上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (7): 893-897.doi: 10.3969/j.issn.1674-8115.2022.07.007

• 论著 · 临床研究 • 上一篇    

预防性拔除下颌第三磨牙牙胚的临床研究

李晨琳1(), 李岩2, 徐光宙2()   

  1. 1.上海市徐汇区牙病防治所口腔颌面外科，上海 200032
    2.上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011
  • 收稿日期:2022-03-19 接受日期:2022-07-08 出版日期:2022-07-28 发布日期:2022-09-04
  • 通讯作者: 徐光宙 E-mail:1342160590@qq.com;xgzmy@163.com
  • 作者简介:李晨琳（1993—），女，住院医师，硕士；电子信箱：1342160590@qq.com。
  • 基金资助:
    浦东新区卫生和计划生育委员会卫生计生科研项目(PW2018D-08);上海申康医院发展中心临床科技创新项目(SHDC12019X01)

Clinical study of preventive extraction of impacted mandibular third molar germ

LI Chenlin1(), LI Yan2, XU Guangzhou2()   

  1. 1.Department of Oral Surgery, Shanghai Xuhui District Dental Center, Shanghai 200032, China
    2.Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
  • Received:2022-03-19 Accepted:2022-07-08 Online:2022-07-28 Published:2022-09-04
  • Contact: XU Guangzhou E-mail:1342160590@qq.com;xgzmy@163.com
  • Supported by:
    Health and Family Planning Scientific Research Project of the Health and Family Planning Commission of Pudong(PW2018D-08);Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center(SHDC12019X01)

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摘要：

目的·研究预防性拔除有阻生倾向的下颌第三磨牙（mandibular third molar，M3M）牙胚的短期和远期临床效果。方法·选取2018年9月—2020年4月在上海交通大学医学院附属第九人民医院口腔外科就诊的患者，有阻生倾向的M3M牙胚纳入试验组，共计21例；同时纳入21例完全骨埋伏阻生的牙根发育完全的M3M作为对照组。2组均采用超声骨刀、气动手机进行分牙拔除M3M，分别于术后1 d、3 d、7 d、3个月、6个月随访，比较2组拔牙时间、下颌第二磨牙 （mandibular second molar，M2M）远中骨缺损深度（bone defect depth，BDD）、探诊深度（probing depth，PD）、菌斑指数（plaque index，PLI）、牙龈指数（gingival index，GI）、疼痛程度 （视觉模拟评分法，visual analog score，VAS）、肿胀程度、张口受限程度、不良反应等。采用IBM SPSS Statistics 25软件进行统计分析，定量资料以x±s表示，采用独立样本t检验、Mann-Whitney U检验比较2组的主要结局和次要结局的组间差异；采用Kruskal-Wallis H检验分析主要结局的组内变化，进一步组内两两比较采用Mann-Whitney U检验。P<0.05表示差异有统计学意义。结果·试验组手术时间为（7.62±1.50） min，对照组手术时间为（10.76±2.21）min，2组的手术时间比较差异有统计学意义（P=0.000）。术后6个月，试验组BDD为（0.65±0.33）mm，对照组BDD为（2.49±1.37）mm，2组BDD、PD、PLI、GI比较差异有统计学意义（P=0.000，P=0.012，P=0.011，P=0.042）。2组术后6个月的BDD较术前显著增加，且差异有统计学意义（P=0.009，P=0.000）。2组术后3d的VAS比较差异有统计学意义（P=0.044）。在术后1、3、7 d复诊时段，2组肿胀程度比较差异有统计学意义（P=0.005，P=0.031，P=0.019）。对照组发生1例下牙槽神经损伤，其余患者均未发生出血、神经损伤、干槽症等不良反应。结论·预防性拔除有阻生倾向的M3M牙胚，手术时间缩短，术后局部反应小，术后M2M远中牙周状况佳，能够获得较好的远期临床效果。

关键词: 下颌第三磨牙, 拔牙, 下颌第二磨牙, 骨缺损, 牙周指数

Abstract:

Objective·To study the short-term and long-term clinical effect of preventive extraction of mandibular third molar (M3M) germ with impaction tendency.

Methods·From September 2018 to April 2020, 21 cases of M3M germs with impaction tendency were included in the experimental group at the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. At the same time, 21 adult M3Ms which were completely impacted were included as the control group. M3Ms were extracted by ultrasonic osteotome and turbine drill. The patients were followed up 1 d, 3 d, 7 d, 3 months and 6 months after surgery. The surgery time, bone defect depth (BDD), probing depth (PD), plaque index (PLI), gingival index (GI), pain degree (visual analog score, VAS), degree of swelling, mouth opening restriction degree, and adverse reactions were compared between the two groups. IBM SPSS statistics 25 software was used for statistical analysis, and the quantitative data were expressed in x±s. The independent sample t-test or Mann-Whitney U test was used for the comparison between the two groups in primary and secondary outcomes. Kruskal-Wallis H test was used to analyze the intragroup changes of the primary outcomes, and Mann-Whitney U test was used for further pairwise comparison within the group. Statistical significance was accepted at a value of P<0.05.

Results·The surgery time of the experimental group was (7.62±1.50) min and that of the control group was (10.76±2.21) min. There was a significant difference in the surgery time between two groups (P=0.000). The BDD of the experimental group was (0.65±0.33) mm and that of the control group was (2.49±1.37) mm at 6 months after surgery. There were significant differences in BDD, PD, PLI and GI between the two groups at 6 months after surgery (P=0.000, P=0.012, P=0.011, P=0.042). The BDD of the two groups at 6 months after surgery was significantly higher than that at baseline, and the difference was statistically significant (P=0.009, P=0.000). There was a significant difference in VAS between the two groups at 3 d after surgery (P=0.044). At each follow-up period after surgery, there was a significant difference in the degree of swelling between the two groups (P=0.005, P=0.031, P=0.019). In the control group, 1 case of inferior alveolar nerve injury occurred, and the other patients did not have adverse reactions such as bleeding, nerve injury, dry socket disease, etc.

Conclusion·Preventive extraction of M3M germ with impaction tendency can shorten the surgery time, and reduce postoperative reaction, which can obtain better long-term clinical effect compared with adult impacted M3M extraction.

Key words: mandibular third molar, tooth extraction, mandibular second molar, bone defect, periodontal index

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