下颌埋伏第三磨牙拔除后残余牙囊对邻牙牙周健康影响的研究

Effect of residual dental follicle after removal of impacted mandibular third molars on the periodontal health of adjacent second molars

目的探讨下颌埋伏第三磨牙拔除后牙槽窝内残余牙囊是否对邻牙牙周健康产生影响,为第三磨牙拔除后残余牙囊的处理提供临床参考。方法研究前瞻性纳入2020年11月1日至2022年11月30日就诊于武汉大学口腔医(学)院口腔颌面外科并拔除双侧下颌埋伏第三磨牙的患者82例。采用自身对照,将每例患者双侧下颌第三磨牙根据随机数字表法随机分为A组(拔除第三磨牙并彻底刮除残余牙囊组织)和B组(拔除第三磨牙后不对留存的牙囊组织作任何处理)。记录手术时间及不良反应。术后6个月随访对两组患者进行临床及影像学检查,评估双侧下颌第二磨牙的牙周指标及牙槽骨高度,比较两组间有无差异。结果所有患者的双侧下颌第三磨牙均成功拔除,均未发生出血、创口感染、干槽症、下唇麻木等不良反应,两组手术时间、术后疼痛及面部肿胀差异均无统计学意义(P>0.05)。术后6个月时,A组第二磨牙远中探诊深度[2.67(2.00,3.67)mm]显著小于B组[4.00(3.00,5.00)mm](Z=-6.55,P<0.001);A组第二磨牙远中临床附着丧失[1.00(0.00,3.00)mm]显著少于B组[3.00(2.00,5.00)mm](Z=-5.99,P<0.001);A组第二磨牙远中牙槽嵴顶至釉质牙骨质界的距离[(1.86±1.34)mm]显著小于B组[(3.04±1.89)mm](t=-6.87,P<0.001)。在年龄≥20岁的患者中,A组第二磨牙远中牙槽骨高度恢复至正常水平的比例[42.3%(11/26)]显著高于B组[0(0/26)](P<0.01),而在年龄<20岁的患者中,A组第二磨牙远中牙槽骨高度恢复至正常水平的比例[63.3%(19/30)]与B组[46.7%(14/20)]差异无统计学意义(P>0.05)。结论下颌埋伏第三磨牙拔除后牙槽窝内残余牙囊可对邻牙的牙周健康产生不良影响;拔除下颌埋伏第三磨牙术中刮除残余牙囊有利于术后第二磨牙远中牙槽骨高度的恢复,尤其是20岁以上的患者。

Objective To investigate whether residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars affect the periodontal health of adjacent mandibular second molars,in order to provide clinical reference for the management of residual dental follicles after third molar extraction.Methods A total of 82 patients who underwent bilateral impacted mandibular third molar extraction at the Department of Oral Surgery,School and Hospital of Stomatology Wuhan University,from November 1,2020,to November 30,2022,were included in the study.Using a self-controlled method,each patient′s bilateral mandibular third molars were randomly divided into two groups:Group A underwent third molar extraction with thorough removal of residual dental follicle tissue,while Group B underwent third molar extraction without any treatment of the remaining dental follicle tissue.Operation time and adverse reactions were recorded.Clinical and radiographic examinations were performed at 6-month follow-up to evaluate the periodontal parameters and alveolar bone height of the bilateral mandibular second molars,and differences between the two groups were compared.Results All patients had successful bilateral mandibular third molar extractions,and no serious complications occurred intraoperatively or postoperatively.There were no statistically significant differences in surgical time,postoperative pain,or facial swelling between the two groups(P>0.05).At the 6-month follow-up,the probing depth on the distal aspect of the mandibular second molars in Group A[2.67(2.00,3.67)mm]was significantly less than that in Group B[4.00(3.00,5.00)mm](Z=-6.55,P<0.001).The clinical attachment loss on the distal aspect of the mandibular second molars in Group A[1.00(0.00,3.00)mm]was less than that in Group B[3.00(2.00,5.00)mm](Z=-5.99,P<0.001).The distance from the alveolar crest to the cementoenamel junction on the distal aspect of the mandibular second molars in Group A[(1.86±1.34)mm]was less than that in Group B[(3.04±1.89)mm](t=-6.87,P<0.001).In patients aged≥20 years,the probability of recovery of alveolar bone height to normal level on the distal aspect of the mandibular second molars in Group A[42.3%(11/26)]was significantly higher than that in Group B[0(0/26)](P<0.01),while there was no statistically significant difference between Group A[63.3%(19/30)]and Group B[46.7%(14/20)]in patients aged<20 years(P>0.05).Conclusions Residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars adversely affect the periodontal health of adjacent teeth.Thorough removal of residual dental follicles during impacted mandibular third molar extraction is beneficial for the postoperative recovery of alveolar bone height of the distal aspect of the mandibular second molars,especially in patients aged≥20 years.