角形切口设计和愈合方式与下颌阻生智齿拔除术后并发症

Effect of triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars

目的:探讨两种角形切口设计和愈合方式对下颌阻生智齿拔除术后并发症的影响。方法:采用分口设计,共纳入60例患者(120侧)。所有患者均有双侧埋伏阻生下颌智齿,且双侧阻生方式相同。按照牙冠是否完全骨埋伏将患者分为A组(冠完全骨埋伏,30例)和B组(冠部分骨埋伏,30例)。一侧采用角形瓣,术后一期缝合完全关闭创口(triangular flap-primary healing,TF-P);对侧采用改良角形瓣,缝合后在第二磨牙远中遗留三角形的牙龈缺损,二期愈合(modified triangular flap-secondary healing,MTF-S)。所有手术由同一医师完成。术后第1天、第3天和第7天复查,检测术后疼痛(VAS评分和布洛芬用量)、肿胀和张口受限程度。术后6个月复查,检查第二磨牙远中探诊深度(probing depth,PD)。配对t检验对比两种方案在术后疼痛、肿胀和开口受限方面的差异。结果:A组中,术后第1天和第3天,MTF-S方案疼痛、肿胀程度低于TF-P方案(P<0.05);术后第1天、第3天和第7天MTF-S方案张口受限程度低于TF-P方案(P<0.05)。B组中,两种方案在术后疼痛、肿胀和张口受限方面差异无统计学意义,但术后第4天,MTF-S方案侧疼痛有加重趋势。术后6个月第二磨牙远中探诊,A、B两组中两种方案的PD差异无统计学意义。结论:MTF-S方案能够减轻完全骨埋伏下颌智齿拔除术后的并发症;术后6个月,两种方案在第二磨牙远中PD方面差异无统计学意义。

Objective:To evaluate the effect of different triangular flap design and healing procedure on the sequelae after extraction of impacted lower third molars.Methods:In this prospective,split-mouth study,60 healthy patients with bilateral,symmetrically fully impacted lower third molars(LM3)were included,of whom 30 patients with totally bony impacted LM3 were allocated into group A,while the other patients with partially bony impacted LM3 were allocated into group B.All the teeth were extracted by the same surgeon.Triangular flap was used on one side,and the wound was primarily closed with two sutures(TF-P).On the other side,modified triangular flap was used with a triangular region of mucosa posterior to LM2 removed during operation,and a triangular soft tissue defect was left for drainage after suture(MTF-S).The patients were followed up on postoperative days 1,3 and 7.Clinical parameters included postoperative pain,swelling,and trismus.Distal probing depth of adjacent second molar was assessed 6 months after extraction.Doctors responsible for the evaluation did not know the group and flap design.Paired sample t test was used to analyze the differences of postoperative sequelae between the two strategies.Results:In group A,MTF-S strategy could reduce postoperative pain,ibuprofen consumption,and swelling significantly compared with TF-P strategy on the postoperative 1st and 3rd days(P<0.05).Besides,the trismus in the patients with TF-P strategy was more serious than that with MTF-S strategy on the postoperative 1st,3rd and 7th days(P<0.05).However,statistic difference between the two strategies in pain,swelling and trismus was not detected in group B.Additionally,the VAS score in the patients with MTF-S strategy in group B increased slightly on the postoperative 4th day.The probing depth of the adjacent second molar was evaluated 6 months after extraction.Statistic difference was not detected between MTF-S strategy and TF-P strategy in the both groups.Conclusion:Modified triangular flap with secondary healing procedure could effectively reduce the postoperative complications of totally bony impacted LM3.However,the difference between the two strategies in the probing depth of the adjacent second molar was not statically significant 6 months after extraction.