埋伏阻生齿微创拔除方法

Minimally Invasive Extraction of Embedded or Impacted Teeth

目的初步研究埋伏牙和阻生牙的微创拔除方法及技巧。方法选择口腔门诊和住院的埋伏阻生牙患者180例,其中上颌第三磨牙埋伏阻生11例、上颌埋伏尖牙阻生26例、上颌埋伏多生牙13例、下颌埋伏多生牙14例、下颌第三磨牙埋伏阻生116例(又随机分为微创拔牙A组58例和对照的传统拔牙B组58例)。排除拔牙禁忌症,术前拍摄全颌曲面断层片或牙科锥束CT,评估患牙位置及其与毗邻重要解剖结构(牙和神经等)的位置关系,设计牙龈翻瓣,上下颌埋伏牙和下颌智齿的A组利用仰角机头等微创拔牙器械与技术拔除,B组采用传统劈冠法拔除。记录术中及术后患者主观感受、手术并发症发生率等,评估微创拔牙技术的临床效果。结果埋伏阻生牙用微创拔牙器械和技术,极大限度地降低了埋伏阻生牙的拔除难度,并且拔牙时间可预测和可控制,耗时5~35 min,平均为15 min。与传统拔牙方法对比,患者主观牙科畏惧感和术后不良反应如术区肿胀疼痛、张口受限、下唇麻木、干槽症等发生率明显较低,无一例严重并发症发生。结论通过微创拔牙方法可拔除各类埋伏阻生牙,手术时间可控制、可预测,并发症少,反应轻,是一种值得在临床上推广普及的技术。

Objective To study the methods and techniques of minimally invasive extraction of embedded or impacted teeth.Methods One hundred and eighty embedded or impacted teeth were involved in this study,including11 maxillary wisdom teeth,26 maxillary embedded canine,13 maxillary supernumerary teeth,14 mandibular supernumerary teeth and 116 mandibular wisdom teeth(randomly divided to group A and group B).All the patients with extraction contraindications were excluded.Preoperative panoramic X-ray or cone beam CT was executed to locate the impacted teeth and the relationship between impacted teeth and adjacent anatomical structures.Then over the gingival flap was cut and turned,and the impacted teeth using minimal invasive apparatus was extracted.The operation time,intraoperative and postoperative patient′s feeling and complications were recorded to assess the effect of minimally invasive extraction.Results Almost all the impacted teeth could be extracted by minimally invasive techniques.The operation time was divinable and controllable,which lasted from5 to 35 minutes with the mean 15 minutes.Compared with the traditional extraction,the patients maintained good comfort during operation.The intraoperative and postoperative complication incidence,such as swelling,pain,limitation of mouth opening,numbness of lower lip and dry socket,was significantly lower.None had serious reactions.Conclusions It is possible and effective to extract all kinds of embedded or impacted teeth by minimal invasive extraction methods.The extraction time is divinable and controllable.The complications and reaction are light.This technique is worthy of popularizing.