截冠术在下颌阻生第三磨牙治疗中的应用效果分析

Analysis of the application of coronectomy in the treatment of mandibular impacted third molars

目的探讨传统拔牙与截冠术在高风险下颌阻生第三磨牙治疗中的效果及预后。方法收集2021年6月至2022年6月于中山大学附属口腔医院口腔颌面外科门诊就诊患者300例作为观察样本(均通过锥形束CT检查下颌阻生第三磨牙牙根接触、突入或贯穿下牙槽神经),告知治疗方案后由患者自行选择治疗方式,其中选择传统拔牙术者244例、选择截冠术者56例。传统拔牙组去骨分冠并取出牙根,截冠组完整去除牙冠并保留牙根。χ2检验比较两组术后下牙槽神经损伤、舌神经损伤、拔牙术后出血及干槽症发生率差异。同时评估截冠术后预后情况。结果传统拔牙组下牙槽神经损伤率(6.6%),高于截冠术组(0%),差异有统计学意义(χ^(2)=3.879,P=0.049);常规组舌神经损伤发生率(0.4%)、术后出血(2.9%)、干槽症发生率(2.5%)与截冠术组舌神经损伤发生率(0%)、术后出血(1.8%)、干槽症发生率(1.8%)比较,差异均无统计学意义(χ^(2)舌神经损伤=0.230,P舌神经损伤=0.631;χ^(2)术后出血=0.206,P术后出血=0.650;χ^(2)干槽症=0.090,P干槽症=0.763)。截冠术组仅有1例因牙根萌出需要二次手术拔除牙根,其晚期并发症发生率低,但持续存在。结论截冠术在下颌阻生第三磨牙治疗中术后并发症发生率低,是一种更加安全的选择,可作为智齿拔除的替代方案。

Objective To compare the effectiveness and prognosis of traditional tooth extraction and coronation surgery in the treatment of high-risk mandibular impacted third molars,so as to provide clinical reference for the application of coronation surgery.Methods A total of 300 patients in the Department of Oral&Maxillofacial Surgery,Hospital of Stomatology,Sun Yat-sen University,from June 2021 to June 2022,were recruited.All patients were examined with CBCT for the root position of the mandibular impacted third molars.Based on the patients′decision on treatment plans,244 patients underwent traditional tooth extraction surgery and 56 patients underwent coronation surgery.In the traditional tooth extraction group,the whole molars were extracted by pieces,while in the coronation group,only the crowns of molars were removed.The incidence of nerve injury,bleeding and dry socket was compared between the two groups.The prognosis of coronation surgery was also evaluated.Results The incidence of inferior alveolar nerve injury in the conventional group(6.6%)was statistically higher than that in the coronation group(0%,χ^(2)=3.879,P=0.049).The incidence of lingual nerve injury,postoperative bleeding and dry socket in the conventional group was comparable with that in the coronation group(χ^(2)lingual nerve injury=0.230,Plingual nerve injury=0.631;χ^(2)postoperative bleeding=0.206,Ppostoperative bleeding=0.650;χ^(2)dry socket syndrome=0.090,P dry socket syndrome=0.763).In the coronal surgery group,there was only one case that a second surgery was required to remove the root due to root eruption,indicating that the incidence of such late complications was low,but persisted.Conclusions Coronation surgery had a lower incidence of postoperative complications in the treatment of impacted mandibular third molars,which would be a safer option for the extraction of wisdom teeth.