近中颌面磨除法拔除近中及水平阻生第三磨牙临床效果及安全性分析

Clinical effects and safety of mesial and horizontal impacted third molars removed by mesial occlusalf surface grinding

目的探讨近中颌面磨除法拔除近中及水平阻生第三磨牙临床效果,并对安全性进行分析。方法120例近中及水平阻生第三磨牙患者,随机分为断冠法组和近中颌面磨除法组,每组60例(近中阻生42例,水平阻生18例),分别采取断冠法和近中颌面磨除法两种方法拔除。观察2组患者手术指标(拔牙时间、术中出血量)、面颊肿胀、拔牙窝完整性、张口受限程度、颞下颌关节不适、拔牙窗口疼痛发生情况,并统计患者不良反应发生率。结果 2组患者下颌近中及水平阻生第三磨牙均顺利拔除。近中颌面磨除法组拔除牙齿可见中颌面少量磨除。2组拔牙时间分布比较差异有统计学意义(P<0.05),其中近中颌面磨除法组拔牙时间Ⅰ级分布高于断冠法组,差异有统计学意义(P<0.05)。2组拔牙时间、术中出血量比较,差异有统计学意义(P<0.05)。2组面颊肿胀情况比较差异无统计学意义(P>0.05)。2组拔牙窝完整性比较,差异有统计学意义(P<0.05),其中近中颌面磨除法组拔牙窝完整率高于断冠法组,差异有统计学意义(P<0.05),近中颌面磨除法组完整性评分低于断冠法组,差异有统计学意义(P<0.05)。2组张口受限程度比较,差异有统计学意义(P<0.05),其中近中颌面磨除法组轻度张口受限率高于断冠法组,差异有统计学意义(P<0.05)。2组颞下颌关节不适情况比较差异有统计学意义(P<0.05),其中近中颌面磨除法组无不适率高于断冠法组,差异有统计学意义(P<0.05)。2组拔牙窗口疼痛比较,差异有统计学意义(P<0.05),其中近中颌面磨除法组无疼痛发生率高于断冠法组,中度疼痛率、VAS评分低于断冠法组,差异均有统计学意义(P<0.05)。近中颌面磨除法组并发症发生率低于断冠法组,差异有统计学意义(P<0.05)。结论采用近中颌面磨除法拔除近中及水平阻生第三磨牙手术时间短,术中出血量少,安全性高且并发症发生率低。

Objective To investigate the clinical effects and safety of mesial and horizontal impacted third molars removed by mesial occlusalf surface grinding. Methods A total of 120 patients with mesial and horizontal impacted third molars were randomly divided into two groups： broken crown method group and mesial occlusalf surface grinding group,with 60 patients in each group,including 42 mesial impacted cases and 18 horizontal impacted cases. The patients in broken crown method group and mesial occlusalf surface grinding group were treated by broken crown and mesial occlusalf surface grinding,respectively. The operation indexes including tooth extraction time and intraoperative bleeding volume,cheek swelling,extraction socket integrality,mouth restriction degree,temporomandibular joint discomfort feeling and the incidence of tooth extraction wound pain and incidence rate of adverse reactions were observed and compared between two groups. Results The mandibular mesial and horizontal impacted third molars were successfully removed in both groups. A small amount of mesial occlusalf surface abrasion was observed in mesial occlusalf surface grinding group. There was significant difference in tooth extraction time distribution between the two groups（ P 〈0. 05）. The distribution of tooth extraction time grade Ⅰ in mesial occlusalf surface grinding group was significantly higher than that in broken crown group（ P 〈0. 05）. There were significant differences in tooth extraction time and bleeding volume between two groups（ P 〈0. 05）. However there was no significant difference in cheek swelling between two groups（ P 〈0. 05）. There was significant differences in extraction socket integrality between two groups（ P 〈0. 05）,in which the complete rate of extraction socket in mesial occlusalf surface grinding group was significantly higher than that in broken crown group（ P 〈0. 05）. There was significant differences in limitation degree of mouth opening between two groups（ P 〈0. 05）,in which the restriction degree of mouth opening in mesial occlusalf surface grinding group was significatly higher than that in broken crown group（ P 〈0. 05）. There was significant difference in temporomandibular joint discomfort feeling between the two groups（ P 〈0. 05）,and the discomfortable rate of maladjustment in mesial occlusalf surface grinding group was significantly slighter than that in broken crown group（ P 〈0. 05）. There was significant difference in tooth extraction wound pain between two groups（ P 〈0. 05）. The incidence rate of no pain in mesial occlusalf surface grinding group was higher than that in broken crown group,however,the moderate pain rate and VAS scores were significantly lower than those in broken crown group（ P 〈0. 05）. In addition the incidence rate of complications in mesial occlusalf surface grinding group was significantly lower than that in broken crown group（ P 〈0. 05）. Conclusion The mesial occlusalf surface grinding in removing mesial and horizontal impacted third molars has the advantages of shorter operation time,less intraoperative bleeding volume,high safety and low incidence rate of complications.