuit being connectable to the first duct of the device.

2. Equipment according to claim 1, further comprising a source of a liquid, in which the scattering particles are suspended, the source being in fluid communication with the first duct.

3. Equipment according to claim 1, wherein the light guide is arranged inside the first duct and extends longitudinally along the first duct, up to a position adjacent to the open distal end of the first duct.

4. Equipment according to claim 1, wherein the light guide comprises at least one optical fiber.

5. Equipment according to claim 1, wherein the light guide comprises a connector for connection to a laser radiation source.

6. Equipment according to claim 1, wherein a cross section of the distal end of the first duct is approximately circular or approximately elliptical.

7. Equipment according to claim 1, wherein a position of the light guide with respect to the first duct is adjustable according to a longitudinal direction of the first duct.

8. Equipment according to claim 1, further comprising a second suction duct to remove liquid from a treated area, the second suction duct having an inlet arranged near the open distal end of the first duct.

9. Equipment according to claim 1, wherein at least one pump is arranged in the hand-piece to pump said liquid containing scattering particles.

10. Equipment according to claim 9, wherein said at least one pump is configured and arranged to pump liquid containing scattering particles into the first duct and to suck liquid containing scattering particles through a second suction duct.

11. Equipment according to claim 1, wherein the laser source emits laser radiation in a wavelength range comprised between about 700 nm and about 3000 nm.

12. Equipment according to claim 1, wherein parameters of the laser radiation scattered by the scattering particles are selected to have a sterilizing effect or a bio-stimulating effect.

13. A method for conveying a laser radiation towards a surface to be treated by means of said laser radiation, the method comprising the following steps: arranging a first duct, for supplying a liquid containing scattering particles, adjacent to said surface to be treated; arranging a light guide adjacent to said surface to be treated; supplying, through the first duct, the liquid containing scattering particles and wetting the surface to be treated with the liquid containing the scattering particles; emitting a laser beam by means of said light guide in a volume occupied by the liquid; distributing, through the scattering particles, the laser radiation on the surface wet by the liquid containing the scattering particles.

14. A method according to claim 13, further comprising the step of sucking liquid and scattering particles from said volume.

15. Equipment according to claim 2, wherein the light guide is arranged inside the first duct and extends longitudinally along the first duct, up to a position adjacent to the open distal end of the first duct.

16. Equipment according to claim 2, wherein the light guide comprises at least one optical fiber.

17. Equipment according to claim 3, wherein the light guide comprises at least one optical fiber.

18. Equipment according to claim 9, wherein a cross section of the distal end of the first duct is approximately circular or approximately elliptical, wherein said at least one pump is configured and arranged to pump liquid containing scattering particles into the first duct and to suck liquid containing scattering particles through a second suction duct.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0034] The invention will be better understood by following the description and the accompanying drawing, which shows non-limiting practical embodiments of the invention. More particularly, in the drawing:

[0035] FIG. 1 shows a schematic longitudinal cross section of a device according to the invention in a first embodiment;

[0036] FIGS. 2A and 2B show cross sections according to II-II of FIG. 1 in two different embodiments;

[0037] FIG. 3 shows a longitudinal cross section, similar to that of FIG. 1, of a further embodiment;

[0038] FIGS. 4 and 5 show longitudinal cross sections of further embodiments of the device; and

[0039] FIGS. 6 and 7 show modes of use of the device.

DETAILED DESCRIPTION OF EMBODIMENTS

[0040] The following detailed description of the exemplary embodiments refers to the accompanying drawings. The same reference numbers in different drawings identify the same or similar elements. Additionally, the drawings are not necessarily drawn to scale. Also, the following detailed description does not limit the invention. Instead, the scope of the invention is defined by the appended claims.

[0041] Reference throughout the specification to one embodiment or an embodiment or some embodiments means that the particular feature, structure or characteristic described in connection with an embodiment is included in at least one embodiment of the subject matter disclosed. Thus, the appearance of the phrase in one embodiment or in an embodiment or in some embodiments in various places throughout the specification is not necessarily referring to the same embodiment(s). Further, the particular features, structures or characteristics may be combined in any suitable manner in one or more embodiments.

[0042] Below, specific reference will be made to dental applications, but it should be understood that a device according to the invention can be also used for other medical or veterinary applications, where similar problems of bacterial proliferation occur in areas that are difficult to be accessed by means of usual light guides.

[0043] With initial reference to FIG. 1, number 1 schematically indicates an equipment according to the invention. Reference number 3 indicates a device for applying the laser radiation to a patient's organ or tissue. In the illustrated embodiment, the device 3 comprises a hand-piece or handle 5, to which a light guide, constituted by one or more optical fibers 7, arrives. Below, reference will be specifically made to an embodiment with only one optical fiber, but it should be understood that this configuration is only a non-limiting example.

[0044] The optical fiber 7 may be connected, for example through a connector 9, to a laser source 11 of the equipment 1, schematically shown only in FIG. 1. In the embodiment illustrated in FIG. 1, the end portion of the optical fiber 7 extends inside a first duct 14, the proximal end whereof is attached to the hand-piece 5 and the distal end 14A whereof is open. The distal end 7A of the optical fiber 7 may be arranged near the open distal end 14A of duct 14. In some embodiments, the position of the distal end 7A of the fiber may be adjusted with respect to the duct 14, so that the distal end may be positioned either exactly in correspondence of the open distal end 14A of the duct 14, or in a back position inside the duct 14, as illustrated in FIG. 1, or projecting outside the duct 14, for example by a length varying from some tenths of millimeter to some millimeters.

[0045] In some embodiments, the duct 14 may be connected to the hand-piece or handle 5 by means of a screw connection or the like, schematically indicated with 15, in order to allow the duct 14 to be removed and replaced. For hygienic reasons, the duct 14 may be a disposable duct, for example, or it may be removed through the connection 15 in order to be easily sterilized.

[0046] As schematically illustrated, for reasons that will be clearly apparent below, a gasket 17 separates the inside of the hand-piece 5 from the inside of the duct 14 by sealingly contacting the surface of optical fiber 7.

[0047] The duct 14 is in fluid connection with an inlet port 18, through which a liquid, for example a physiologic solution, may be supplied. The inlet port 18 may be provided where a side duct 19 is connected to the duct 14. In the schematic of FIG. 1, number 21 indicates a pump of equipment 1, pumping the liquid from a tank 23 to the side duct 19. The liquid pumped from the tank 23 to the side duct 19 flows along the duct 14 and exits from the open distal end 14A thereof. The gasket 17 prevents the liquid from flowing back towards the inside of the hand-piece 5 along the optical fiber 7.

[0048] The liquid flows through the free area between the optical fiber 7 and the inner wall of the duct 14, the cross section whereof may be of various shapes. FIGS. 2A and 2B show two alternative embodiments of the end part of duct 14. In FIG. 2A, the cross section of the duct 14 is substantially round, while in FIG. 2B it is substantially elliptical. In both cases, the optical fiber 7 may be arranged approximately at the center of the cross section of the duct and, if necessary, it may be kept in this position by means of suitable radial spacers, not shown. The shape of the cross section of the duct 14 may be variable, and several interchangeable ducts may be provided, for example for different applications. The shape of FIG. 2A is particularly useful for root canal treatment and for treating gingival fistulas or spaces between implant pins and bony tissue in case of pin detachment. Vice versa, the shape of FIG. 2B is useful for the treatment of gingival pockets or other applications, where the area to be treated can be better accessed by means of a flat device.

[0049] In the embodiment of FIG. 1, the duct 14 is rectilinear. In other embodiments, the duct 14 may be curved, as schematically shown in FIG. 3, where the same reference numbers indicate equal or equivalent parts to those described with reference to FIG. 1.

[0050] Similarly to FIG. 1, FIG. 4 shows a schematic of a different embodiment of an equipment according to the invention. The same reference numbers indicate the same or equivalent parts to those described with reference to FIG. 1, which will not be described again. In FIG. 4, the distal end 7A of the optical fiber 7 is shown in a position slightly projecting from the open distal end 14A of the duct 14. Differently from the embodiment of FIG. 1, in FIG. 4 the device 3 comprises a suction duct 31 that may be integral with duct 14 and may have an open distal end 31A arranged near the open distal end 14A of the duct 14. In the embodiment of FIG. 4, the open distal end 31A of the suction duct 31 is arranged slightly back with respect to the open distal end 14A of the duct 14. The suction duct 31 may be in fluid connection with a suction pump 33 that sucks the liquid through the suction duct 31 and conveys it to a collection tank 33, for purposes that will be better explained below.

[0051] With such an arrangement, the liquid supplied by the pump 21 through the duct 14 wets the area to be treated with the device 3 and is then removed from said area thanks to the suction effect of the suction duct 31.

[0052] FIG. 5 shows a modified embodiment of the device od FIG. 4. Equal numbers indicate equal or equivalent parts to those described above with reference to FIGS. 1 and 4. In the embodiment of FIG. 5, the suction duct 31 and the side duct 19 are associated with a single pump 34, for example a peristaltic pump. The pump 34 may be miniaturized and arranged inside the hand-piece 5. In other embodiments, the ducts 19 and 31 may project from the hand-piece 5 and be connected to a pump 34 arranged outside the hand-piece.

[0053] In some embodiments, the peristaltic pump 34 may comprise a single rotor acting on two flexible pipes extending around the rotor itself and forming part of the side duct 19 and of the suction duct 31 respectively. The rotor is schematically indicated in FIG. 5 with number 36, and the rotation direction thereof is indicated with f36. Thanks to the arrangement of the ducts 19 and 31, the rotation of the single rotor 36 causes the fresh liquid taken from the tank 23 to be pushed into the duct 14 and the exhausted liquid to be sucked through the open distal end 31A of the suction duct 31 and to be discharged into the collection tank 36.

[0054] FIG. 6 shows a mode of use of the device 3 for treating gingival pockets. D indicates a tooth, and G indicates the gum. T indicates a gingival pocket. The gingival pocket shall be treated to eliminate the microorganisms present on the tissues and to eliminate inflammations. The treatment substantially occurs as described below. The operator puts the distal end 14A of the duct 14 at the entrance of, or inside, the gingival pocket T. In this application, in order to facilitate the positioning of the distal end it is useful to use a device 3 wherein the cross section of the duct 14 is flat at least in the end area, as schematically indicated in FIG. 2B.

[0055] One or more control buttons may be provided on the hand-piece or handle 5 of device 3 to control the members of the equipment 1, in particular the laser source 11 and the pump(s) 21, 33, 34 according to the device configuration.

[0056] Alternatively, the controls, or part of them, may be given through a separate console, one or more pedals or other suitable interface devices or members, not shown.

[0057] When the open distal end 14A of the duct 14 has been positioned, the operator starts the treatment cycle. The liquid is dispensed through duct 14 and flows in the area to be treated, in this case the inside of the gingival pocket. The liquid may be any bio-compatible liquid, for example a physiologic solution, or distilled water.

[0058] The liquid contains a suspended scattering substance, for example in the form of powder. Powder means, in the present description, any form where the scattering substance is subdivided into particles that are sufficiently small to circulate in the area to be treated, carried by the liquid. The particles may be spherical, approximately spherical, or granular in shape, or they may even have the shape of flakes or any other shape ensuring the desired scattering effect.

[0059] In fact, the scattering substance has the function of scattering the laser beam the operator activates during treatment. The laser beam emitted by the source 11 is fired from the distal end 7A of the fiber and hits against the scattering particles suspended in the liquid. In fact, the liquid, flowing through the open distal end 14A of the duct 14, fills the volume of the area to be treated, that is, in the case of FIG. 6, the gingival pocket T.

[0060] In this way, the laser light is scattered by means of the scattering particles suspended in the liquid, and achieves the surrounding tissues, following a complex path, determined by the various reflections on the suspended particles, instead of a rectilinear one. In this way the laser radiation can also achieve non-visible areas of the cavity where the liquid is supplied.

[0061] The parameters of the laser radiation are selected to cause sterilization of the surfaces whereon the radiation impinges. In other words, the liquid, thanks to the scattering particles suspended therein, conveys the laser radiation, emitted by means of the fiber 7 and immersed in the liquid, onto all the surfaces wet by the liquid, also onto the surface portions that do not see the optical fiber, i.e. that are not on a rectilinear path of the laser beams exiting from the fiber.

[0062] The laser radiation may be so selected as to obtain not only tissue sterilization and elimination of the pathogen germs, but also bio-stimulation of the tissues. This is particularly useful and important in odonto-stomathology applications mentioned herein, as it allows a better recovery.

[0063] In use, the liquid with the suspended scattering particles starts to be pumped preferably before the laser irradiation, so that the laser beam is scattered from the very beginning and never achieves directly the surrounding tissues. This allows to treat the tissues with the laser not directly, but in a mediate manner through the powder substance suspended in the liquid.

[0064] When the device is of the type illustrated in FIG. 4 or 5, the liquid with the suspended particles is also sucked from the treated area, thus making the treatment more comfortable and less invasive for the patient. In fact, the liquid with the scattering particles is dispensed towards and gradually removed from the treated area, thus avoiding accumulations that are uncomfortable for the patient. Thanks to the suction of the exhausted liquid through the duct 31, i.e. of the liquid already sprayed on the treated area, it is possible to work also with high liquid flows without trouble for the patient. The liquid flow may be metered, for example in order to achieve a constant cooling of the treated area, that otherwise could overheat due to the effect of laser power supplied by the optical fiber 7, with consequent troubles for the patients or even damages to the tissues. The continuous or controlled supply of scattering liquid allows also washing and removal of material that detaches during the treatment. If a suction duct 31 is provided, the debris and residues detached from the structures wet by the liquid are accumulated together with the exhausted liquid and can be eliminated, for example by collecting them in single-use containers or tanks that can be sealed.

[0065] FIG. 7 illustrates a further use of the device in odonto-stomathology. The device is indicated again with reference number 3. In this example, the device 3 and the equipment 1 are used to treat root canals CR of a tooth D, for example following a devitalization due to a caries that seriously damaged the pulp cavity P. The open distal end 14A of the duct 14 is inserted in the pulp cavity P and in the root canal CR to be treated. The operator starts to supply the liquid containing the scattering particles and then, with a suitable delay, starts to supply the laser beam. The laser radiation achieves the whole surface wet by the liquid containing the scattering particles, even in areas that cannot be achieved by a direct laser beam.

[0066] In FIG. 7, the duct 14 is curved, as shown for instance in FIG. 2. In some embodiments, a kit of interchangeable ducts 14 may be provided, the ducts being different from one another in lengths, outer diameters and curvatures, in order to achieve the inside of root canals of different shape and (cross and/or longitudinal) dimensions.

[0067] In some embodiments, the duct 14 may be made of flexible material, so as to adapt to the shape of the root canal.

[0068] When a device 3 of the type described herein is used for the treatment of root canals CR, the treatment method can be as follows. The operator opens the tooth D accessing the pulp cavity P and partially or completely removes the soft tissues from the interior of the cavity by means of known mechanical systems. Lastly, the operator performs a final sterilization treatment by means of device 3. The circulation of liquid with the suspended scattering particles allows scattering the light, achieving the whole wet surface, to control the tooth temperature, and to remove any residues of tissue, blood or other debris inside the tooth.

[0069] The device 3 and the equipment 1 described above may be also used for other applications, such as the treatment of spaces between the implant pins and the surrounding bone when there are detachments between pin and bony tissue following infections, or the treatment of cavities due to abscesses, infected areas surrounding metal suture points or the like. In any cases, the device 3 with the hydraulic circuit supplying the liquid with the suspended scattering particles and with the laser source and the corresponding radiation conveying system, allows to disinfect or sterilize the tissues also in areas that cannot be accessed directly by means of the laser beam emitted by the optical fiber. Moreover, the laser radiation has a bio-stimulating effect on the tissues, facilitating or accelerating the recovery, for instance by promoting the proliferation of tissue that fills the empty space between bony tissue and pin in the case of implant pin detachment.

[0070] In some embodiments, the wavelengths of the laser source 11 usable in the equipment 1 described herein is comprised between about 700 and about 3000 micrometers.

[0071] The diameter of the optical fiber 7 or fiber bundle may be comprised between about 50 micrometers and about 1000 micrometers, and preferably between about 200 micrometers and about 400 micrometers.

[0072] In advantageous embodiments, the laser average power may be comprised between about 1 W and about 30 W, preferably between about 2 W and about 20 W.

[0073] The laser radiation may be a continuous radiation or a pulsed radiation. In the second case, the peak power may be comprised, for example, between 100 W and 10 kW, with impulsive waveforms, the duration whereof is comprised between about 20 nanoseconds and about 1000 microseconds, and repetition frequency which can be comprised between 1 kHz and 20 Hz.

[0074] The laser source may be, for example, a single source or a multiple source in the wavelength range between about 700 nm and about 3000 nm, suitable for continuous, pulsed or Q-switching emission, for example an Nd:YAG laser.

[0075] The scattering powder substance, suspended in the liquid, may be selected from the group consisting of hydroxylapatite, or other bio-compatible powder substances. The scattering substance may have an average grain size comprised, for example, between about 300 nm and about 1500 nm.

[0076] Even if, in the embodiments described above, reference has been made to a scattering substance in the form of solid suspended powder or particles, according to other embodiments the scattering particles may be particles of a gaseous scattering substance, dispersed, for instance, in the form of gaseous micro-bubbles, or a liquid substance, in the form of emulsion in water, physiologic solution, or other carrying liquid.

[0077] In general, the dimension of the scattering particles suspended in the liquid and the quantity of particles per liquid volume unit may be proportioned to support a laser diffusion allowing to achieve, at a maximum work distance from the fiber distal end 7A, an intensity not lower than 40%, preferably not lower than 50%, more preferably not lower than 70% of the initial power, near the emitting surface of the fiber. For example, the maximum work distance may be comprised between about 7 mm and about 28 mm, according to the application.

[0078] The laser source may be a Nd:YAG laser generated by a solid-state source operating in both continuous and pulsed mode in the free-running mode or, if necessary, in the Q-switching mode. The high peak powers achievable in Q-switching mode and, partially, in pulsed mode, generate a supplementary photomechanical effect contributing to the removal of the bacterial film in the treated area.

[0079] It is understood that the drawing only shows an example provided by way of a practical arrangement of the invention, which can vary in forms and arrangement without however departing from the scope of the concept underlying the invention. Any reference numerals in the appended claims are provided to facilitate reading of the claims with reference to the description and to the drawing, and do not limit the scope of protection represented by the claims.