锥形束CT在下颌阻生第三磨牙微创拔牙中的临床应用

Clinical study of CBCT on the minimally invasive extraction of third impacted mandibular third molar

目的对比CBCT介导下与常规X线介导下进行微创拔除下颌阻生第三磨牙的两种操作,术中及术后并发症出现的情况,进而了解CBCT在拔除下颌第三磨牙中应用的临床效果。方法筛选我科需要进行下颌第三磨牙微创拔除、全景曲面体层片(panoramic radiography,PAN)显示下颌智齿根尖部与下颌管相邻、部分重叠或显影不清的患者,随机分为实验组和对照组,实验组术前进一步CBCT检查,而对照组仅摄PAN。微创拔牙术后立即记录拔牙时间、牙龈撕裂、术中断根及邻牙损伤情况,术后复诊拆线时回访患者关于拔牙后疼痛、出血、肿胀及下唇麻木情况。结果应用CBCT介导下微创拔除的42例病例中,出现并发症的有2例,占4.76%;应用PAN介导下微创拔除的42例病例中,出现并发症的有9例,占21.3%,差异有统计学意义。患者阻生齿拔除术主观满意度为CBCT介导组高于常规组。结论 CBCT在下颌第三磨牙阻生的微创拔牙术中较常规X线片具有更优越的风险预防作用,可以降低并发症的发生几率,从而提高临床安全性及患者满意度。

Objective To investigate the clinical of CBCT in minimally invasive extraction of mandibular third molar through evaluating the intra- and post-operative complications under X-ray and CBCT guidance. Methods Patients with mandibular impacted third molar meeting the extraction criteria, and the apical of which was adjacent to or overlap with mandibular canal showed in panoramic radiography（PAN） were enrolled in this study. Patients were divided into experiment group and control group. Further CBCT examinations pre-operation were conducted in experiment group, whereas PAN examinations were taken in control group. All patients received minimally invasive mandibular third molar extraction. The extraction time, gingival laceration, root fracture and damage of adjacent teeth during extraction, and the followed post-operative pain, bleeding, swelling and lower lip numbness were recorded respectively. Results 2 of 42 cases with extraction under CBCT guidance showed complications accounting for4.76% of total while 10 of 42 cases under PAN guidance showed complications, the proportion was 23.8%. The patients satisfaction in experiment group was significantly higher in comparison with control group. Conclusion In conclusion,compared with conventional X-ray, CBCT exhibited superior risk prevention potential to lower the complication occurrence rate, resulting in improved patients satisfaction and safety in minimally invasive extraction of mandibular impacted third molar.