应用骨盖技术拔除下颌低位骨性埋伏阻生第三磨牙的疗效观察

Clinical outcome of bone lid technique in the extraction of the deeply impacted mandibular third molar

目的观察骨盖技术应用于下颌低位骨性埋伏阻生第三磨牙拔除术的效果,评估其临床和影像学结果。方法收集2022年4—12月期间在中山大学附属口腔医院口腔颌面外科门诊行下颌低位骨性埋伏阻生第三磨牙拔除术患者52例,包括骨盖组和对照组各26例,其中骨盖组采用超声骨刀手术制备骨盖,显露拔除患牙后将骨盖复位;对照组则采用超声骨刀去骨后拔除患牙,随访观察患者术后恢复情况及治疗效果。结果52例患者术后恢复良好,无下唇麻木等神经损伤症状及骨坏死等严重并发症,骨盖组患者术后疼痛反应与对照组无明显差别(P>0.05),术后第3天肿胀反应与对照组比相对较轻(Z_(3 d)=2.088,P_(3 d)=0.037),而术后7 d肿胀程度差异无统计学意义(Z_(7 d)=1.866,P_(7 d)=0.062)。影像学检查显示骨盖整合情况及邻牙远中牙槽骨高度恢复良好。结论骨盖技术可以有效减少术后骨组织缺损,术后并发症少,有利于骨组织恢复,可作为下颌低位骨性埋伏阻生第三磨牙拔除手术入路的一种理想选择。

Objective To observe the effect of bone lid technique on the extraction of the third molar deeply impacted in the bone,and to evaluate its clinical and imaging results.Methods A total of 52 patients who underwent extraction of deeply bone impacted mandibular third molar were recruited in Department of Oral&Maxillofacial Surgery,Hospital of Stomatology,Sun Yat-sen University,from April to December 2022,which included 26 patients in the bone lid group and 26 patients in the control group.In the bone lid group,a bone lid was prepared by piezo surgery before extracting the tooth,which was restored after the tooth extraction.In the control group,the tooth was extracted after bone remove with piezo surgery.Postoperative follow-up was conducted to observe the recovery of the patients and the therapeutic effect.Results All patients showed a good recovery after surgery,without serious complications including nerve injury and osteonecrosis.There was no significant difference in postoperative pain between the bone lid group and the control group(P>0.05).The swelling reaction in the bone lid group was less than that of the control group on the 3rd day after surgery(Z_(3 d)=2.088,P_(3 d)=0.037).While there was no significant difference on the 7th day(Z_(7 d)=1.866,P_(7 d)=0.062).The bone lid integration and alveolar bone recovery were good,and the distal alveolar bone height of the adjacent teeth was also well preserved.Conclusions The bone lid technique can effectively reduce the bone tissue defect and postoperative complications,which is beneficial to the recovery of bone tissue,and can be used as a reliable choice for the extraction of the deeply impacted third molar.