两种微创法拔除下颌阻生第三磨牙的临床效果比较研究

Comparative studies on the clinical effect of two minimally invasive extraction methods for impacted mandibular third molars

目的比较研究两种微创法拔除下颌阻生第三磨牙的临床效果。方法选取2017年8月至2018年6月于上海交通大学医学院附属第九人民医院口腔综合科就诊的需拔除双侧下颌阻生第三磨牙患者50例。采用随机、单盲、自身牙弓左右侧交叉对照的研究方法,一侧患牙使用45°冲击式气动手机法(联合使用加长球钻去骨、加长裂钻分牙)拔除,对侧患牙使用超声骨刀法(超声骨刀去骨、45°冲击式气动手机配合加长裂钻分牙)拔除。比较两种方法术中去骨时间、阻生牙完全脱位时间、患者术后48 h疼痛视觉模拟评分法(visual analog scale,VAS)评分及患侧面部肿胀百分率等。结果 50例患者的100颗患牙均顺利拔除,所有患者均未出现术后出血、创口感染、干槽症等并发症。45°冲击式气动手机法术中平均去骨时间和阻生牙完全脱位时间均短于超声骨刀法,差异均有统计学意义(均P <0.05)。45°冲击式气动手机法术后48 h疼痛VAS评分和患侧面部肿胀百分率均略高于超声骨刀法,但差异均无统计学意义(均P> 0.05)。结论 45°冲击式气动手机法和超声骨刀法均为安全性较高、术后反应较小的下颌阻生第三磨牙微创拔除方法,两者在拔除相同阻生类型的患牙时产生的手术创伤基本相当,但前者具有手术时间更短、设备成本更低的优势,适合在临床中推广应用。

Objective To compare the clinical effect of two minimally invasive extraction methods for impacted mandibular third molars. Methods From August 2017 to June 2018,a total of 50 patients with impacted mandibular third molars on both sides were selected from the Department of General Dentistry,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine. A randomized,single-blind,self-dental arch crossover method was used.The teeth on one side were extracted by surgical impact air handpieces(osteotomy with surgical round burs;separation with surgical fissure burs),while the teeth on the other side were extracted by piezosurgery(osteotomy with piezosurgery;separation with handpieces and surgical fissure burs);compare the osteotomy time,total extraction time,visual analog scale(VAS)pain scores and swelling percentage 48 h after the surgeries. Results The 100 teeth from 50 patients were extracted successfully. No complications occurred,such as postoperative bleeding,wound infection or dry socket. The average osteotomy time and average total extraction time of extractions by surgical impact air handpieces were shorter than those by piezosurgery,and there was significant difference between them(both P < 0.05). The average VAS pain score and average swelling percentage of extractions by surgical impact air handpieces were higher than those by piezosurgery,but there was no significant difference between them(P > 0.05). Conclusion Both of these two minimally invasive extraction methods for impacted mandibular third molars are safe and with minor postoperative reaction,and the trauma caused is also similar. Considering that the former has a shorter surgery duration and is with lower costs,it is worth being popularized.