牙椅慢速直机辅助拔除下颌复杂阻生智齿临床研究

Study of extraction of complex impacted mandibular third molars using the dental chair's low-speed straight handpiece

目的探讨应用牙椅慢速直机去除下颌复杂中、低位阻生智齿拔除阻力的可行性。方法 (1)选择拔除的完整智齿20颗,将每颗智齿纵向分开,左右分为两组,比较应用牙椅慢速直机(实验组)与高速涡轮机(对照组)分割牙体组织的效率。(2)选择2016年1-12月北京大学口腔医院第二门诊部口腔外科诊治的需要预防性或治疗性拔除下颌中、低位复杂阻生智齿且无拔牙禁忌证的患者166例,用牙椅慢速直机辅助拔除阻生智齿。分析其阻生类型、去阻的细节、拔除时间、术后并发症和患者的主观感受。结果 (1)应用慢速直机与高速涡轮机的冠根分开时间分别为15.1 s和12.6s,差异有统计学意义(P<0.05);牙冠分割时间分别为18.2s和17.5s,差异无统计学意义(P>0.05)。(2)牙椅慢速直机辅助拔除下颌复杂阻生智齿的平均手术时间为10.5 min。术后并发症中,出现下齿槽神经暂时损伤1例,没有病例发生皮下气肿和舌神经损伤,患者对拔牙过程评价为容易配合者158例(95.2%)。结论在下颌复杂中、低位阻生智齿拔除中应用牙椅慢速直机辅助去骨和分牙,可明显缩短拔牙时间,减少术后并发症,减轻患者对拔牙的焦虑和恐惧。该方法不需要额外配置设备,方法简便,利于临床推广应用。

Objective To explore the possibility of applying the dental chair＇s low-speed straight handpiece in removing the complex impacted mandibular wisdom teeth middle-lower-positioned.Methods （1）Select 20 complete wiscdom teeth.Split each teeth vertically,and use the left and right part as two groups.Compare the efficiency of the dental chair＇s low-speed straight handpiece with that of the high speed turbine in segmenting the teeth.（2）The middle-lower impacted mandibular wisdom teeth of 166 cases were extracted with the dental chair＇s low-speed straight handpiece.The types of impacted wisdoms,the details of the removal,the time of extraction,the complications and the subjective feelings of the patients were analyzed.Results The time of splitting the crown and the root with the low-speed straight handpiece and the high-speed turbine was 15.1 and 12.6 seconds,respectively,and the time of the crown segmentation time was 18.2 and 17.5 seconds,respectively;the former had sighificant difference （P 〈 0.05）,while the latter didn＇t （P 〉 0.05）.The average time of extraction by low-speed straight handpiece for mandibular complex impacted wisdom teeth was 10.5 minutes.In the postoperative complications,1 patient suffered from temporary injury of the inferior alveolar nerve.No patient suffered from subcutaneous emphysema or lingual nerve injury.There were 158 patients （95.2%）who evaluated the extraction procedure as ＆quot;easy to cooperate＆quot; in 166 patients.Conclusion In the extraction of middle and lower impacted wisdoms,the dental chair＇s low-speed straight handpiece can obviously shorten the extraction time,reduce the incidence of postoperative complications,and reduce patient＇s anxiety and fear of tooth extraction.The method does not need additional equipment,and it is simple and convenient,and is favorable for clinical popularization and application.