折裂磨牙的分类及拔除方法探讨

Classifications and extraction of fractured molars

目的:探讨折裂磨牙的分类及手术拔除方法。方法:统计分析486例折裂磨牙的折裂类型,在拔除方法上随机分为实验组和对照组,实验组386例先用牛角钳拔,对照组100例先用磨牙钳拔。对牙钳夹碎牙冠后的残留部分,先分根再分别挺出;对残留的牙根分别采用普通牙挺或根尖挺、三角挺挺出;对于残留牙槽窝内位置较深的断根,采用根尖挺或翻瓣去骨的办法拔除,统计各种方法拔除牙的数量。应用SPSS13.0软件包对数据进行多元方差分析。结果:上颌磨牙以纵折为主,下颌磨牙以斜折为主。上颌第一磨牙用牛角钳和磨牙钳完全拔除率分别是35%(50/143)和12.5%(8/40),差异有显著性(P=0.041);上颌第二磨牙用牛角钳和磨牙钳完全拔除率分别是40%(30/75)和23.5%(4/17),差异有显著性(P=0.016);下颌第一磨牙用牛角钳和磨牙钳完全拔除率分别是37.5%(45/120)和21.4%(6/28),差异具有显著性(P=0.004);下颌第二磨牙用牛角钳和磨牙钳完全拔除率分别是48%(23/48)和20%(3/15),差异无显著性(P=0.662)。结论:对于折裂磨牙的拔除,应首选牛角钳,约40%的牙可以完整拔除,70%以上的牙可以不同程度地拔除,然后再选用牙挺或三角挺拔除残留牙根;对个别残留较深的断根,采用根尖挺或翻瓣去骨法拔除。按此流程操作,可以快速拔除折裂牙,减少创伤,减少手术时间,减轻患者痛苦。

PURPOSE： To analyze the characteristics of fractured molars and to explore efficient measures of their extraction.METHODS： Four hundred and sixty-eight fractured molars were randomly divided into the experimental group and control group.368 fractured molars in the experimental group were extracted first with the cowhorn forceps,while the remaining in the control group were extracted first with the molar forceps,then the rate of teeth extraction was counted separately.Residual crowns were pulled out with tooth elevators after separating the roots;Residual roots were pulled out with tooth elevators,or root elevators,or triangle elevators;Fractured roots in the deep position of sockets were pulled out with root elevators or flap operation.Then the number of teeth pulled out with different methods was recorded.The data was analyzed with SPSS13.0 software package.RESULTS： About 39.3% of maxillary molars were longitudinal fracture,and about 30% of mandibular molars were oblique fracture.The complete removal rate for the maxillary first molars pulled out with cowhorn forceps and molar forceps were 35% and 12.5%（P=0.041）;The complete removal rate for the maxillary second molars pulled out with cowhorn forceps and molar forceps were 40% and 23.5%（P=0.016）;The complete removal rate for the mandibular first molars pulled out with cowhorn forceps and molar forceps were 37.5% and 21.4%（P=0.004）;The complete removal rate for the mandibular first molars pulled out with cowhorn forceps and molar forceps were 48% and 20%（P=0.662）.CONCLUSION： Cowhorn forceps are the first choice to pull out the fractured molars.About 40% of them could be completely removed.More than 70% could be partial removed and the residual roots could be pulled out with tooth elevators or triangle elevators.The fractured roots in the deep position of sockets could be pulled out with root elevators or flap operation.According to this process,it can not only pull out the whole fractured teeth rapidly,decrease the wound,reduce operation time but also relieve patients＇ suffering.