下颌阻生第三磨牙拔除同期植骨对第二磨牙远中牙槽骨缺损修复的影响

Effect of bone grafting on the repair of distal alveolar bone defect of the second molar after extraction of mandibular impacted third molar

目的:观察下颌阻生第三磨牙拔除时,于拔牙创内同期植入自体骨混合Bio-Oss人工骨粉,对第二磨牙远中牙槽骨缺损修复的影响。方法:术前根据下颌第三磨牙与第二磨牙的位置,预估下颌阻生牙拔除后,第二磨牙发生远中骨组织缺损的风险,分为低、中、高风险3组。在中、高风险组中再根据是否在术中行同期植骨,分为植骨组与不植骨组,术后1、6个月进行复查,剔除术后感染及失访病例后,植骨组(A组)共计36例,不植骨组(B组)共计45例。术后复查指标包括患者主观感觉,第二磨牙远中探诊深度,曲面体层片观察第二磨牙远中牙槽骨高度变化。数据采用SPSS 19.0软件包进行t检验。结果:术后6个月中风险组中,植骨组第二磨牙远中主观感觉冷热刺激不适者0例,不植骨组中为6例,差异有统计学意义(P<0.05)。第二磨牙远中牙周探诊深度植骨组为(2.93±0.34)mm,不植骨组为(2.95±0.50)mm,差异无统计学意义(P=0.931)。X线片检查第二磨牙远中牙槽骨高度增量Δh植骨组为(3.31±1.02)mm,不植骨组为(3.10±1.72)mm,差异有统计学意义(P=0.749)。高风险组中,植骨组第二磨牙远中主观感觉冷热刺激不适者4例,不植骨组为10例,差异有统计学意义(P<0.05)。第二磨牙远中牙周探诊深度植骨组为(3.08±0.37)mm,不植骨组为(3.24±0.41)mm,差异无统计学意义(P=0.162)。X线片检查第二磨牙远中牙槽骨高度增量Δh植骨组为(5.21±1.79)mm,不植骨组为(2.99±2.42)mm,差异有统计学意义(P<0.001)。结论:术前对阻生牙拔除后第二磨牙远中骨组织缺损进行风险分型,有助于判断术中是否需要植骨。在牙槽骨缺损较多的情况下(高风险型),于拔牙创内同期植入自体骨混合Bio-Oss人工骨粉,对第二磨牙远中牙槽骨高度的恢复促进作用更显著,并且能够减少第二磨牙因远中牙根暴露所致的不适。

PURPOSE:To observe the effect of bone grafting during the extraction of mandibular third molar on repair of distal alveolar bone defect distal to the second molar.METHODS:The risks of the distal alveolar bone defect in the second molar were estimated after removal of the impacted teeth according to the position of the third molar and second molar before operation.It was divided into three groups:low risk group,medium risk group and high risk group.The medium risk group and high risk group were further divided into bone graft subgroup(group A)and non-bone graft subgroup(group B).There were 36 cases in group A and 45 cases in group B.Postoperative re-examination indicators included subjective perception of the patients,depth of probing and height of alveolar bone in the distal molar of the second molar by X-ray examination.The data were analyzed with SPSS 19.0 software package.RESULTS:Six months after operation,in mediun risk group,0 cases in group A had subjective feelings of cold and heat stimulation;in group B,the number was 6 cases,the difference was significant(P<0.05).Distal periodontal probing depth of the second molar was(2.93±0.34)mm in group A and(2.95±0.50)mm in group B.There was no significant difference between 2 groups(P=0.931).X-ray examination of the alveolar bone height increment of the second molarΔh:(3.31±1.02)mm in group A,(3.10±1.72)mm in group B,the difference was not significant(P=0.794).In high risk group,4 cases in group A had subjective feelings of cold and heat stimulation;in group B,the number was 10 cases,the difference was significant(P<0.05).Distal periodontal probing depth of the second molar was(3.08±0.37)mm in group A and(3.24±0.41)mm in group B.There was no significant difference between 2 groups(P=0.931).X-ray examination of the alveolar bone height increment of the second molarΔh:(5.21±1.79)mm in group A,(2.99±2.42)mm in group B,the difference was significant(P<0.05).CONCLUSIONS:Risk classification of the second molar distal bone defects after extraction of the impacted teeth is essential,which is helpful to determine whether bone grafting is needed during operation.Autologous bone mixed with Bio-Oss artificial bone powder can promote recovery of the alveolar bone height of the second molar,especially in high risk group,and discomfort caused by exposure can be reduced.