上颌正中埋伏多生牙拔除入路选择的临床研究

Clinical research of approach selection of extraction of maxillary embedded mesiodens

目的探求拔除上颌正中埋伏多生牙采取单侧翻瓣和改变手术计划为双侧翻瓣的相关因素。方法回顾性分析拔除上颌正中埋伏多生牙的81例患者。主要结果变量是:计划手术(单侧翻瓣)和计划外手术(双侧翻瓣)。次要结果变量是:手术时间和术后肿胀程度。预测变量为:多生牙距离唇侧和腭侧骨板的最短距离差值,分为差值≥1.5 mm组和<1.5 mm组;邻牙根尖至鼻底距离与多生牙长径比值,记录为≥1和<1。采用SPSS 20统计软件完成统计学分析。结果距离差值<1.5 mm时,计划外手术可能性增大,计划手术的概率是计划外手术概率的0.085倍;年龄每增加1岁,计划手术的概率逐步降低,HR=0.745;腭侧入路术后肿胀仅为唇侧入路的0.374倍;随着年龄的增加其手术时间有逐渐增加趋势,B=1.213。邻牙根尖至鼻底距离与多生牙长径比值并未影响到术中手术计划改变。结论多生牙距离唇侧和腭侧骨板的最短距离差值可作为拔除上颌正中埋伏多生牙选择手术入路的参考依据。

Objective To explore the related factors for the unilateral flap and bilateral flap by changing the original operation plan in the extraction of maxillary impacted mesiodens.Methods 81 patients with impacted mesiodens in the middle of the maxillary were retrospectively analyzed.The primary outcome variables were planned surgery(unilateral flap)and unplanned surgery(bilateral flap).The secondary outcome variables consisted of operation time and postoperative swelling.The predictive variables were as follows:the differential value of the shortest distance from the supernumerary tooth to the labial and palatal bone plates,which was divided into≥1.5 mm group and<1.5 mm group;the ratio of the distance from the adjacent tooth apex to the nasal floor,compared to the length of the supernumerary teeth,was recorded as≥1 and<1.A statistical software SPSS 20 was used to complete the statistical analysis.Results When the differential value was less than 1.5 mm,the possibility of unplanned surgery increased,and the probability of planned surgery was 0.085 times than that of unplanned surgery.With age growing each 1-year,the probability of planned surgery gradually decreased,HR=0.745.The postoperative swelling of the palatal approach was only 0.374 times than that of the labial approach.With age increasing,the operation time increased gradually,B=1.213.The ratio of the distance from the adjacent tooth apex to the nasal floor to the length of the supernumerary teeth did not affect the change of the surgical plan during the operation.Conclusion The shortest distance difference between the supernumerary teeth and the labial and palatal bone plates can be used as a reference for the selection of surgical approach for the extraction of maxillary impacted mesiodens.