改良位点保留法拔除复杂下颌阻生第三磨牙对临床成骨愈合的作用初探

doi:10.3969/j.issn.1674-8115.2022.06.006

摘要/Abstract

摘要：

目的·评估拔除低位骨埋伏下颌第三磨牙（M3）时，阻生齿上方牙槽骨顶壁的保留对同侧第二磨牙（M2）远中成骨的临床效果。方法·选取2020年8月—2021年8月于上海交通大学医学院附属第九人民医院口腔外科行低位骨埋伏阻生齿位点保留法拔除术拔除M3的患者19例为试验组，以接受传统拔牙术式的8例患者为对照组，分别于术后1周、3个月和6个月时对患者进行随访。随访时记录患者术后感染、神经损伤等情况；对术区M2进行口内临床检查，包括冷热刺激痛、牙体叩诊结果、松动度。在术后3个月和6个月时测量牙周袋探诊深度（probing depth，PD）以及临床附着水平（clinical attachment level，CAL）等；同时拍摄锥形束 CT，并通过CS3DImaging软件重建和测量同侧M2远中牙槽骨缺损深度（osseous defect depth， ODD）。结果·所有患者术后均未发生感染及神经损伤等并发症。2组患者术后6个月时M2远中颊侧PD、CAL及ODD较其术后3个月时均有明显改善（均P<0.05）；同时，试验组在术后随访的各阶段分别与对照组比较，该3项指标差异均有统计学意义（均P<0.05）。结论·低位骨埋伏阻生齿上方牙槽骨顶壁的保留，对于同侧第二磨牙远中侧成骨具有显著的促进作用。

关键词: 位点保留, 下颌阻生第三磨牙, 牙槽骨缺损深度, 成骨

Abstract:

Objective·To evaluate the efficacy of the preservation of alveolar crest in situ for regeneration of periodontal osseous defect distal to the mandibular second molar (M2) after mandibular third molar extractions.

Methods·After screening by evaluation, a total of 19 patients were enrolled and accepted the mandibular third molar extractions with modified ridge preservation at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from August 2020 to August 2021. Meanwhile, 8 cases of traditional tooth extraction were included in the control group. All the patients were followed up at 1 week, 3 months and 6 months after operation. Postoperative symptoms including pain, swelling and nerve injury were also recorded in detail. Intraoral clinical examination was performed on M2, including cold and heat stimulation, tooth percussion results and looseness. Osseous defect depth (ODD) on the disto-buccal aspect of M2 was taken as the primary outcome variable. Probing depth (PD) and clinical attachment level (CAL) were taken as the secondary outcome variables during the follow-up period. In the meantime, all the patients received cone beam computed tomography (CBCT), and the data were analyzed and reconstructed for the measurement of ODD through CS3DImaging software.

Results·No obvious postoperative complications such as infection or never injury were found in any patient. The PD, CAL and ODD on the disto-buccal aspect of M2 at 6 months after operation in the two groups were both improved compared with those at 3 months after operation (P<0.05 for all). Furthermore, all the data in the experimental group were lower than those of the control group at any time of the follow-up (P<0.05 for all).

Conclusion·Modified ridge preservation has a notable improvement in regeneration of periodontal osseous defect distal to the M2 after mandibular third molar extractions.

Key words: ridge preservation, mandibular third molar, osseous defect depth, bone growth

中图分类号:

R782.05

陆叶平, 陈敏洁. 改良位点保留法拔除复杂下颌阻生第三磨牙对临床成骨愈合的作用初探[J]. 上海交通大学学报（医学版）, 2022, 42(6): 729-734.

LU Yeping, CHEN Minjie. Efficacy of modified ridge preservation on socket healing after mandibular third molar extractions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 729-734.

图/表 4

图1 试验组手术过程Note：A.The alveolar bone was separated into proximal and distal parts by ultrasonic bone knife. B.The proximal part was removed and the distal part was temporarily uplift while retaining its lingual periosteum attachment. C.The tooth extraction socket was filled with colloidal silver and then the distal part was restored. D.The impacted teeth and the proximal part (white arrows in Figure A and B indicate the lingual periosteum attachment).

Fig 1 Surgical procedures of the experimental group

图2 利用CS3DImaging软件测量ODDNote：A.The mesio-distal dimension of M2 was bisected by the purple line. Meanwhile, the bucco-lingual dimension was bisected by the green line. B.The yellow line was across the dental pulp center of M2. C. Measurement of ODD.

Fig 2 Measurement of ODD using CS3DImaging software

表1 试验组与对照组主要结局指标比较

Tab 1 Primary outcome variables of the control and experimental groups

Measurement	Control group （n=8）	Experimental group（n=19）
ODD/mm
1 week after operation	6.0±0.5	6.5±0.9
3 months after operation	4.5±0.7	2.7±1.1^①
6 months after operation	2.4±1.3	0.2±0.3^②
PD/mm
3 months after operation
Distal buccal side	7.8±0.8	4.9±0.9^③
Distal side	6.2±0.6	3.1±0.8
Distal lingual side	5.9±0.6	2.6±0.5
6 months after operation
Distal buccal side	4.7±0.9^⑦	2.3±0.7^④⑦
Distal side	3.8±0.9	1.9±0.2
Distal lingual side	3.5±1.0	1.7±0.3
CAL/mm
3 months after operation
Distal buccal side	5.0±0.8	2.7±1.0^⑤
Distal side	4.1±0.8	1.7±0.5
Distal lingual side	3.9±0.6	1.3±0.5
6 months after operation
Distal buccal side	3.0±1.3^⑧	0.1±0.4^⑥⑦
Distal side	2.3±1.0	0
Distal lingual side	2.2±0.9	0

图3 试验组与对照组术后CBCT图像Note：A.One week after operation in the experimental group.B. Three months after operation in the experimental group. C.Six months after operation in the experimental group.D.Six months after operation in the control group

Fig 3 Postoperative 3-D reconstruction of CBCT images of the experimental and control groups after operation

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