Ultrasonic piezotome surgery: is it a benefit for our patients and does it extend surgery time? A retrospective comparative study on the removal of 100 impacted mandibular 3rd molars

Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the begin-ning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to tra- ditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Al- though—as it is with all new surgical tools and pro- tocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learn- ing curve.

Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.

内镜下经下颌角-颈静脉孔区手术入路的解剖学研究

目的探讨内镜下经下颌角-颈静脉孔区手术入路的解剖学基础。方法收集湿性尸头标本5具,模拟内镜下经下颌角-颈静脉孔区手术入路对湿性尸头标本进行解剖,观察相关解剖结构,测量手术操作深度和角度。结果该手术入路形成了带蒂下颌角骨瓣,骨瓣长为(23.74±0.95)mm,宽为(18.95±0.56)mm。移位下颌角骨瓣后手术操作深度为(8.54±0.55)mm,复位下颌角骨瓣后手术操作深度为(24.94±0.90)mm,差异有统计学意义(P<0.05);移位下颌角骨瓣后手术操作角度为(69.60±3.30)°,复位下颌角骨瓣后手术操作角度为(26.20±2.20)°,差异有统计学意义(P<0.05)。结论内镜下经下颌角-颈静脉孔区手术入路形成带蒂下颌角骨瓣,可以增加手术操作角度、缩短操作深度,提高手术自由度,该手术入路值得进一步研究和在临床实践中探讨。

The Effect of Acupuncture on Post-operative Oral Surgery Pain

An important problem in the eviluation of acupuncture has been the difficulty in defining and designingan appropriate control group.In order to examine our methodoly for a control group,patientswith one mandibular third molar extraction were randomly assigned to an acupuncture group or aplacebo acupuncture group.The following acupuncture points were used in which the needles werePlaced ipsilateral to the tooth extraction side:Hegu（LI4）,Jiache（ST 6）,Xiaguan（ST

Hyoid Bone Position as an Etiological Factor in Mandibular Divergence and Morphology

Objectives: The objective is to determine whether there are differences in the position of the hyoid bone at rest in natural head position in subjects with mandibular hyperdivergence and to evaluate whether there are differences in hyoid position and antegonial notch depth in mandibular hyperdivergent males and females. Methods and Materials: This is a retrospective cohort study involving a review of lateral cephalometric radiographs of 45 adult men and women with mandibular hyperdivergency. Hyperdivergency was determined by cephalometric ranges of: SN-GoGn as least +2 SD from normal, Y-axis, PP-GoGN, and gonial angle greater than +1SD from normal. A group of 45 normodivergent adults served as a control, with cephalometric ranges of: SN-GoGn within ±1 SD of normal, with only one measurement of the other three between +1 and +1.5 standard deviations. A custom digital cephalometric analysis, the Hyoid Analysis, was designed, to measure the vertical and horizontal position and inclination of the hyoid and the antegonial notch depth. Results: In hyperdivergent subjects, the posterior aspect of the hyoid is located lower and more posterior, compared to the control group, while there is no difference in position of the anterior surface of the hyoid and the antegonial notch is 0.6 mm deeper. In males, the posterior aspect of hyoid is lower by 8.5 mm, while the anterior surface is located 9.0 mm lower. In males, the hyoid is inclined more steeply than in females by 4.4 degrees and the antegonial notch is deeper than in females by 0.6 mm. Conclusions: There are differences in hyoid bone position and mandibular morphology in hyperdivergent subjects compared to normodivergent subjects and in males compared to females.

Stable,dynamic,elastic miniplate osteosynthesis in cranio-maxillofacial surgery:evolution of concepts,biomechanical study and applications

An osteosynthesis of the mandible should be called stable when this type of treatment does not need to be supported by intermaxillary fixation,without disturbing the healing process.In that intention,many techniques of osteosynthesis based on different concepts were proposed during the last century.A classification of these concepts was formulated.The adaptive osteosynthesis which is pragmatically i.e.empirical,wherein the goal is immobilizing the fracture by bringing the fragments together and fixing them with rigid screwed plates.The rigid compressive osteosynthesis which is an extrapolation of the ideas of Lane proposed in 1912.The stable dynamic elastic osteosynthesis whose principles,equipment and technique as their applications were developed exclusively through biomechanical studies.The basic principle was the recovery of mobility by neutralization of detrimental distraction stresses,and reestablishment of favorable compressive stresses providing dynamic physiological stimulations.The biomechanical characteristics of the plates and the screws made possible the use of the fixation of all types of fractures or orthognathic procedures in mandibular surgery.With the application of mini or microplates in other facial bones and the skull,the art of fracture treatment and of reconstructive surgery of the craniomaxillofacial skeleton,including orthognathic and reconstructive surgery with or without bone grafting,has profoundly changed.At the present time,metal plates are sometimes superseded by resorbable plates and screws.Nevertheless,the fundamental biomechanical principles of osteosynthesis and bone healing remain unchanged.

RESEARCH OF BASIFACIAL CONTOURING SCULPTURE BY MANDIBULAR ANGLE OSTECTOMY

Objective Mandibular angle ostectomy is usually applied to the facial contouring sculpture. We evaluated the various techniques in order to enhance the precision and avoid unnecessary damage. Methods Before operation the area and quantity resected bone were designed according to facial measurement, mandible pantomagraphy and orthophoria and lateral localized radiograph of skull. The Incises of mandibular angle ostectomy included intraoral, retroauricular or intraoral associated with retroauricular. Howerer, the sagittal resection of mandible outer table was necessary in all intraoral incise. Results Single mandibular angle ostectomy was not satisfactory for the patients having mandible hypertrophy with over-width basifacial contouring. Mandibular angle ostectomy combined with the sagittal resection of outer table of mandibular angle were required. Good symmetry and appearance were gained in 206 cases. One case had facial paralysis. Two patients occured mandibular fracture during the operation. Three cases complicated angled deformity at mandible body. Conclusion Reduction mandibuloplasty should be selected depends on varied types of mandibular angle hypertrophy before operation.

Combined Therapy for Mandibular Prognathism:Sagittal Split Osteotomy with Excision of Tongue

In the evaluation of the beauty and functional integrity of the lower face, the oral cavity, teeth, mandible, maxilla, and the size and position of the tongue are important. The tongue locates forward and is larger than normal in prognathism, in which the jaw protrudes from the skull. It is not clear whether an enlarged tongue causes the open bite, protrusion or dental arch misalignment, or is a result of them. Here, we report two patients with mandibular prognathism and relative macroglossia, which were treated by mandibular setback surgery using a bilateral sagittal split osteotomy (BSSO) and excision of the tongue. This procedure achieved aesthetic improvement of the face and dentition.

成人下颌发育不足的外科矫治

下颌发育不足是牙颌面畸形的常见类型之一,严重影响患者的面部美观和咬合功能。外科矫治是目前最有效的治疗方法,可以通过手术治疗改变下颌骨位置和形态,恢复患者正常面部外形。本文从外科治疗的角度,将颞下颌关节这一关键因素纳入成人下颌发育不足的诊疗设计中,阐述成人下颌发育不足的常用矫治方法,包括正颌外科手术、颞下颌关节外科手术、正畸-正颌联合治疗和牵张成骨技术等,总结不同类型成人下颌发育不足的治疗流程。为临床医生治疗该疾病提供参考,提高这一疾病的治疗水平。

正颌外科规划软件中下颌运动交互模块的初步构建

目的:基于下颌运动轨迹构建数字化正颌外科规划软件中的下颌交互模块并进行临床验证。方法:基于CCMF Plan正颌规划软件,使用空间矩阵算法解算下颌运动轨迹数据,实现下颌运动的还原,根据距离重要性采样算法拟合患者个性化的下颌旋转轴并验证模拟下颌运动的精确性。使用下颌旋转轴指导手术规划,验证术中髁突位置实现的准确性。结果:开发出可再现患者下颌运动,以下颌旋转轴指导升支旋转的下颌运动交互模块。该模块还原模拟的下颌运动轨迹与真实轨迹误差约1 mm,同一开口度时的下颌骨模型表面距离均方根值(root mean square,RMS)值约0.3 mm。其指导的正颌手术术后髁突的角度偏差约为3°,距离偏差约1.5 mm。结论:该下颌运动交互模块可以较为精确地拟合下颌旋转轴,并还原患者个性化的下颌运动,术后髁突位置实现的精确性满足临床的要求。

骨性Ⅲ类错[牙合]畸形下颌偏斜患者正颌手术前后髁突形态变化的研究

目的:探讨正颌手术对骨性Ⅲ类错[牙合]畸形下颌偏斜患者髁突形态的影响,以及不同偏斜程度患者髁突形态和变化的差异。方法:选取20例骨性Ⅲ类错[牙合]畸形伴下颌偏斜患者,根据颏下点偏离值(menton deviation,MD)分为A组(轻度偏斜组:4 mm≤MD<10 mm)和B组(重度偏斜组:MD≥10 mm),每组各10例。将患者术前(T1)、术后6个月(T2)颅面部CT数据导入Proplan CMF软件,三维重建获得髁突模型,读取髁突体积、表面积,计算髁突形态学指数(morphometric index,MI)。结果:T2时A组偏斜侧(the deviated side,DS)与非偏斜侧(the non-deviated side,NDS)髁突体积与表面积均减小(P<0.05);2组T1、T2时NDS髁突体积、表面积、MI均大于DS,双侧差异的统计学意义,B组更显著;A组各指标数值大于B组,2组DS各指标的差异有统计学意义(P<0.05);T2较T1时髁突变化幅度不同,2组DS体积、表面积变化幅度差异有统计学意义(P<0.05)。结论:正颌手术会导致术后髁突体积与表面积减小,且术后6个月时轻度偏斜组髁突体积与表面积减小的统计学差异更加显著。患者DS髁突体积、表面积及MI小于NDS,轻度偏斜者DS髁突体积、表面积及MI大于重度偏斜者,术后髁突形态变化与偏斜程度相关。

数字化口腔虚拟仿真培训系统在阻生下颌第三磨牙拔除教学中的应用

目的探讨数字化口腔虚拟仿真培训系统在阻生下颌第三磨牙拔除教学中的应用效果。方法选择2022年5月—2023年5月于南昌大学第二附属医院口腔颌面外科基地轮转的113名医学生作为教学对象,按照随机数表法分为试验组和对照组,其中试验组57名,对照组56名。对照组接受传统教学模式(即观摩带教老师操作+教师的椅旁教学)培训,试验组接受传统教学模式结合数字化口腔虚拟仿真培训系统进行阻生下颌第三磨牙拔除的培训。轮转结束前3天,比较2组的理论知识考核、临床技能考核和教学效果。结果试验组的理论考核成绩为(79.14±6.55)分,高于对照组的(76.84±5.63)分,差异有统计学意义(P<0.05)。试验组的技能考核成绩为(81.02±5.21)分,高于对照组的(78.71±5.67)分,差异有统计学意义(P<0.05)。试验组的提高知识掌握程度[(7.56±0.66)分]、增进临床技能水平[(7.80±0.67)分]、激发学习兴趣[(7.77±0.68)分]和学习效果满意度[(7.75±0.71)分]评分高于对照组[(7.32±0.54)分、(7.50±0.69)分、(7.50±0.60)分、(7.45±0.63)分],差异有统计学意义(P<0.05)。结论相较于单一的传统教学模式,数字化口腔虚拟仿真培训系统可以作为一种提升阻生下颌第三磨牙拔除术理论知识掌握度和临床技能操作水平的有效辅助手段。

下颌神经管分支在下颌骨内的走行

目的 通过观察胶东地区成年人口腔锥形束CT(cone beam computed lomography, CBCT)结果,对下颌神经管的分支在下颌骨内走行进行分析统计,为口腔医学临床工作尤其是牙槽外科、口腔种植科操作提供准确的临床影像数据。方法 选取2021年12月到2022年1月期间在烟台市口腔医院拍摄CBCT影像且符合纳入标准的188例成年人(男性78人,女性110人,年龄18~59岁)患者的口腔CBCT数据,应用NNT图像系统分析观察,汇总统计分支发生率。结果 下颌神经管分支发生率为52.12%,侧别发生率为43.35%,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型的发生率分别为11.70%、9.30%、9.84%、6.38%、6.11%。男性和女性左侧和右侧下颌神经管分支的发生率的差异无统计学意义(P>0.05)。结论 CBCT相较于平片更能够清晰显示下颌神经管及其分支的解剖特征,对于牙槽外科及口腔种植科进行手术时,可以更细致进行术前设计,避免损伤神经分支。

下颌第二磨牙牙冠延长术后疗效观察及其风险因素分析

目的:观察下颌第二磨牙牙冠延长术后治疗效果,确定其风险因素;探讨风险因素个数对其疗效的影响。方法:纳入2019~2021年于天津市口腔医院接受牙冠延长术的下颌第二磨牙314颗。6周复查时,按照拟定标准将其分为效果良好组和效果欠佳组。筛选影响两组患牙疗效的风险因素,并分析其数量与治疗效果的相关性。结果:314颗患牙中,成功者占88.54%,失败者为11.46%。龈缘-断端距离(P<0.01)、术前断端-嵴顶距离(P=0.032)及牙根形态(P=0.006)是影响术后疗效的风险因素。随着风险因素数量的增加,手术失败率呈线性增长的趋势,风险因素达到3个时,失败风险明显增高(P<0.01)。两者之间呈正相关(P<0.01)。结论:龈缘-断端距离、术前断端-嵴顶距离及牙根形态是影响冠延长疗效的风险因素,其数量与手术失败率之间呈正相关,风险因素达到3个时,失败风险明显增高,需谨慎选择适应证。

骨性Ⅲ类偏颌畸形牙骨特征、分类及治疗相关研究进展

随着人们对美学需求的增加,偏颌畸形逐渐成为一项重要的临床问题。骨性Ⅲ类偏颌畸形不仅会影响面部美观,同时会对口腔功能产生不良影响。偏颌畸形的成因复杂,表现多样,在硬组织方面主要表现为面部各单元的空间位置不对称、颌骨形态不对称以及牙列代偿性变化等。基于偏颌患者综合颌面特征的分类对于诊断、治疗和手术计划至关重要。该文旨在对骨性Ⅲ类偏颌畸形的牙骨特征、分类和治疗研究进展进行综述,为临床诊断和治疗提供参考。

无菌敷贴预防下颌后牙种植术中口角损伤

下颌后牙种植术中使用缝线牵拉舌侧龈瓣有损伤术区对侧口角的风险,该研究探究了无菌敷贴在手术过程中预防口角损伤的效果。共纳入患者506例,未使用无菌敷贴143例,使用无菌敷贴363例。基于术后口角损伤情况对受试者进行分析、验证和护理。结果表明无菌敷贴可在种植手术中缩短手术时间、预防缝线摩擦伤、简化术后护理以及提高患者术后满意度。

基于CBCT骨微参数与骨阻力分析辅助下颌第三磨牙微创拔除

目的锥形束CT(cone-beam computed tomography,CBCT)结合CTAn软件辅助下颌第三磨牙拔除术骨阻力分析的可行性研究。方法选取我院口腔科2021年1月1日至2023年7月31日因第三磨牙阻生拍摄CBCT患者共53例,91颗下颌第三磨牙。CTAn处理CBCT图像获取下颌第三磨牙颊、舌侧骨体积区域,进行骨三维微结构参数分析。结果总样本和分层分析(下颌第三磨牙近中倾斜阻生与垂直阻生、性别分组),颊、舌侧总骨组织体积、骨小梁体积/总骨组织体积,骨组织表面积/骨小梁体积,骨组织表面积/总骨组织体积,骨密度之间的差异均有统计学意义(P<0.05)。高、中位近中倾斜阻生、垂直阻生分组中,女性下颌第三磨牙颊、舌侧骨三维微结构参数差异与男性相比更显著。结论CBCT结合CTAn辅助下颌第三磨牙拔除术骨阻力分析可行,舌侧总骨体积小于颊侧,但舌侧骨单位体积内骨组织含量更多,骨小梁更致密。下颌第三磨牙拔除过程中挤压颊侧牙槽骨容易获得骨小梁压缩间隙、磨除颊侧牙槽骨相对舌侧容易、从而实现合理的牙根颊侧脱位。高、中位近中倾斜阻生、垂直阻生四种类型,女性患者拔除下颌第三磨牙时,更应遵循颊侧路径。通过骨微参数及精准骨阻力分析,对于阻生齿微创拔除有指导意义。

聚焦解决模式下心理护理对下颌阻生智齿拔除术患者睡眠质量的影响

目的探究在对下颌阻生智齿拔除术患者护理时开展聚焦解决模式下心理护理的作用。方法在2021年11月至2022年10月我院下颌阻生智齿拔除术患者中纳入140例为对象,随机数字表法划分对照组(70例,手术期间接受常规护理)和观察组(70例,手术期间接受常规护理+聚焦解决模式下心理护理)。分析患者睡眠质量、心理状态等改善情况。结果对比患者睡眠质量,干预前无差异,干预后观察组后第5天匹兹堡睡眠质量指数(PSQI)评分(4.36±0.96)低于对照组(P<0.05)。对比两组心理状态,干预前贝克焦虑量表(BAI)以及贝克抑郁量表(BDI)评分无差异,干预后观察组BAI评分(5.25±0.32)分以及BDI评分(6.02±1.12)分低于对照组(8.72±0.41)分、(8.56±1.08)分(P<0.05)。对比患者手术配合度以及术中疼痛程度,观察组配合度高于对照组,疼痛程度低于对照组(P<0.05)。结论在对下颌阻生智齿拔除术患者护理中开展聚焦解决模式下心理护理,可以提升患者睡眠质量,降低患者负面情绪评分,增加患者手术期间配合性,降低疼痛程度。

微创拔牙术治疗下颌复杂阻生牙的临床效果分析

目的:探讨微创拔牙术治疗下颌复杂阻生牙的临床效果。方法:选取2021年7月—2022年7月南华大学附属长沙中心医院收治的下颌复杂阻生牙患者84例作为研究对象,通过抛硬币法分为常规组与试验组,各42例。常规组采用常规拔牙术治疗,试验组采用微创拔牙术治疗。比较两组拔牙时间、出血量、不良事件发生情况、并发症发生情况、治疗效果。结果:试验组拔牙时间短于常规组,拔牙出血量少于常规组,差异有统计学意义(P<0.001)。试验组不良事件总发生率低于常规组,差异有统计学意义(P=0.034)。试验组并发症总发生率低于常规组,差异有统计学意义(P=0.023)。试验组治疗总有效率高于常规组,差异有统计学意义(P=0.003)。结论:微创拔牙术治疗下颌复杂阻生牙的临床效果显著,可减少不良事件、降低并发症发生率,且手术时间短,患者术中出血量少,值得临床推广。

手术导板联合动态导航植入方法对下颌后牙区植入精度的影响

目的探究手术导板联合动态导航植入方法在下颌后牙区植入精度的临床应用价值。方法选取2020年2月-2022年2月于本院实施下颌后牙区种植修复的60例患者,根据随机数表法分为对照组(30例,41颗患牙)、观察组(30例,40颗患牙),对照组接受手术导板植入方法,观察组接受手术导板联合动态导航植入方法;获得12个月随访,观察手术及随访情况;测量植入后位置偏离情况。结果本研究60例患者均完成随访,术中未出现不良事件、不良反应;经口腔检查,修复体外观恢复良好,稳定性良好,咬合正常,未发现种植体周围炎、松动等不良事件,未见明显牙槽骨吸收。术后经常规检查,修复体稳定性、外观及咬合均正常,无牙槽骨吸收、种植体松动等不良事件。观察组下颌后牙区种植体植入后冠部偏差、根部偏差、角度偏差、水平偏差、深度误差、平行度均小于对照组,差异有统计学意义(P<0.05)。结论手术导板联合动态导航植入方法能够提高下颌后牙区种植体植入的精准度,获得最佳准确性。